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Denadai R, Araujo KM, Campos RL, Lo CC, Seo HJ, Sato N, Tu JCY, Chou PY, Lo LJ. Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept. Cleft Palate Craniofac J 2024:10556656241247625. [PMID: 38646778 DOI: 10.1177/10556656241247625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. DESIGN Retrospective single-surgeon (RD) study. PATIENTS Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. INTERVENTIONS Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. MEAN OUTCOME MEASURES Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. RESULTS The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. CONCLUSION The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | | | | | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Junior Chun-Yu Tu
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Komisarek O, Bartkowska P, Matthews-Brzozowska T. Li-hong P, Shi-jie T, Qin L. Intense pulsed light and laser treatment regimen improves scar evolution after cleft lip repair surgery. J Cosmet Dermatol. 2018;1-4. https://doi.org/10.1111/jocd.12684. J Cosmet Dermatol 2019; 18:2050. [PMID: 31021027 DOI: 10.1111/jocd.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Oskar Komisarek
- Department of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, Bukowska 70, Poznań, 61-733, Polska.,Department of Maxillofacial Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Patrycja Bartkowska
- Students Research Group of Maxillofacial Surgery and Orthognathic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Teresa Matthews-Brzozowska
- Department of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, Bukowska 70, Poznań, 61-733, Polska
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Bonanthaya K, Shetty PN, Fudalej PS, Rao DD, Bitra S, Pabari M, Rachwalski M. An anatomical subunit-based outcome assessment scale for bilateral cleft lip and palate. Int J Oral Maxillofac Surg 2017; 46:988-992. [PMID: 28408147 DOI: 10.1016/j.ijom.2017.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/03/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022]
Abstract
As there is currently no internationally accepted outcome measurement tool available for complete bilateral cleft lip and palate (CBCLP), the goal of this prospective study was to develop a numerical evaluation scale that allows reliable scoring of this cleft deformity. Our cohort comprised 121 Indian subjects with CBCLP who underwent surgical repair (mean age at time of surgery 6.53 months) using a modified Millard technique. A panel of three professionals evaluated each subject's outcome of bilateral cleft lip repair 6 months postoperatively on two-dimensional (2D) full-face photographs in the frontal view and worm's eye view. A simple two-point rating system was applied to separately analyse a total of 12 components of lip, nose, and scar. The results and mean scores for the analysed anatomical areas were 2.2±1.01 (max=3) for nose, 5.4±1.54 (max=8) for lip, and 1.9±1.3 (max=3) for scar, with a total score 7.7±2.21 (max=12) indicating a good surgical outcome. The inter-examiner ICC for nose, lip, scar, and total score was calculated at 0.836, 0.889, 0.723, and 0.927 respectively and indicated a strong level of repeatability and reliability that was highly significant (P<0.001). In conclusion, we were able to develop and test a scoring system for measuring outcomes in CBCLP that warrants simplicity of use, reliability and reproducibility.
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Affiliation(s)
- K Bonanthaya
- Department of Oral and Maxillofacial Surgery, Bangalore Institute of Dental Sciences, Bangalore, India; Smile Train Cleft Palate Centre, Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
| | - P N Shetty
- Smile Train Cleft Palate Centre, Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
| | - P S Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University of Olomouc, Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - D D Rao
- Smile Train Cleft Palate Centre, Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
| | - S Bitra
- Smile Train Cleft Palate Centre, Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
| | - M Pabari
- Smile Train Cleft Palate Centre, Department of Oral and Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India.
