• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.1
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• pp.140-149
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• 2007

Cleft lip and palate are congenital craniofacial malformation. Reconstruction of dental arch in patient with alveolo-palatal clefts is very important, because they have many problems in functions and esthetics. Malnutrition, poor oral hygiene, respiratory infections, speech malfunctions, maxillofacial deformity, and psychological problems may be occured without proper treatment during the long period of management of the cleft lip and palate. So the treatment should be managed with a multidisciplinary approach. Bone grafting is a consequential step in the dental rehabilitation of the cleft lip and palate patient A complete alveolar arch should be achieyed of the teeth to erupt in and to form a stable dentition. And the presence of the cleft complicate the orthodontic treatment. Therefore bone grafting in patients with cleft lip and palate is a widely adopted surgical procedure. Grafted bone stabilizes the alveolar process and allows the canine or incisor to move into the graft site. After the bone grafting, orthodontic closure of the maxillary arch has become a common practice for achieving dental reconstruction without any prosthodontic treatment. Various grafting materials have been used in alveolar clefts. Iliac bone is most widely fovoured, but tibia, rib, cranial bone, mandible have also been used. And according to its time of occurrence, the bone graft may be divided into primary, early secondary, secondary, late secondary. Bone grafting is called secondary when performed later, at the end of the mixed dentition. It is the most accepted procedure and has become part of treatment of protocol A secondary bone graft is performed preferably before the eruption of the permanent canine in order to provide adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. In this report, we report here on a patient with unilateral cleft lip and palate, who underwent iliac bone graft. The cleft was fully obliterated by grafted bone in the region of the alveolar process. The presence of bone permitted physiologic tooth movement and the orthodontic movement of adjacent tooth into the former cleft area. Satisfactory arch alignment could be achieved in by subsequent orthodontic treatment.

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.591-598
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• 2000

This study was designed to analysis the airway which affects to breathing, speech and facial growth pattern in unilateral cleft lip and palate patients. Upper airway and the position of hyoid bone pattern were analyzed on the lateral cephalometric radiographs of the 78 subjects of complete unilateral cleft lip and palate group and each group was divided two sub-groups by circumpubertal growth peak and gender. These data were statistically analyzed to examine the difference between pre-circumpubertal growth peak group and post-circumpubertal growth peak one, and between male and female group. The results of this study were as follows: 1. After circumpubertal growth peak stage, the position of hyoid bone was lower than before in both male and female group. 2. After circumpubertal growth peak stage, the measurement were increased in CV3ia-APH, PNS-ad which related to the volume of pharyngeal space. This was due to the decrease of adenoid and anteroiferior growth of mandible and affected to breathing and speech after circumpubertal growth peak. 3. During circumpubertal growth peak stage, all measurements increased more in male than female group, which due to the different amount of growth in different gender. 4. The position of hyoid bone was lower in male than female group in all age group. 5. After circumpubertal growth peak stage, CV3ia-APH increased more in male. This was due to the more growth in madible of male which resulted in the activation of digastric muscle.

• Korean Journal of Cleft Lip And Palate
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• v.12 no.1
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• pp.33-40
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• 2009

구개열이 있으면 언어장애 음식섭취의 어려움, 구개범장근의 기능장애로 인한 이관의 개폐기능부전으로 중이의 액체고임, 부정교합등 여러 문제가 생길 수 있다. 따라서 구개성형술은 갈라진 경구개와 연구개를 막아주며 동적인 연구개를 만들어 주어 충분한 구개인두폐쇄를 하여 정상적 발음을 하는데 그 목표가 있다. 그 외에도 음식물을 정상적으로 섭취할 수 있고 중이염 및 난청을 일으킬 수 있는 기능을 개선시키고 정상적인 교합을 만들어주는데 있다. 위의 목표를 이루기 위해 지금까지 많은 수술 방법이 개발되었고 개선되어 왔다. 하지만 아직도 가장 효과적인 수술방법, 수술시기에 대하여 논쟁거리가 되고있다. 언어를 분명하게 하려면 연구개는 인두벽에 닿기 위해 후상방으로 올라가고 인두의 후벽과 측벽은 올라온 연구개에 닿으려고 수축함으로써 비인두와 구인두 사이의 공간이 좁아지게 됨으로써 가능하다. 따라서 발음이 정확하려면 비인두괄약(nasopharyngeal sphincter)을 합리적으로 만들어주어 비인두와 구인두를 분리해 주어야 한다. 비인두괄약을 조성해 주는 방법에는 구개범거근이 괄약기능을 할수 있도록 연구개내근성형술(intravelar veloplasty)을 시행하여 양편구개범거근을 횡위로 옮겨 연결하여 올림근 걸이(levator muscle sling)을 만드는 방법, 구개 연조직을 후방으로 밀어 구개 길이를 연장하는 방법, 인두 피판술을 하는 방법등이 있다. 구개범거근의 주행방향과 부착이 잘못되어 있는 것으로, 정상에서는 구개범거근이 횡으로 주행하여 연구개의 정중봉선(median raphe)에 부착하는 데 반해 구개열에서는 구개범거근이 전방으로 주행하여 개열 가까이에 있는 구개열 후연과 골선 개열연에 부착되어 있고 구개인두근과 구개수근이 연구개를 그냥 지나쳐직접 구개열 후연에 붙는다. 저자등은 완전 양측성 구개열을 연구개내근성형술 및 서골피판을 동반한 2개 점막성골막판을 이용한 구개성형술로 수술을 시행하여 다소의 지견을 얻었기에 문헌고찰과 함께 보고하는 바이다

