• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.85-92
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• 2021

Background: Patients with secondary deformities associated with unilateral cleft lip and nose might also suffer from nostril stenosis due to a lack of tissue volume in the nostril on the cleft side. Here, we used full-thickness skin grafts (FTSGs) to reduce nostril stenosis and various methods for skin volume augmentation. We compared the changes in the symmetry of both nostrils before and after surgery. Methods: From February 2016 to January 2020, 34 patients underwent secondary cheiloplasty and open rhinoplasty for secondary deformities of the unilateral cleft lip and nose with nostril stenosis. FTSG was used on the nostril floor, nasal columella, and alar inner lining. The measured nasal profile included the nostril surface, nostril circumference, width of the nostril floor, and distance from the alar-facial groove to the nasal tip. The "overlap area," which was defined as the largest overlapping area when the image of the cleft nostril was flipped to the left and right and overlaid on the image of the normal side nostril, was also calculated. The degree of symmetry was evaluated by dividing the value of the cleft side by that of the normal side of each measured profile and expressed as "ratios." Results: The results of all profile ratios, except for the nostril floor width, became significantly close to 1, which represents full symmetry. The overlap area ratio improved from 62.7% to 77.3%, meaning that the length and width of the nostril as well as the overall shape became similar (p< 0.05). Conclusion: When performing cleft rhinoplasty with nostril stenosis, FTSG is useful to achieve symmetry in the nostril size and shape. Skin grafting is simpler to perform than the other types of local flap, and the results are generally satisfactory.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.2
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• pp.65-72
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• 2009

Quadrilateral flap technique for primary cheiloplasty in patients with cleft lip was initially developed by Hagedorn in 1884. After Le Mesurier presented this procedure in 1940's, many surgeons adopted this technique for clinical advantage of reconstruction of Cupid's bow and lesser amount of tissue discarding than straight line technique. However, owing to its drawbacks such as sacrifice of Cupid's bow and prominent scar on philtral ridge, other techniques like Tennison's triangular flap and Millard's rotation-advancement flap have gradually taken its place. Nevertheless, some clinicians like Dr. Wang has modified this quadrilateral flap technique for better clinical outcomes. In this report we present 3 cases of unilateral complete cleft lip patients who underwent primary cheiloplasty with favorable outcomes based on Dr. Wang's modified quadrilateral flap technique.

• The Journal of the Korean dental association
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• v.11 no.2
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• pp.117-121
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• 1973

The authors had treated 45 cases of cleft lip and cleft palate patients including 30 male patients and 15 female patients. There were 41 cases of unilateral cleft lip patients and 4 cases of bilateral cleft lip patients, and 4 cases with together cleft lips and cleft palates among the total 45 cases were showed. We had accomplished that surgical plastic closures of cleft lips and cleft palates had been performed by using of Millara's, Hagedorn's, Meyer's, LeMesurier's and Veau's methods with Z-plasty.

• The korean journal of orthodontics
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• v.43 no.4
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• pp.168-177
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• 2013

Objective: In this study, we aimed to examine the relationship between chin deviation and the positional and morphological features of the mandible and to determine the factors that contributed to chin deviation in individuals with a unilateral cleft lip and palate (UCLP). Methods: Cone-beam computed tomography (CBCT) images of 28 adults with UCLP were analyzed in this study. Segmented three-dimensional temporomandibular fossa and mandible images were reconstructed, and angular, linear, and volumetric parameters were measured. Results: For all 28 individuals, the chin was found to deviate to the cleft side by 1.59 mm. Moreover, among these 28 individuals, only 7 showed distinct (more than 4 mm) chin deviation, which was toward the cleft side. Compared to the non-cleft side, the mandibular body length, frontal ramal inclination, and vertical position of the condyle were lower and inclination of the temporomandibular fossa was steeper on the cleft side. Furthermore, the differences in inclination of the temporomandibular fossa, mandibular body length, ramus length, and condylar volume ratio (non-deviated/deviated) were positively correlated with chin deviation. Conclusions: UCLP individuals show mild chin deviation to the cleft side. Statistical differences were noted in the parameters that represented positional and morphological asymmetries of the mandible and temporomandibular fossa; however, these differences were too small to indicate clinical significance.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.483-486
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• 2020

Midline clefts of the upper lip are rare, and it is therefore important that surgeons have access to a methodical approach for when these presentations are encountered. We adapted principles of the anatomic subunit approximation for unilateral cleft lip, to the repair of midline clefts. The overt use of anatomic landmarks to define the repair results in a design that inherently adjusts to varying degrees of clefts and can accommodate asymmetries. The "measure twice, cut once" style is an advantage to new surgeons and to surgeons who seldom encounter this presentation. We describe the details of surgical repair in the context of a patient with Pai syndrome and associated nasal hamartomas that resulted in nasolabial asymmetry. This is the first report of surgical outcome following treatment of Pai syndrome and includes early and 5-year follow-up. The system of repair that we describe is applicable to both symmetric and asymmetric midline clefts.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.376-382
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• 2011

Purpose: In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. Methods: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo. Results: Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty. Conclusion: The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.

