• Archives of Plastic Surgery
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• v.44 no.5
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• pp.400-406
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• 2017

Background The purpose of this study was to evaluate changes in nasal growth after the implementation of a preoperative nasal retainer in patients with bilateral incomplete cleft lip. Methods Twenty-six infants with bilateral incomplete cleft lip and cleft palate were included in the study. A preoperative nasal retainer was applied in 5 patients from the time of birth to 2.6-3.5 months before primary cheiloplasty. Twenty-one patients who were treated without a preoperative nasal retainer were placed in the control group. Standard frontal, basal, and lateral view photographs were taken 3 weeks before cheiloplasty, immediately after cheiloplasty, and at the 1- and 3-year postoperative follow-up visits. The columella and nasal growth ratio and nasolabial angle were indirectly measured using photographic anthropometry. Results The ratio of columella length to nasal tip protrusion significantly increased after the implementation of a preoperative nasal retainer compared to the control group for up to 3 years postoperatively (P<0.01 for all time points). The ratios of nasal width to facial width, nasal width to intercanthal distance, columellar width to nasal width, and the nasolabial angle, for the two groups were not significantly different at any time point. Conclusions Implementation of a preoperative nasal retainer provided significant advantages for achieving columellar elongation for up to 3 years postoperatively. It is a simple, reasonable option for correcting nostril shape, preventing deformities, and guiding development of facial structures.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.174-182
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• 2009

Purpose: The Mulliken's method is a one of the very excellent technique to correction of the unilateral cleft lip. It could decrease the need of additional operation and second operation by the early simultaneous correction of unilateral cleft lip and nasal deformity, at a time. Numerous procedures were advocated for the correction of nasal deformity, but with general dissatisfaction of the results, it became obvious that no one procedure is the ideal one. The authors have been operating on unilateral cleft lip by Mulliken's method and long term follow - up of postoperative result was evaluated. Methods: The authors have done long term follow - up of result in the 75 cases unilateral cleft lip patient, during 1 ~ 7 years. That was repaired by simultaneous correction of cleft lip and nasal deformity by Mulliken's method at the period from June, 1997 to December, 2007. The patients were unilateral complete cleft lip 39 cases, unilateral incomplete cleft lip 36 cases. In the severe complete cleft lip cases, lip adhesion operation was done before definite operation. The mean age of unilateral cleft lip operation was 3.2 months. Five anthropometric parameters, which were upper lip, cutaneous lip and vermilion mucosa height, nasal tip protrusion, columella length were measured by Sliding Vernier Caliper. The anthropometric analysis was performed preoperative and postoperative at 6 months, 3, 5 and 7 years and the results were com pared with those of age - matched, normal children. T - tests were used to analyze the differences between the measurements. Results: Long - term postoperative results were evaluated by anthropometrically. Most patients showed adequate growth of upper lip height, vermilion mucosa height and columella length. But nasal tip protrusion was relatively short compare with normal value. Incomplete cleft lip group was nearly normal growth results than complete cleft lip group. Conclusion: In conclusion, we could make harmonious Cupid's bow, natural philtrum and lip, appropriate nasal shape by Mulliken's method. But nasal tip protrusion was under the normal values on complete and incomplete group. And incomplete group was more good results than complete group. We have experienced repair of cleft lip by Mulliken's method with 75 cases of unilateral cleft lip patients and conclude that it was very useful and good method.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.740-746
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• 2011

Purpose: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. Methods: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. Results: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. Conclusion: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.5
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• pp.230-236
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• 2014

Esthetic reconstruction of cleft lip nose deformity is a challenging task in surgical management of patients with orofacial cleft. The author reconstructed cleft lip nose deformity effectively using autogenous auricular cartilage and a relatively new graft material of porcine dermal collagen, $Permacol^{TM}$. After correction of the deformed lower third of the nose with patient's auricular cartilage, we applied $Permacol^{TM}$ to augment the entire nasal dorsum. Three patients were treated and followed for up to five years. All patients improved in nose aesthetics without any inflammatory or immunogenic reaction. The author suggests that the use of $Permacol^{TM}$ for nasal profile augmentation in the treatment of cleft lip nose deformity is an alternative surgical strategy with minimal surgical invasiveness. The author report long-term experience with combined use of auricular cartilage and $Permacol^{TM}$ in nasal reconstruction for cleft lip nose deformity.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.50 no.2
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• pp.116-120
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• 2024

