• Korean Journal of Cleft Lip And Palate
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• v.7 no.1
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• pp.25-34
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• 2004

The present study was carried out to investigate the change of the palatal length after palatoplasty in congenital cleft palate. With the data from one hundred and twelve patients with cleft palate who had been treated at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital over a period of 10 years(April 1995 to April 2004). The epidemiological characteristics, the method of palate repair, the postoperative complications and the extent of palatal lengthening were investigated and analyzed statistically. Incomplete cleft palate occurs more frequently than complete cleft palate. Male were affected 2.1 times more than female in complete cleft palate, and female were affected 1.2 times more than male in incomplete cleft palate. Dorrance method and Wardill V-Y method were frequently used in repair of incomplete cleft palate. Wardill V-Y method, Furlow double opposing Z-plasty, two flap method, and Perko method were widely used in repair of complete cleft palate. The extent of palatal lengthening was greater in the incomplete cleft palate group(5.84 mm) than in the complete cleft palate group(4.71 mm), and in the Furlow double opposing Z-plasty group(5.70 mm) than in the push back palatoplasty group(5.33 mm). But no significant difference was noted. Palatal fistula and wound dehiscence were popular postoperative complications in cleft palate. These results indicate that the extent of palatal lengthening, which contributing to speech function, is a range of 3.5% to 24.0%(average 10.8%) after palatoplasty in cleft palate patients.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.80-86
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• 2024

Background Among the cleft types, bilateral cleft lip and palate (BCLP) generally requires multiple surgical procedures and extended speech therapy to achieve normal speech development. This study aimed to describe speech outcomes in 5-year-old Korean children with BCLP and examine whether normal speech could be achieved before starting school. Methods The retrospective study analyzed 52 children with complete BCLP who underwent primary palatal surgery at a tertiary medical center. Three speech-language pathologists made perceptual judgments on recordings from a speech follow-up assessment of 5-year-old children. They assessed the children's speech in terms of articulation, speech intelligibility, resonance, and voice using the Cleft Audit Protocol for Speech-Augmented-Korean Modification. Results The results indicated that at the age of five, 65 to 70% of children with BCLP presented articulation and resonance within normal or acceptable ranges. Further, seven children with BCLP (13.5%) needed both additional speech therapy and palatal surgery for persistent velopharyngeal insufficiency and speech problems even at the age of five. Conclusion This study confirmed that routine follow-up speech assessments are essential as a substantial number of children with BCLP require secondary surgical procedures and extended speech therapy to achieve normal speech development.

• 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.

• The korean journal of orthodontics
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• v.49 no.5
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• pp.286-298
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• 2019

Objective: The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. Methods: A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: $14.20{\pm}8.09days$ and $118.16{\pm}10.06days$, respectively) comprised the treatment group, while 26 infants without clefts (mean age: $115.81{\pm}8.71days$) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. Results: During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. Conclusions: During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.3
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• pp.171-177
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• 2017

Amniotic constriction band is a rare clinical entity with varied manifestations that range from a combination of congenital malformations to isolated malformations that are unique to each patient. The etiology of this entity remains unknown. Herein, we highlight two cases of amniotic constriction band that presented to our unit with unique clinical characteristics. To the best of our knowledge, an isolated circumferential band of scarring on the face with ocular involvement, as demonstrated by the first case, and a combination of bilateral complete cleft lip and palate with bilateral microphthalmia, auto-amputation of the right thumb, and a constriction band on the left thumb, as demonstrated by the second case, are extremely rare presentations of amniotic constriction band that were not previously reported in the literature and therefore necessitate a special mention. We discuss potential etiologies for these cases and review the existing literature on this entity.

• 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.

• The korean journal of orthodontics
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• v.30 no.4 s.81
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• pp.399-411
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• 2000

This study was designed to evaluate the correlations between the morphology and growth of cranial base and the position of nasomaxillary complex and mandible in complete unilateral cleft lip and palate patients. Craniofacial skeletal morphology Pattern was analyzed on the lateral cephalometric radiographs of the 100 subjects of complete unilateral cleft lip and palate group and the 100 normal grower group and each group was divided three sub-groups by age-range like spheno-ethmoidal synchodrosis growing group, spheno-occipital synchondrosis growing group and finished synchondrosis growth group. These data were statistically analyzed to examine significant difference between both groups and between each sub-groups. The results of this study were as follows: 1. In complete unilateral cleft group, the length, thickness of clivus, and the rate of increase in length of clivus showed smaller amount by adolescence. The anterior length of cranial base and the rotation pattern of clivus with age showed no significant difference between two group. 2. In complete unilateral cleft group, nasomaxillary complex were located more posteriorly. This difference between two groups is larger by adolescent group than adult. Vertical position showed no significant difference between two groups. There was significant correlation between the cranial base of cleft group and the horizontal measurements(p<0.01). PtmS showed no significant increment in cleft group. This showed the deficiency of growth in posterior part of maxilla. 3. In mandible, there was no significant difference between normal group and complete unilateral cleft group but articular angle showed significantly smaller in cleft group than in normal one. And the measurements of nasomaxillary complex position, cranial base and the position of mandible had significant correlation(p<0.01).