• The korean journal of orthodontics
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• v.28 no.6 s.71
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• pp.905-914
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• 1998

The goals of this study were to present presurgical naso-alveolar molding (PNAM) appliance in unilateral cleft lip and palate treatment and to evaluate the effects of PNAM appliance on alveolar molding. Samples were consisted of 4 unilateral cleft lip and palate infants (3 males and 1 female, mean age=23.2 days after birth) who were treated with PNAM appliances in Department of Orthodontics, Seoul National University Dental Hospital. Average alveolar cleft gap between the greater and lesser segment was 8.27mm and average duration of alveolar molding treatment was 9.7 weeks. These patients' models were obtained at initial visit (T1) and alter successful alveolar molding (T2). Seven linear and five angular variables were measured by using photometry and digital caliper. All statistical analyses were performed by SPSS win ver. 7.5 program. Paired t-test was used to compare the mean values. 1. The posterior part of alveolar segments are the stable structures during alveolar molding treatment period in infants. 2. Forward growth of the greater segment may be hindered by the action of alveolar molding. 3. The closure of cleft gap during alveolar molding were usually due to inward and backward bending of the anterior part of the greater segment and outward bending of the whole lesser segment.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.1
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• pp.23-29
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• 2005

The facial cleft and duplicated maxilla are lire congenital anomaly. After Rushton and Walker had reported a unilateral facial cleft with excess tooth and bone formation in 1937, few authors described similar cases. The etiology of this anomaly is not well understood, but considered embryologically as a neurocristopathy. A neurocristopathy is defined as a condition arising from aberrations in early migration, growth and differentiation of neural crest cells. This aberrations result in facial malformation such as facial clefts and loss or duplication of facial structures. We experienced a male newborn baby with bilateral facial cleft and duplicated maxilla. The cleft was surgically corrected when he was 5 months old. The function and appearance of lip are improved. Duplicated maxilla will be surgically removed. We report this case with review of literatures.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.4
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• pp.314-318
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• 2011

Purpose: The purpose of this study is to evaluate the results of alveolar bone grafting in patients with various types of cleft lip and to compare the success rates according to the lateral incisors and canines. Methods: The postoperative radiographs of 20 patient with a cleft lip and alveolar process alone (CLAP), complete unilateral cleft lip and palate (UCLP) and complete bilateral cleft lip and palate (BCLP) were retrospectively analyzed. The alveolar bone height was classified according to ${\AA}$byholm (1981) and Bergland (1986) and we evaluated the dentition at the time of surgery and the existence of a lateral incisor and impacted canines. Results: 16 (80%) of the 20 patients were assigned to Type I & II and they were considered successful. In the UCLP group, the success rate was significantly better than that of the UCLP and BCLP groups. The success rate was significantly better than when the cleft was grafted with the existence of a lateral incisor and before the eruption of the canines. Conclusion: The severity of the deformity influenced the success rate. The timing of the operation was a critical variable that affected the outcome in patients with cleft lip and palate.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.35.1-35.7
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• 2015

After cleft lip repair, many patients suffer from nasolabial fistulas, asymmetrical nasal floor, or an indistinct nostril sill, as well as intraoral wound dehiscence and subsequent scar contracture of surgical wounds leading to vestibular stenosis. For successful primary nasolabial repair of complete cleft deformity of the primary palate, cleft surgeons need special care in reconstructing the sound nasal floor. Especially when the cleft gap is wide or when any type of nasoalveolar molding therapy was not performed, three-dimensional reconstruction of the nasal floor is critical for a balanced nasal shape. In this study, the author describes an effective method for reconstructing a double-layered nasal floor using two mucosal flaps from both sides of the fissured upper lip. This is a report of six patients with unilateral or bilateral complete cleft of the primary palate with a detailed description of the surgical technique and a literature review.