• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권4호
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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.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 1997년도 종합학술대회
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• pp.57-57
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• 1997

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.430-435
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• 2000

Cleft lip and palate is one of the congenital anomalies which need comprehensive and multidisciplinary treatment plan because 1) oral cavity is an important organ with masticatory function as a start of digestive tract, 2) anatomic symmetry and balance is esthetically important in midfacial area, and 3) it is also important to prevent psycho-social problems by adequate restoration of normal facial appearance. There are many different protocols in the treatment of cleft lip and palate, but our department has adopted and modified the $Z{\"{u}}rich$ protocol, as published in the Journal of Korean Cleft Lip and Palate Association in 1998. The first challenge is feeding. Type of feeding aid ranges from simple obturators to active orthopedic appliances. In our department we use passive-type plate made up of soft and hard acrylic resin which permits normal maxillary growth. We use Millard's method to restore normal appearance and function of unilateral complete cleft lip. In consideration of both maxillary growth and phonetic problems, we first close soft palate at 18 months of age and delay the hard palate palatoplasty until 4 to 5 years of age. When soft palate is closed, posterior third of the hard palate is intentionally not denuded to allow normal maxillary growth. In hard palate palatoplasty the mucoperiosteum of affected site is not mobilized to permit residual growth of the maxilla. We have treated a patient with unilateral complete cleft lip and palate by Ajou protocol, which is a kind of modified $Z{\"{u}}rich$ protocol. It is as follows: Infantile orthopedics with passive-type plate such as Hotz plate, cheiloplasty with Millard's rotation-advancement flap, and two stage palatoplasty. It is followed by orthodontic treatment and secondary osteoplasty to augment cleft alveolus, orthognathic surgery, and finally rehabilitation with conventional prosthodontic treatment or implant installation. The result was good up to now, but we are later to investigate the final result with longitudinal follow-up study according to master plan by Ajou protocol.

• 대한치과교정학회지
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• 제54권1호
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• pp.69-73
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• 2024

Since its inception in Europe in the 1950s, alveolar molding treatment for neonates with complete cleft lip and palate has undergone significant evolution in both design and application methodology, demonstrating effectiveness in normalizing the alveolar cleft and nasal shape. However, excessively wide alveolar clefts accompanied by disproportionately wide total maxillary arch pose significant challenges when utilizing conventional alveolar molding methods involving cyclical adding and grinding of acrylic on molding plates. The current report introduces a novel alveolar molding method named Biocreative Alveolar Molding Plate Treatment (BioAMP), which can normalize the maxillary alveolar cleft and arch shape without laborious conventional acrylic procedures. BioAMP sets the target arch form and provides unrestricted space for natural growth of the maxillary alveolar bones while systematically reducing the total maxillary arch width in precise increments. Two exemplary cases are presented as proof-of-concept, showcasing the clinical innovation of BioAMP.

• 대한구순구개열학회지
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• 제12권2호
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• pp.57-64
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• 2009

전방으로 심하게 돌출된 전상악골로 인하여 구순성형술 및 비성형술의 결과가 악화 될 수 있다. 따라서 변위된 전상악골의 이상적인 위치로 재위치 시키려는 다양한 노력이 시도되어 왔다. 에디오피아와 같은 개발도상국에서는 어른이 되어서도 수술을 받지 못하는 구순구개열 환자가 많이 있다. 성인이 될 때까지 수술받지 못한 양측성 완전 구순구개열 환자에서는 근육, 골, 피부, 점막의 연속성이 없어서 전상악골이 심하게 전방으로 혹은 하방, 좌우측으로 변위된 경우가 대부분이다. 이 경우 구순성형술이 거의 불가능하며, 시도된다 할지라도 돌출된 전상악골 때문에 양쪽 구륜근을 봉합하여 주기가 대단히 어렵다. 따라서 이상적인 결과를 얻기 위해서는 구순성형술 전 혹은 동시에 전상악골의 재위치 술식이 필수적이다. 저자는 한국국제협력단에서 국제협력의사로 선발되어 에디오피아에서 30 개월간 근무하였다. 그 동안 다양한 양측성 완전 구순구개열 환자에서 전상악골의 재위치 술식을 경험하였다. 저자가 경험한 전상악골의 재위치 술식(전상악골의 재위치와 골이식술 동시 시행, 전상악골의 재위치와 구개열 성형술 동시시행)에 대하여 문헌고찰과 함께 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.20.1-20.6
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• 2016

Background: Most of cleft lip and palate patients have the esthetic and functional problems of midfacial deficiencies due to innate developmental tendency and scar tissues from repeated operations. In these cases, maxillary protraction is required for the harmonious facial esthetics and functional occlusion. Case presentation: A 7-year old boy had been diagnosed as severe maxillary constriction due to unilateral complete cleft lip and palate. The author tried to correct the secondary deformity by early distraction osteogenesis with the aim of avoiding marked psychological impact from peers of elementary school. From 1999 to 2006, repeated treatments, which consisted of Le Fort I osteotomy and face mask distraction, and complementary maxillary protraction using miniplates were performed including orthodontics. But, final facial profile was not satisfactory, which needs compromising surgery. Conclusions: The result of this study suggests that if early distraction treatment is performed before facial skeletal growth is completed, an orthognathic surgery or additional distraction may be needed later. Maxillofacial plastic and reconstructive surgeons should notify this point when they plan early distraction treatment for cleft maxillary deformity.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.31-34
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• 2015

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.

• 대한구순구개열학회지
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• 제3권2호
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• pp.41-50
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• 2000

The alar base on the cleft side in unilateral complete cleft lip, alveolus and palate is markedly displaced laterally, caudally and dorsally, By incising the pyriform margin from the cleft margin of the alveolar process, including mucosa of the anterior part of the inferior turbinate, to the upper end of the postnasal vestibular fold, the alar base is released from the maxilla, A physiological correction of nasal deformity can be accomplished by careful reconstruction of nasolabial muscle integrity, functional repair of the orbicular muscle, raising and rotating the displaced alar cartilage, and finally by lining the lateral nasal vestibule, The inferior maxillary head of the nasal muscle complex is identified as the deeper muscle just below the web of the nostril, The muscle is repositioned inframedially, so that it is sutured to the periosteum that overlies the facial aspect of the premaxilla in the region of the developing lateral incisor tooth, And then, the deep superior part of the orbicular muscle is sutured to the periosteum and the fibrous tissue at the base of the septum, just in front of the anterior nasal spine, The nasal floor is surgically created by insertions of the nasal muscle complex in deep plane and of the orbicular muscle in superficial one, The upper part of the lateral nasal vestibular defect is sutured by shifting the alar flap cephalically, The middle and lower parts of this defect are closed by use of cleft margin flaps of the philtral and lateral segments, respectively, Authors stress the importance of nasal floor reconstruction at primary surgery and report the technique and postoperative results.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 2003년도 종합학술대회
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• pp.34-34
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• 2003

• Archives of Plastic Surgery
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• 제44권3호
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• pp.202-209
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• 2017

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ${\geq}17$ years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.