• 대한치과교정학회지
• /
• 제18권2호
• /
• pp.329-342
• /
• 1988

In methods of finding causes for cleft palate, many cases have been studied by investigators using teratogenic agents. Among them, a synthetic agent known as triamcinolone acetonide (TA) was widely used. When this drug was injected into mice during palatogenesis, it induced lowered body weight and a deformed mandible. But many cases have been studied on growth changes, only of the developmental stages of the palate. Therefore, the objective of this study was to evaluate craniofacial growth in experimentally induced cleft palate mice after finishing palatogenesis namely just before birth. Normal, alcohol treated, and TA treated DDY mice were obtained at 18-days of gestation and heads were prepared for serial sectioning in the sagittal plane. The midsagittal sections were photographically enlarged (${\times}40$) and measurements made to asses the amount of growth. The obtained results were as follows. 1. The incidence of cleft palate was 41.2% when TA was injected. 2. The body weight of the cleft palate group was lower than the control group. 3. In the cleft palate group, mandibular length (H-M) was lighter than the control group. 4. In the cleft palate group, degree of staining was not distinct compared to the control group by the double staining method. 5. In the cleft palate group, anteroposterior posture of the tongue tip to facial plane (C-M) was more posterior than the control group. 6. The cause of posterior posture of the tongue tip to facial plane (C-M) in the cleft palate group, was not short and retracted tongue but the mandibular length was increased. 7. The anteroposterior relationship of hyoid cartilage to cranial base was the same in all groups.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권5호
• /
• pp.392-400
• /
• 2011

Purpose: Cleft lip and palate is one of the most frequent hereditary deformities of the maxillofacial region which can arise in facial and jaw abnormalities as well as malocclusion and speech problems. In particular, unilateral cleft lip and palate is characterized by midface deformity resulting in maxillary anterior nasal septal deviation and nasal deformity. The aim of this study is to analyze the facial deformity of untreated unilateral cleft lip patients for contribution to primary cheiloplasty. Methods: Thirty-three patients with unilateral cleft lip and palate were impressioned before operation and facial casts were made. The casts were classified into complete cleft lip and incomplete cleft lip groups and each group were classified into affected side and normal side. Anthropometric reference points and lines were setted up and analysis between points and lines were made. Results and Conclusion: The obtained results were as follows: 1. The intercanthal width had no significant difference between the incomplete and complete cleft lip groups. 2. Cleft width and alar base width were greater in the complete group, and nasal tip protrusion was greater in the incomplete group. 3. Involved alar width and nostril width were greater in the complete group and in both complete and incomplete groups, involved alar width and nostril width were greater than the non-involved side. 4. The lateral deviation of the subnasale was greater in the complete group in both involved and non-involved sides. 5. The nasal laterale was placed inferiorly in both cleft groups. 6. The subnasale was deviated to the non-involved side in both cleft groups. 7. The nose tip was deviated to the non-involved side in both cleft groups and had greater lateral deviation in the complete cleft group. 8. The midpoint of cupid's bow had no vertical difference between complete and incomplete groups, but had a greater lateral deviation in the complete group. 9. In the complete cleft group, correlation between differences in cleft width and nostril width and columella height difference were obtained.

• 대한구순구개열학회:학술대회논문집
• /
• 대한구순구개열학회 1998년도 종합학술대회
• /
• pp.40-40
• /
• 1998

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제48권6호
• /
• pp.390-396
• /
• 2022

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

• 대한두개안면성형외과학회지
• /
• 제14권1호
• /
• pp.11-15
• /
• 2013

Background: In cleft lip patients, the necessity of a thorough preoperative analysis of facial deformities before reconstruction is unquestioned. The surgical plan of cleft lip patient is based on the information gained from our preoperative anthropometric evaluation. A variety of commercially available three-dimensional (3D) surface imaging systems are currently introduced to us in plastic surgery for these use. However, few studies have been published on the soft tissue morphology of unrepaired cleft infants described by these 3D surface imaging systems. Methods: The purpose of this study is to determine the accuracy of facial anthropometric measurements obtained through digital 3D photogrammetry and to compare with direct anthropometry for measurement in unilateral cleft lip patients. We compared our patients with three measurements of dimension made on both sides: heminasal width, labial height, and transverse lip length. Results: The preoperative measurements were not significantly different in both side of labial height and left side of heminasal width. Statistically significant differences were found on both side of transverse lip length and right side of heminasal width. Although the half of preoperative measurements were significantly different, trends of results showed average results were comparable. Conclusion: This is the first study in Korea to simultaneously compare digital 3D photogrammetry with traditional direct anthropometry in unilateral cleft lip patients. We desire this study could contribute the methodological choice of the many researchers for proper surgical planning in cleft lip reconstruction field.

• 대한구순구개열학회지
• /
• 제10권1호
• /
• pp.17-22
• /
• 2007

The vertebrate upper lip forms from initially freely projecting maxillary, medial nasal, and lateral nasal prominences at the rostral and lateral boundaries of the primitive oral cavity. These facial prominences arise during early embryogenesis from ventrally migrating neural crest cells in combination with the head ectoderm and mesoderm and undergo directed growth and expansion around the nasal pits to actively fuse with each other. Initial fusion is between lateral and medial nasal processes and is followed by fusion between maxillary and medial nasal processes. Fusion between these prominences involves active epithelial filopodial and adhering interactions as well as programmed cell death. Slight defects in growth and patterning of the facial mesenchyme or epithelial fusion result in cleft lip with or without cleft palate, the most common and disfiguring craniofacial birth defect. This review will summarize the current understanding of the basic morphogenetic processes and molecular mechanisms underlying upper lip development.

