• The korean journal of orthodontics
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• v.50 no.6
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• pp.383-390
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• 2020

Objective: To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). Methods: The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998-2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using non-parametric statistical analysis. Results: The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. Conclusions: Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

• Korean Journal of Cleft Lip And Palate
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• v.11 no.1
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• pp.31-36
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• 2008

The variations of cleft lip deformities imposed the difficulty to the surgical correction for them. Straight line technique for cleft lip surgery has been ignored quite long since other techniques were developed. Initially the straight line technique was introduced and widely accepted because it is simple and easy to perform during the period of no adequate anesthetics. But it was abandoned for its several shortcomings such as tighten lip, vermilion notching, anatomical distortion, and wound contractures. Recently, some groups advocated the usefulness of straight line technique which has a significant modification from its original form. Additionally the variable degree of cleft lip deformity allows simple straight line closure for those patients. Here a case of simple straight line technique was presented and discussed for its reliability and plausible results as well.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.87-94
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• 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.

• Korean Journal of Cleft Lip And Palate
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• v.11 no.2
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• pp.71-75
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• 2008

The outcome of primary surgery for cleft lip is judged by its effects on the quality of oro-facial function and development. Many surgical techniques have been tried to obtain better results, however, Delaire introduced a technique of functional closure of the lip and nose, based on the findings of no true hypoplasia in the tissues either side of the cleft. In a seven-month-old Asian male patient with unilateral incomplete cleft lip, we carried out the primary closure by modified Delaire's technique. With no alveolar bone graft, the vertical incision on the nasal base was omitted in this patient because of his acceptable symmetry of nose. Also, a small Z plasty was added on the non-cleft side. The V-shaped incisions, whose notch was located on each side of the red vermilion, were designed and beveled incisions were performed for the rehabilitation of lip length and thickness, considering the postoperative wound contracture. We assured that this modification of Delaire's technique could be applied for various cases of primary closure of incomplete cleft lip.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.3
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• pp.260-264
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• 1997

The congenital deformities of cleft lip and cleft palate have been known to afflict man since prehistoric time. Efforts to correct these abnormities have evolved over the centuries as scientific knowledge has advanced. Although there is no agreement as to when the surgery should be performed, most surgeons adhere to "rule of 10" : the infant must be 10 week old weigh 10 Ibs, have a hemoglobin value 10gm/dl and have a white blood cell count no greater than 10 $thousands/mm^3$. Consensus favors performing initial palatal surgery in the child when he is between 18 and 24 months old. The timing of cleft alveolus surgery is usually between 10 and 11 years old. In the period from 1992 to 1996, 38 patients with cleft lip and cleft palate treated at the department of oral and maxillofacial surgery, Chosun university, dental hospital were analysed clinically. The obtained results were as follows. 1. The ratio of male to female was 1.92 : 1 (25/23) 2. The ratio of cleft lip, cleft palate and cleft lip & palate was 1.5 : 1 : 2.5 (12/8/18) 3. The ratio of unilateral to bilateral cleft lip was 5 : 1 (25/5) 4. The ratio of left to right side in unilateral cleft lip was 1.5 : 1 (15/10)

• Archives of Plastic Surgery
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• v.47 no.3
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• pp.263-266
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• 2020

Infantile hemangiomas have a growth phase and an involution phase. For this reason, serial observation has generally been recommended as the treatment for uncomplicated infantile hemangiomas. Recently, however, individualized approaches have been emphasized. Although cleft lip and infantile hemangioma are common congenital diseases, infantile hemangiomas on the cleft side (i.e., in the operative field of the cleft lip) are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had an infantile hemangioma on the cleft side. In accordance with general treatment guidelines, cleft repair was performed 3 months after birth. The Millard rotation-advancement technique, which involves the use of a lower small triangular flap, was used for the repair. No intraoperative complications, such as massive bleeding, or postoperative complications were noted. The patient has received regular follow-up for the past 18 years, and other than a reddish scar on the lower lip, he currently has no related issues. Therefore, this case demonstrates that cleft lip repair performed according to cleft lip treatment guidelines produces good outcomes, even in cases involving a hemangioma on the cleft side.

• Korean Journal of Cleft Lip And Palate
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• v.13 no.2
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• pp.77-84
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• 2010

Vomer flap is used to repair anterior hard palate in complete cleft lip and palate patients. As the midline structure located in between the two cleft segments of hard palate, the vomer flap is very useful because of its vicinity to cleft site and their ease of execution when it is done with primary cheiloplasty simultaneously. In addition, the quality of tissue is very similar to that of the nasal mucosa with good vascularity. In cases of simultaneous repair of cleft lip with anterior palate using vomer flap, the hard palate can be repaired at the same time with primary cheiloplasty which is earlier period than other techniques. With simultaneous close of cleft lip and cleft hard palate by vomer flap, subsequent palatoplasty does not require wide dissection, and consequently chance of oronasal fistula formation will be minimized. Additionally, surgical time will be reduced and, the harmful effects on mid-facial growth will be diminished. In this article, we will introduce the comprehensive vomer flap technique with primary lip closure and review the comparative studies of the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.2
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• pp.61-68
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• 2012

Cleft lip and palate is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. When treating the patients with unilateral cleft lip, many surgeons adopt the rotation advancement flap method originally developed by Millard, or the triangular flap technique developed by Tennison, Randall or the modifications of these techniques. Among these, Millard's rotation advancement flap method has its advantage in designing the flap using the patient's anatomic landmarks. For performing this rotation advancement technique, skillful operation is needed to obtain esthetically satisfactory results. Vomer flap sometimes is used to repair anterior hard palate in complete cleft lip and palate patients. Vomerine tissue is readily available in the vicinity of the palatal defect and elevation of the vomerine flap is relatively simple procedure. In this article, we will introduce the comprehensive vomer flap technique conjunction with primary lip closure and review the comparative studies of the outcome of simultaneous repair of cleft lip and cleft hard palate with Millard's rotation advancement method and vomer flap.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.5
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• pp.323-329
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• 2003

The present study was carried out to evaluate the postoperative results of Millard rotation-advancement repair (MR) and lip adhesion followed by Millard rotation-advancement repair (LAMR) in unilateral complete cleft lip. Twenty patients with unilateral complete cleft lip underwent MR or LAMR at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital over a period of 6 years (January 1994 to December 1999) were analyzed. The surgical results following the operation were assessed on the basis of scoring, vertical lip length, and scar hypertrophy. The mean score was better in LAMR group ($74.74{\pm}1.09$, n=13) than in MR group ($66.50{\pm}1.14$, n=7) for both lip and nose segments. Scar hypertrophy developed in MR group with 28.6% and in LAMR group with 23.1%. No significant difference was noted in the ratio of lip length between LAMR and MR groups ($0.84{\pm}0.08\;and\;0.73{\pm}0.10$). These results suggest that LAMR is better than MR in repairing the unilateral complete cleft lip.