• Archives of Plastic Surgery
• /
• v.33 no.1
• /
• pp.75-79
• /
• 2006

The upper and lower lateral cartilages provide the key to the lower cartilaginous portion of the nose. Lifting the cartilages is essential procedure for correction of unilateral cleft lip nose deformity. After correction of cleft lip nose deformity, authors used acoustic rhinometry (AR) to compare the lower nasal cavity of cleft side with non-cleft side. AR is a well known new, non-invasive diagnostic technique in which nasal geometry is assessed by means of acoustic reflection. From June 1996 to January 2004, we performed acoustic rhinometric analysis after correction of unilateral cleft lip nose deformity. This study involved 40 children of age ranged from 3 months to 8 years. Subjects were divided into the group of incomplete unilateral cleft lip nose deformity(20 subjects), and the group of complete unilateral cleft lip nose deformity(20 subjects). Results show that lower nasal cavity volume between non-cleft side and cleft side has no difference, and better results were obtained when nasal molding prong was applied at cleft side nostril. The results between incomplete type and complete type have no significant difference. In conclusion, AR is an effective method to calibrate cross sectional area and nasal cavity volume of unilateral cleft lip nose deformity, and furthermore effective in comparing the volume of cleft side with non-cleft side after unilateral cleft lip nose deformity correction with lifting the lower lateral cartilages to the upper lateral cartilages.

• Archives of Plastic Surgery
• /
• v.36 no.6
• /
• pp.702-706
• /
• 2009

Purpose: Analysis of lower nose and upper lip asymmetry in patients with unilateral cleft lip nose deformity has been proceeded through direct measurement and photo analysis. But there are limitation in presenting real image because of its 2 dimensional trait. The authors analyzed such an asymmetry using 3D VECTRA system (Canfield, NJ, USA) in quantitative way. Methods: In 25 Patients with unilateral cleft lip nose deformity(male 12, female 13, age ranging from 4 to 19), patients with right side deformity were 10 and left were 15. Analysis of asymmetry was proceeded through 3D VECTRA system. After taking 3 dimensional photo, alar area, upper lip area, nostril perimeter, nostril area, Cupid's bow length, nostril height and nostril width were measured. Correlation coefficient and inter data quotients were calculated. Results: In nostril perimeter, maximal difference of cleft side and non - cleft side was 39.3%, asymmetric quotient Qasy = Qcl/Qncl(Qcl, value of cleft side; Qncl, value of non - cleft side) was ranged from 0.84 to 1.85 and in seven cases the length of cleft side was smaller. In nostril area, maximal difference was 69.6% and in 13 cases cleft side was smaller. In lower nasal area, maximal difference was 37.2% asymmetric quotient Qasy = Qcl/Qncl was ranged from 0.47 to 2.03 and in 20 cases cleft side was smaller. The correlation coefficients of nostril perimeter and area were 0.8345. Conclusion: Using 3D VECTRA system, the authors can measure nostril perimeter and lower nasal area that could not been measured with previous methods. Asymmetry of midface was analyzed through area comparison in quantitative way. Futhermore, post operative change can be measured in quantitative method.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.637-641
• /
• 2009

Purpose: Most unilateral secondary cleft lip nose deformities have depressed nostril base and sill on the cleft side. To obtain a symmetric nose, correction of the recession on nostril is critical. The authors have worked out effective methods to elevate the nostril of the cleft side according to the extent of the depression. Methods: A total of 115 unilateral secondary cleft lip nose deformity patients with nostril depression were evaluated. Data were acquired from patients' charts and photography with special reference to the height difference of the nostrils between the cleft side and the non - cleft side. Patients were divided into three groups based on the difference and operated with various techniques : (1) mild degree(< 1 mm) with graft, (2) moderate degree(1 ~ 3 mm) with C - flap or suspension suture of septal cartilage (3) severe degree(> 3 mm) with graft, C - flap and suspension suture. Follow - up period averaged 21.3 months. Results: Forty - six patients(40 percent) were in mild group, and forty - two(37 percent) were in moderate. In twenty - seven patients(23 percent), nostril recession was more than 3 mm. The elevated nostril base and sill were maintained without height alteration during follow - up. Conclusion: The symmetry of the nostril base, especially projection of nostril sill influences successful correction of unilateral cleft lip nose deformity. Our tolerable techniques can be applied to most deformities with nostril depression and can present a new guideline.

• Archives of Plastic Surgery
• /
• v.48 no.6
• /
• pp.630-634
• /
• 2021

To date, there have been no reports of patients showing a Tessier number 7 cleft with unilateral complete cleft lip and palate. Furthermore, no studies have established the sequence, plan, or timing of surgical methods for treating patients presenting the above anomalies simultaneously. We report a case of a Tessier number 7 cleft with unilateral complete cleft lip and palate. Two months after birth, lip adhesion was performed on the unilateral complete cleft lip and total excision was performed on the skin tag. At 4 months of age, Tessier number 7 cleft was corrected. At 6 months of age, surgery involving two small triangular flaps was performed on the unilateral incomplete cleft lip after performing lip adhesion. At 13 months of age, two-flap palatoplasty with a vomer flap was performed on the complete cleft palate. At 6 years of age, open rhinoplasty was performed on the unilateral cleft lip nose deformity. At 9 years of age, bone grafting was performed for the alveolar cleft. At follow-up appointments up to 13 years of age, there were no major complications. Here, we present this patient, surgical procedures and timelines, and show our results demonstrating good postoperative outcomes.

• Korean Journal of Cleft Lip And Palate
• /
• v.8 no.2
• /
• 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.

• Korean Journal of Cleft Lip And Palate
• /
• v.12 no.1
• /
• pp.41-46
• /
• 2009

Historically, various techniques to correct the deformity of lip and nose in functional and esthetic ways were developed and applied in dealing the patients with cleft lip. When treating the patients with unilateral cleft lip, many surgeons adopt the rotation-advancement method originally developed by Millard, or the triangular flap technique developed by Tennison, Randall or the modifications of these techniques. Among these, triangular flap technique has its advantage in designing the flap using the patient's anatomic landmarks. It enables less skillful operator to perform this technique relatively easily and produce reasonable results. In this report we present 8 cases of unilateral complete cleft lip and 3 casesof unilateral incomplete cleft lip. They all underwent primary cheiloplasty based on triangular flap technique, and functional, esthetic outcomes were favorable.

• Archives of Craniofacial Surgery
• /
• v.24 no.3
• /
• pp.91-104
• /
• 2023

Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures.

• Korean Journal of Cleft Lip And Palate
• /
• v.2 no.1_2
• /
• pp.23-28
• /
• 1999

The author presents Bardach' s technique for the residual unilateral cleft lip nasal deformity, The key to a successful and stable correction of the nasal deformity is to lengthen the columella on the cleft side and to mobilize alar cartilage from its surrounding tissue, creating a symmetric shape and length, The major advantages of the technique are lengthening of the cleft columella and creation of a symmetric and well-projected nasal tip.

• Archives of Craniofacial Surgery
• /
• v.13 no.1
• /
• pp.11-21
• /
• 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
• /
• v.11 no.2
• /
• pp.71-75
• /
• 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.