External nasal splints are commonly used for immobilization following nasal fracture reduction or rhinoplasty procedures. The literature documents the use of various materials like thermoplastic materials, aluminum, Orthoplast, fiberglass, plaster of Paris, and polyvinyl siloxane. These materials are bulky, time-consuming, expensive, and cumbersome to use, and have been associated with complications including contact dermatitis and epidermolysis. Furthermore, they cannot be retained if the situation warrants prolonged stabilization and immobilization. We introduce a new technique using readily available scalp vein catheter flanges as an external nasal stent. The technique is easy to master, inexpensive, and limits edema and ecchymosis, while stabilizing the reconstructed nasal skeleton in position during the healing period.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.422-428
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• 2007

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.11-21
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• 2012

Purpose: Mulliken's method allows for normal nasal and lip growth, which in turn forms a natural shape of the philtrum. Therefore, we used a modified Mulliken's method to correct unilateral and bilateral cleft lip nasal deformities and followed the patients for 10 years. Methods: Ninety-one patients, who had undergone repair of unilateral and bilateral cleft lip and nasal deformity simultaneously using Mulliken's method during the time period from June 1997 to June 2009, were enrolled into this study. To follow-up of the growth of the lips and nose after the operation, the following 5 anthropometric measurements were analyzed: nasal tip protrusion, columellar length, upper lip height, cutaneous lip height, and vermilion mucosa height. Results: Using this method, we obtained a result that there was no significant difference in the development of the lip compared to the normal control group, and that the bilateral cleft lip patients' nasal projection and columellar length was shorter than that in normal persons. Both measures were statistically significant. Conclusion: Mulliken's method is a superb surgical technique, which enables the normal development of the nose and lip, which further allows for the innate philtrum appearance. The author's result does not seem to be meaningful, because the normal rate of nasal growth is slow before adolescence; however, we recommend additional follow-up and accordant treatment, if needed, once the nasal growth is complete.

• Korean Journal of Cleft Lip And Palate
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• v.10 no.1
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• pp.17-22
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• 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.

• Speech Sciences
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• v.5 no.1
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• pp.105-119
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• 1999

Cleft palate patients have general speech problems with resonance disorders and articulation disorders. The aim of this study is to find the aerodynamic and acoustic characteristics of the nasalization in cleft palate speakers. Thirteen control groups and three cleft palate patients pre- and post operation were selected for these studies. The test words are composed by polysyllabic words: consonants between high vowel /i/ analysis. The cleft palate patients repeated test words pre- and post-operation from one, three and six month periods. The subjects repeated test words on Macquirer and on Nasometer Model 6200-3. The aerodynamic and acoustic results of nasalization show as follows: (1) The nasal rate in overall airflow of aspirated consonant for cleft palate patients shows higher levels than that of the control group. It had decreased since one month after operation. (2) The overall airflow of cleft palate patients is higher than in the control group, however oral air pressure is lower than control group. (3) The nasal airflow and the nasal rate in overall airflow of cleft palate patients has higher than the control group, however its decreased after operation. (4) The nasalance scores of cleft palate patients were 40% higher than that of the control group. The scores did not decrease after operation. The nasalance score of lateral and fricative sounds did not decrease after operation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.2
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• pp.153-158
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• 1995

A wide variety of deformities can occur following repair of the cleft lip. Especially, cleft lip nasal deformities offer the severe psychologic, esthetic, and functional impairment. We must restore the deformities of alar cartilge, nasal tip, septum, columella, or pyriform aperture. The authors reconstructed the cleft lip nasal deformities using with the alar cartilage rearrangement, postauricular cartilage graft, and/or columellar lengthening. The 3 case reports are presented.