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.57-59
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• 2012

Purpose: Congenital sinus of the upper lip is extremely rare and only 3 cases have been reported domestically. We report a case of congenital sinus of midline upper lip, which was found in an adolescent patient. Methods: A 14-year-old girl presented with a small pit on midline of the upper lip, which was visible at birth. The patient had never been treated for the congenital sinus because it was asymptomatic. Surgical excision under local anesthesia was performed. Results: The sinus had a tract extending into 5 mm posteroinferior and had not penetrated the oral cavity. Histological examination showed a fistulous tract lined by keratinized squamous epithelium. After complete excision, there was no recurrence and we obtained a satisfactory cosmetic result. Conclusion: Congenital sinus of the midline upper lip is extremely rare. This is a special case that is reported because it did not cause symptoms for the patient until she reached adolescence.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.133-139
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• 2012

This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.

• The korean journal of orthodontics
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• v.33 no.4 s.99
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• pp.235-245
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• 2003

The goal of the present study was to evaluate the effects of PNAM appliance and cheiloplasty on alveolar molding. Samples consisted of 16 unilateral cleft lip and palate infants (10 males and 6 female, mean age=37.0 days after birth, average alveolar cleft gap=10.46m), who were treated with PNAM appliances by one orthodontist and rotation- advancement cheiloplasty by one surgeon in Seoul National University Hospital. Average duration of alveolar molding treatment was 13.10 weeks and these patients were recalled at average 8.31 weeks after cheiloplasty. These patients' models were obtained at initial visit (T0, mean age : $37.0\pm27.89$ days after birth), after successful alveolar molding (T1, mean age : $119.25\pm40.18$ days after birth), and after cheilopasty (T2, mean age : $190.81\pm42.78$ days after birth). Seven linear and five angular variables were measured using 1 : 1 photometry and soft ware program(V-ceph. Cybermed. Seoul, Korea). Paired t-test was performed to investigate statistical significance at p<0.05 level. 1 The posterior parts of alveolar segments were the stable structures during alveolar molding treatment period and after cheiloplasty in infants. 2. The closure of cleft gap during alveolar molding was usually due to backward bending of the whole part of the greater segment. 3. Although forward growth of the greater segment was hindered by alveolar molding, it resumed after cheiloplasty. 4. Increase of anterior inter-segment angle after cheiloplasty was due to the molding effect of the lip scar pressure.

• The korean journal of orthodontics
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• v.25 no.1 s.48
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• pp.13-18
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• 1995

Craniofacial asymmetry was analyzed in 39 patients with complete unilateral cleft lip and palate(UCLP). The samples are devided into three groups nine below 9 years, twenty three from 9 years 1 month to 14 years and seven over 14 years group. Seventeen measurements were obtained from the tracing of PA X-ray cephalometric headfilms to evaluate the asymmetric characteristics and changes accdording to aging in UCLP. The obtained results were as follows. 1. Facial asymmetry in UCLP is variable(1.22-3.47 $mm/^{\circ}$) and the length from midsagitta1 reference line to maxillary 1st molar, to upper central incisor and the length of mandibular ramus showed significant asymmetry 2. Nasal septum and anterior nasal spine were deviated In the cleft side and the lower border of nasal cavity was 1ower in cleft side. 3. The deviation of nasal septum was continued significantly till after 14 years old.

• Korean Journal of Cleft Lip And Palate
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• v.4 no.1
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• pp.45-53
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• 2001

Congenital craniofacial disorders represent approximately 20% of all birth defects, One of these disorders is syngnathia, Congenital fusion of the maxilla and mandible is rare and can present in a wide range of severity from single mucosal band(synechiae) to complete bony fusion(syngnathia), Syngnathia, congenital bony fusion of the mandible and maxilla, is even less common than synechiae, with only 25 cases reported in the literature, Most of them have presented as an incomplete, unilateral fusion, We report a case of unilateral bony fusion of the maxilla, mandible, and zygomatic arch, Details of operative management and follow-up data are presented with review of literature.

• The korean journal of orthodontics
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• v.31 no.6 s.89
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• pp.601-610
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• 2001

The purpose of this retrospective study was to evaluate the level oi alveolar bone support of the erupted Permanent canine through the reconstructed cleft region compared to the contralateral canine on the non-cleft side. This study was limited to children with complete unilateral cleft lip and palate who underwent secondary alveolar iliac bone gvaft and the apices of the erupted canine roots were closed at the time of evaluation. With these criteria the study included 21 children whose average age at the time of bone graft reconstruction was 9.8 years, with a minimum of 12.4 years of age at the time of the evaluation. The study was limited to the use of iliac cancellous bone as the autograft material for reconstruction of the alveolar cleft. Cranial bone graft and other autogenous bone sources were excluded. The periapical radiographs were used to evaluate alveolar bone level of each canine. The percentages of root supported by the bone were established by dividing the amount of root covered with the bone by the anatomic root length. The canine oi the non-cleft side was used as an internal control and the canine on the cleft side was used as an experimental. There was a statistically significant difference in the alveolar bone support ratio between the control ($92.9\%$) and experimental canines ($8.7\%$). An average of $95\%$ level of alveolar bone support was achieved for the experimental canine in comparison to the control canine. Neither the presence of lateral incisor, nor the stage of root development of the canine at the time of the bone graft appeared to have affected the alveolar bone support ratio of the canine after the secondary bone graft.