• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.1
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• pp.53-60
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• 2009

Maxillary deficiency, anterior cross bite, constriction of maxillary arch, malaligned teeth are frequently observed in patients with cleft lip and palate. Surgery and orthodontics, combined intervention are needed to correct maxillary deficiency. Distraction osteogenesis that currently used has many advantages like less relapse tendency, more advancement of maxilla, capable in growing patients. In case 1, 18 years old girl with BCLP had severe midfacial deficiency and multiple missing of teeth. LeFort I osteotomy, followed by maxillary distraction osteogenesis utilizing rigid external distraction device(RED) system, was performed. After a 6-day latency period, distraction proceeded at a rate of 1mm per day (at 1st week, 1.5mm/day). Total advancement was 19mm. The RED device left in place for the additional 4 weeks for consolidation. After the RED device was removed, face mask was applied with elastic traction for 5 weeks. After achieving acceptable facial appearance and occlusion, orthodontic appliance was removed. The results after 4 years follow-up was sustained pretty well without aggravation of velopharyngeal function. In case 2, 22 years old man with UCLP had severe midfacial deficiency and palatally erupted upper 2nd premolars due to arch length discrepancy, but the anterior segment of maxillary did not show constriction and crowding. patient had no arch width discrepancy, crowding was concentrated on premolar region. Segmental LeFort I osteotomy was performed. After a 6 - day latency period, using internal distraction device, distraction proceeded at a 0.5mm per day(at 1st week, 0.75 - 1 mm/day). Total advancement was 15mm. After internal distraction device was removed, face mask was applied with elastic traction for 4 weeks. After surgical-orthodontic treatment, facial appearance and occlusion was improved pretty good, and after 46 months follow-up the result was retained well.

• Biomedical Science Letters
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• v.16 no.1
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• pp.1-9
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• 2010

In order to understand the effects of all-trans-RA on palate development, RA was injected into the abdominal cavity of pregnant mice and then the embryos were taken in the following days and analyzed morphologically as well as molecular biologically. When RA was administered at the stage of E11 or E15, the overall craniofacial development was retarded. The length from jaw to eye was shortened, compared to that of normal group. When the E11 embryos were exposed to RA, cleft lip was also found along with the cleft palate. In vitro palate culture experiment also revealed that RA caused cleft palate. When RT-PCR was performed, early stage administration of RA at E11 inhibited the upregulation of Hoxa7 expression at E15 through E17. Whereas in control group, high level of Hoxa7 expression was detected in the palate of E15 to E17. In the case of Bax, the expression was decreased from E16, while remaining constant in control group. When TUNEL analysis was performed following the RA treatment at E15, TUNEL positive cells were detected in the mesenchymal cells as well as epithelial cells of palatal shelves of E16 and in E17 embryos. Whereas in normal control, TUNEL positive cells were observed mostly at the epithelium around the nasal cavity and oral cavity where rugae is made. These results altogether indicate that exposure to RA during palate development causes facial deformity including cleft palate and cleft lip by modulating the expression of homeotic genes such as Hoxa7 as well as an apoptosis-related gene, Bax, and thus malregulating the apoptosis.

• Korean Journal of Cleft Lip And Palate
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• v.11 no.2
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• pp.49-58
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• 2008

The development of fetal surgery has led to promising options for many congenital malformations, such as congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma. However, preterm labor (PTL) and premature rupture of membranes continue to be uniquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access techniques were developed and are increasingly employed recently. Lift-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. Recently, improvement of video-endoscopic technology has boosted the development of operative techniques for feto-endoscopic surgery, which has been demonstrated to be less invasive than the open approach. Fetal surgery for repair of cleft lip and palate, a congenital anomaly which is not life threatening, is inappropriate until such time that the benefits are shown to outweigh the risks of both the procedure itself and preterm delivery. Further animal studies will be needed before intrauterine surgery for humans should be considered. For the better understanding of recent techniques and complications associated with fetal intervention of congenital facial defect patients, we reviewed recent related articles about the current knowledge and new perspectives of experimental fetal fetal surgery in the cleft lip and palate defects.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.510-516
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• 2022

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter (p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater (p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.136-142
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• 2015

Background: The incidence and etiology of facial bone fracture differ widely according to time and geographic setting. Because of this, prevention and management of facial bone fracture requires ongoing research. This study examines the relationship between socioeconomic status and the incidence of facial bone fractures in patients who had been admitted for facial bone fractures. Methods: A retrospective study was performed for all patients admitted for facial bone fracture at the National Medical Center (Seoul, Korea) from 2010 to 2014. We sought correlations amongst age, gender, fracture type, injury mechanism, alcohol consumption, and type of medical insurance. Results: Out of the 303 patients meeting inclusion criteria, 214 (70.6%) patients were enrolled in National Health Insurance (NHI), 46 (15.2%) patients had Medical Aid, and 43 (14.2%) patients were homeless. The main causes of facial bone fractures were accidental trauma (51.4%), physical altercation (23.1%), and traffic accident (14.2%). On Pearson's chi-square test, alcohol consumption was correlated significantly with accidental trauma (p<0.05). And, the ratio of alcohol consumption leading to facial bone fractures differed significantly in the homeless group compared to the NHI group and the Medical Aid group (p<0.05). Conclusion: We found a significant inverse correlation between economic status and the incidence of facial bone fractures caused by alcohol consumption. Our findings indicate that more elaborate guidelines and prevention programs are needed for socioeconomically marginalized populations.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.1-4
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• 2016

Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.45-48
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• 2010

Purpose: After surgical interventions of mandible fractures, facial asymmetry can be occurred, and it leads to serious problems for patients. This can be solved by mandible angle ostectomy. Methods: A 19-year-old male underwent percutaneous surgical intervention for left mandibular angle and right parasymphyseal fractures 3.5 years ago. The left angle was protruded compared to the other side. Using a percutaneous approach, $4.5{\times}1cm$ sized piece of mandible angle was sawed off. For the right angle, intraoral approach was performed for angle ostectomy, and the angle was sawed off by a size of $4{\times}1cm$, using a pattern based on the piece from the left side. Results: After surgery, no complications such as subcondylar fractures, refractures, insufficient corrections, secondary angle formations, hematomas, and transient nerve palsies were seen, and symmetric correction of mandible angles were done. Conclusion: In facial asymmetries due to mandibular fractures, mandible ostectomy could be a solution. Using the bone section from the contralateral side, measurement of the amount of bone sawed off was possible, and via percutaneous approach on the previously operated site with simultaneous scar revision, and intraoral approach for the contralateral side, cosmetically satisfactory result was obtained.

• Archives of Craniofacial Surgery
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• v.16 no.2
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• pp.58-62
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• 2015

Background: Age-related changes have been studied for lower and middle facial bones. Although the forehead comprises one-third of the facial area, no studies have investigated age-related changes in the upper part of the face or forehead. The purpose of this study was to use three-dimensional computed tomography (3D CT) to investigate age-related changes in the frontal bone. Methods: A retrospective review was performed for patients who underwent 3D CT scan of facial bones. Patients were divided by gender and age (20 to 40 years, 41 to 60 years, and above 60 years). The frontal bone curvature was evaluated by the length of frontal bone and by two frontal bone angles in relation to the Frankfurt horizon. Results: In both genders, aging was associated with increasing lower slope length. In elderly men (>60 years), the upper slope angle was significantly higher when compared to younger male subjects. Women demonstrated similar age-related changes, but the differences were only statistically significant for the middle and older age groups. Conclusion: This study demonstrates quantifiable age-related changes in the frontal bone. These findings contribute to the understanding of age-related changes of the facial soft tissues. The mean measurements in each age group can be used as a reference when planning forehead reconstruction.

• Archives of Craniofacial Surgery
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• v.16 no.1
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• pp.1-10
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• 2015

Facial symmetry is an important component of attractiveness. However, functional symmetry is favorable to aesthetic symmetry. In addition, fluctuating asymmetry is more natural and common, even if patients find such asymmetry to be noticeable. However, fluctuating asymmetry remains difficult to define. Several studies have shown that a certain level of asymmetry could generate an unfavorable image. A natural profile is favorable to perfect mirror-image profile, and images with canting and differences less than $3^{\circ}-4^{\circ}$ and 3-4 mm, respectively, are generally not recognized as asymmetry. In this study, a questionnaire survey among 434 medical students was used to evaluate photos of Asian women. The students preferred original images over mirror images. Facial asymmetry was noticed when the canting and difference were more than $3^{\circ}$ and 3 mm, respectively. When a certain level of asymmetry is recognizable, correcting it can help to improve social life and human relationships. Prior to any operation, the anatomical component for noticeable asymmetry should be understood, which can be divided into hard tissues and soft tissue. For diagnosis, two-and three-dimensional (3D) photogrammetry and radiometry are used, including photography, laser scanner, cephalometry, and 3D computed tomography.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.3-9
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• 2019

Facial nerve palsy has an effect on a person's well-being functionally and psychologically. Therefore, comprehensive patient management is essential. One of the most common uncomfortable and potentially debilitating features is associated with the incapacity for eye closure. Restoration of eye closure is a key consideration during the surgical management of facial palsy. In this article, we introduce simple surgical methods-which are relatively easy to learn and involve the upper and lower eyelids-for achieving eye closure. Correcting upper eyelid function involves facilitating the component of eye closure that is in the same direction as gravity and is, therefore, less complicated and favorable outcomes than correction of lower lid. Aesthetic aspects should be considered to correct the asymmetry caused by facial palsy. Lower eyelid function involves a force that opposes gravity for eye closure, which makes correction of lower eyelid ectropion more challenging than surgery for the upper eyelid, particularly in terms of effecting a sustained correction. Initially, proper ophthalmic evaluation is required, including identifying the chronicity and severity of ectropion. Also, it is important to determine whether or not lateral canthoplasty is necessary. The lateral tarsal strip procedure is commonly used for lower lid correction. However, effective lower lid correction can be achieved with better cosmesis when extensive supporting techniques are applied, including those involving cheek tissue.