| | - M Rachwalski
- National Reference Center for Cleft Lip and Palate, Department of Maxillofacial and Plastic Surgery, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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Li L, Liao L, Zhong Y, Li Y, Xiang L, Li W. Variation trends of the postoperative outcomes for unilateral cleft lip patients by modified Mohler and Tennison-Randall cheiloplasties. J Craniomaxillofac Surg 2016; 44:1786-1795. [PMID: 27720276 DOI: 10.1016/j.jcms.2016.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate postoperative variation trends of unilateral cleft lip by stages, and to analyze influential factors of nasolabial symmetry. MATERIALS AND METHODS A total of 145 patients with unilateral cleft lip were treated by the modified Mohler or Tennison-Randall technique, and received routine anti-scarring treatment postoperatively. Photogrammetry was applied to respectively measure 5 indices by stages preoperatively, the first week (1 w), the third month (3 m), the sixth month (6 m), and the first year (1 y) postoperatively. Then we calculated the symmetry ratio and drew line charts. Student t tests were used for any group differences; linear regression analysis was used to examine which postoperative stage correlated best with the preoperative stage; cluster analysis was used to classify the severity of the cleft according to preoperative SRsn-cphi, which was used to predict the operative difficulty and to select an appropriate technique. RESULTS The Mohler technique yielded a more symmetric result. With the Tennison-Randall technique, the alar base was more lateral and downward, and the lip height on cleft side seemed longer. A stable effect emerged around 1 year after surgery with both techniques. Conspicuous scars appeared at 3 months, most scars gradually fade at 6 months, and the total evolution took around 1 year. Scars from the Mohler technique fluctuated across a larger range. Preoperative SRsn-cphi of the two techniques had statistical significance and was adopted as the basis for cluster analysis. The critical value was 0.670. The Mohler technique attained an almost identical effect in each interval, whereas the Tennison-Randall technique was better in the interval that SRsn-cphi <0.670. CONCLUSIONS Preoperative SRsn-cphi can be the evaluation index of severity; the modified Mohler technique is more broadly applicable to differences in severity than is the Tennison-Randall technique.
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Affiliation(s)
- Liqi Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Lishu Liao
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuxiang Zhong
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuangui Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Li Xiang
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Wanshan Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China.
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Sitzman TJ, Coyne SM, Britto MT. The Burden of Care for Children with Unilateral Cleft Lip: A Systematic Review of Revision Surgery. Cleft Palate Craniofac J 2016; 53:84-94. [DOI: 10.1597/14-202] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To identify the average rate of revision surgery following cleft lip repair. Design PubMed, CINAHL, and SCOPUS were searched from database inception through March 2013 using the search terms cleft lip and surgery. Two investigators independently screened all abstracts and determined eligibility from review of full manuscripts using prespecified inclusion and exclusion criteria. Strengths and limitation of the studies were assessed, followed by qualitative synthesis. The I2 test of homogeneity was performed to determine if meta-analysis was appropriate. Results The search identified 3034 articles. Of those, 45 met the inclusion criteria. Studies were primarily case series and retrospective cohort studies, with only one randomized controlled trial. One-third of studies (n = 15) did not describe how the study sample was selected. Follow-up duration was not reported in one-fourth of studies (n = 11). Nasolabial aesthetics were reported in 44% of studies (n = 20). The incidence of revision surgery ranged from 0% to 100%. Meta-analysis was precluded because of study heterogeneity (I2 = 97%). Conclusions The average incidence of cleft lip revision surgery cannot be estimated from the published literature, due to significant heterogeneity among existing reports and limited study quality. To provide valid information about the burden of care for unilateral cleft lip, a population-based or multicenter longitudinal cohort study is necessary; this study should measure the number of surgical procedures and the patient's aesthetic outcomes.
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Affiliation(s)
| | | | - Maria T. Britto
- Pediatrics, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Han K, Jeong H, Choi TH, Kim JH, Son D. Curvilinear transformation of z-shaped upper lip scar by diamond-shaped excision in secondary cleft lip deformities: a photogrammetric evaluation. Cleft Palate Craniofac J 2013; 52:143-51. [PMID: 25714266 DOI: 10.1597/13-127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose : The visible Z-shaped upper lip scar that occurs after the Tennison and Randall triangular flap technique remains a cleft stigma. Herein, we present our curvilinear transformation technique for the Z-shaped upper lip scar by diamond-shaped excision and evaluate the results using photogrammetric analyses. Patients and Methods : From 1997 to 2006, 23 patients with secondary cleft lip deformity with the visible Z-shaped upper lip scar underwent correction with the technique. The scar was excised in the diamond shape above the muscle. After curvilinear closure, the elongated length of the upper lip was excised just below the nostril sill, as the measured Cupid's bow height discrepancy. The result was assessed by the authors' standardized photogrammetry technique. Results : There was a statistically significant decrease between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear upper lip scar. The pre- and postoperative Cupid's bow height differences were not statistically significant. Conclusions : The curvilinear transformation of the Z-shaped scar is an efficient procedure that provides (1) a significant decrease in the width of an upper lip scar to make it less conspicuous, (2) incorporation of the scar into the philtral column, (3) a biconcave natural philtral column shape in frontal view, and (4) formation of the natural concave philtral contour in profile view.