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.3-12
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• 2018

Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.2
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• pp.93-106
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• 2004

본 연구의 목적은 편측성 구순구개열 (UCLP) 환자에서 술전 비치조 정형장치 (presurgical nasoalveolar molding appliance, PNAM) 와 구순 봉합수술의 치조골 정형효과를 3차원 (3-D) 분석을 통하여 평가하는 것이다. 연구대상은 16명의 UCLP 환자 (평균 파열부거리: 10.46mm) 이며 PNAM 장치에 의한 치료와 rotation-advancement법에 의한 구순 봉합수술을 받았다 처음 내원시 (평균연령: $37.0{\pm}27.89$ 일), PNAM 치료를 받고 난 후이며 구순봉합수술 1달 전 (평균연령: $119.25{\pm}40.18$ 일), 구순봉합수술 2달 후 (평균연령: $190.81{\pm}42.78$ 일)에 상악의 인상을 채득하였다. 그 후 laser scanning machine (Orapix, Dimennex, Seoul, Korea) 과 3-D view software (3Dxer, Dimennex) 를 사용하여 3-D모형을 제작하였다. 선, 각도, 정중선변이, 거리, 면적 항목을 3-D 모형상에서 계측하고, 각 시기별의 차이를 비교하기 위하여 Wilcoxon signed rank test를 사용하여 분석하였다. PNAM치료 동안과 구순 봉합수술 후에도 치조골 후방부는 안정된 구조물이었다. PNAM치료에 의한 파열부 거리의 감소는 대분절 (greater segment) 의 내측 굴곡 (bending) 에 의하여 발생하였다. 대분절 (greater segment)의 전방 성장은 PNAM치료에 의하여 억제되었으나, 구순 봉합수술 후에 회복되었다. 구순 봉합수술 후에 대분절과 소분절 사이의 전방부 각도의 증가는 구순 반흔 (lip scar) 의 압력에 의한 치조골 정형 효과 때문으로 생각된다. 정중선변이는 PNAM치료에 의하여 개선되었다. PNAM치료 동안과 구순 봉합수술 후에 구개부 (palatal segment) 의 면적은 계속 증가하였다. 치조골 면적과 거리 항목의 증가는 후방부에서 크게 나타났다. 이러한 결과는 PNAM치료에 의한 치조골 정형효과는 주로 전방부에서 발생하며, 치조골의 성장은 구순 봉합수술 후에 후방부에서 주로 발생한다는 것을 의미한다.

• The korean journal of orthodontics
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• v.43 no.3
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• pp.113-119
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• 2013

Objective: To compare three-dimensionally the midfacial hard- and soft-tissue asymmetries between the affected and the unaffected sides and determine the relationship between the hard tissue and the overlying soft tissue in patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) by cone-beam computed tomography (CBCT) analysis. Methods: The maxillofacial regions of 26 adults (18 men, 8 women) with nonsyndromic UCLP were scanned by CBCT and reconstructed by three-dimensional dental imaging. The frontal-view midfacial analysis was based on a $3{\times}3$ grid of vertical and horizontal lines and their intersecting points. Two additional points were used for assessing the dentoalveolar area. Linear and surface measurements from three reference planes (Basion-perpendicular, midsagittal reference, and Frankfurt horizontal planes) to the intersecting points were used to evaluate the anteroposterior, transverse, and vertical asymmetries as well as convexity or concavity. Results: Anteroposteriorly, the soft tissue in the nasolabial and dentoalveolar regions was significantly thicker and positioned more anteriorly on the affected side than on the unaffected side (p < 0.05). The hard tissue in the dentoalveolar region was significantly retruded on the affected side compared with the unaffected side (p < 0.05). The other midfacial regions showed no significant differences. Conclusions: With the exception of the nasolabial and dentoalveolar regions, no distinctive midfacial hard- and soft-tissue asymmetries exist between the affected and the unaffected sides in patients with nonsyndromic UCLP.