• 대한구순구개열학회지
• /
• 제15권1호
• /
• pp.1-10
• /
• 2012

Parry-Romberg syndrome(PRS) is a degenerative disease characterized by progressive hemifacial atrophy. A 10-year-old girl who had been treated for linear scleroderma at the dermatologic department visited the orthodontic department. The frontal facial photograph showed mild facial asymmetry. On the left side, mild atrophy of soft tissue, enophthalmos, cheek depression, and dry skin with dark pigmentation were observed. The radiograph showed the hypoplasia of both the maxilla and mandible on the left side. This case report describes the treatment of a patient with PRS for 7 years. To minimize the effect of progressive atrophy on the facial growth, a hybrid appliance was used. The facial photos and radiographic records were periodically taken to analyze the progression of PRS. Although it is impossible to prevent the progression of facial asymmetry, it appears to be possible to limit the atrophic effect. After the stabilization of PRS, the orthodontic treatment by the fixed appliance was performed. Additionally, autologous fat graft was performed three times at 6 month intervals. After the treatment, the patient had a confident smile and facial asymmetry was improved.

• 대한두개안면성형외과학회지
• /
• 제21권1호
• /
• pp.64-68
• /
• 2020

The coexistence of craniofacial cleft and bilateral choanal atresia has only been reported in three cases in the literature, and only one of those cases involved a Tessier number 3 facial cleft. It is also rare for bilateral choanal atresia to be found in adulthood, with 10 previous cases reported in the literature. This report presents the case of a 19-year-old woman with a Tessier number 3 facial cleft who was diagnosed with bilateral choanal atresia in adulthood. At first, the diagnosis of bilateral choanal atresia was missed and septoplasty was performed. After septoplasty, the patient's symptoms did not improve, and an endoscopic examination revealed previously unnoticed bilateral choanal atresia. Computed tomography showed left membranous atresia and right bony atresia. The patient underwent an operation for opening and widening of the left choana with an image-guided navigation system (IGNS), which enabled accurate localization of the lesion while ensuring patient safety. Postoperatively, the patient became able to engage in nasal breathing and reported that it was easier for her to breathe, and there were no signs of restenosis at a 26-month follow-up. The patient was successfully treated with an IGNS.

• 대한구순구개열학회지
• /
• 제8권2호
• /
• pp.87-94
• /
• 2005

Patients with unilateral cleft lip and palate (UCLP) generally demonstrate the asymmetries in the lip, nose and the naso-maxillary complex. And their skeletal asymmetries are known to be derived from the displacement of nasal septum, anterior nasal spine (ANS) and the pre-maxilla toward the non-affected side during the developmental and growth period. Due to the interruption of the important facial muscles, which are critical for the symmetric growth of premaxilla, functional matrix system fails to develop and results in the displacement of the ANS toward the non-affected side and nasal asymmetry. Therefore the rhinoplasty for CLP patients is required to have inter-skeletal and muscular rearrangement in the naso-maxillary complex in order to let them recover from esthetic and physiologic imbalances. And functional cheilorhinoplasty (FCR) has been a representative treatment of choice for this concept of treatment modality. The outcome and prognosis of primary or repair FCR have been known to be definitely affected by timing of the operation as well as adequate reconstruction of naso-labial muscles. However, sometimes FCR has an ineffective treatment results for patients after the facial growth period, and the limited rhinoplasty around the nose often fails to bring satisfying results. In order to circumvent this limitation, we performed ANS osteotomy for patients with unilateral CLP showing asymmetric nose, as an alternative way for corrective rhinoplasty. We could observe that the nose was rearranged along the facial mid-line by this osteotomy design and asymmetries were evidently improved postoperatively. Here we present this osteotomy method in CLP patients.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제31권5호
• /
• pp.381-385
• /
• 2009

Objective : The objective of this study was to compare the surgical techniques for the correction of congenital cleft palate. Techniques and approaches : Four-hundred-sixity patients operated between 1993 and 2008 were included in this study. The collected data were age, sex, operating time, admission days, and complications. The comparison between techniques were done by independent t-test. Results: The majority (86.9 %) of patients were received the operation later than 1.5 years old. The distribution of each surgical technique was 43.8 % by Bardach palatoplasty, 11.9 % by Furlow palatoplasty, 1.8 % by Veau palatoplasty, and 42.4 % by the new technique developed by us. Postoperative complication such as wound dehiscence, formation of oro-nasal fistulas in the soft and hard palates were shown in 23.0 % of Bardach technique, 44.2 % of Furlow technique, and 37.5 % of Veau technique. However, only 5.4 % of patients were shown complications in our technique (P<0.001). The operation time was recorded 70 minutes under new technique while the others were 110 minutes (P<0.001). The clinical treatment at hospital was required 7.4 days for our technique and 11.3-15.5 days for the other methods. Conclusion : The surgical treatment of congenital cleft palate in Mongolia was conducted later than proper timing for surgery. As the results were indicated, our new technique should be considered for the correction of cleft palate in old aged patients.