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Bell A, Lo TWR, Brown D, Bowman AW, Siebert JP, Simmons DR, Millett DT, Ayoub AF. Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate. Cleft Palate Craniofac J 2013; 51:462-71. [PMID: 23369016 DOI: 10.1597/12-140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. DESIGN Retrospective multicohort comparative study. PATIENTS AND METHODS Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. RESULTS Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). CONCLUSIONS Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.
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Frans FA, van Zuijlen PP, Griot JD, van Der Horst CM. Assessment of Scar Quality after Cleft Lip Closure. Cleft Palate Craniofac J 2012; 49:171-6. [DOI: 10.1597/10-254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess scar quality after cleft lip repair. Design The linear scars of patients with cleft lip with or without cleft palate were evaluated in a prospective study using the Patient and Observer Scar Assessment Scale. Linear regression was performed to identify which scar characteristics were important according to patients and observer. Setting Regular outpatient follow-up visit with the cleft palate teams of two tertiary centers. Patients All consecutive patients were asked to participate in this study after informed consent, minimally 1 year postsurgery. Main Outcome Measure Scar characteristics influencing patient and observer opinion after cleft lip repair. Results A total of 86 patients with cleft lip with or without cleft palate were included, resulting in evaluation of 99 scars. Two scar characteristics, itching and pain, were seldom a concern for the patients. Linear regression showed that scars assessed longer after surgery had a better outcome. Conclusion Scar itching and pain did not seem to have an effect on patient opinion of the quality of the scar, and the majority of the patients were more satisfied with the outcome of their scar than the observer was.
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Affiliation(s)
- Franceline A. Frans
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Paul P.M. van Zuijlen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; and Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - J.P.W. Don Griot
- Department of Plastic, Reconstructive, and Hand Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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Ayoub A, Bell A, Simmons D, Bowman A, Brown D, Lo TW, Xiao Y. 3D assessment of lip scarring and residual dysmorphology following surgical repair of cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 2010; 48:379-87. [PMID: 20815731 DOI: 10.1597/10-057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate lip scarring and the three-dimensional (3D) lip morphology following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous noncleft data. DESIGN Retrospective, cross-sectional, controlled study. SETTING Glasgow Dental Hospital and School, University of Glasgow, U.K. PATIENTS AND PARTICIPANTS Three groups of 10-year-old children: 51 with UCLP, 43 UCL (unilateral cleft lip), and 68 controls. METHODS Three-dimensional images of the face were recorded using stereo cameras on a two-pod capture station, and 3D coordinates of anthropometric landmarks were extracted from the facial images. A novel method was applied to quantify residual scarring and the associated lip dysmorphologies. The relationships among outcome measures were investigated. RESULTS Residual lip dysmorphologies were more pronounced in UCLP cases. The width of the Cupid's bow was increased due to lateral displacement of the christa philteri left (cphL) in both UCL and UCLP patients. In the upper part of the lip, the nostril base was significantly wider in UCLP cases when compared with UCL cases and controls. Scar redness was more pronounced in UCL than in UCLP cases. No relationship could be identified between lip scarring and other measurements of lip dysmorphology. CONCLUSIONS Stereophotogrammetry, together with associated image analysis, allow early detection of residual dysmorphology following cleft repair.
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