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Rivers CM, Drake D, Devlin MF, Russell C. Philtral Height Discrepancy in Patients with Complete and Incomplete Cleft Lips + /-Palate - Results from a Single Nation Consecutive Cohort. Cleft Palate Craniofac J 2024; 61:953-956. [PMID: 36632018 DOI: 10.1177/10556656221150874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The aim of unilateral cleft lip repair is to restore form and function, including symmetrisation of cleft and non-cleft philtral height. Expectation of best outcome is achieved in situations with minimal asymmetry and is assumed occurs most often in incomplete cleft lip only patients. We sought to investigate philtral height discrepancy (PHD) in children with unilateral cleft lip + /-palate from a single nation cohort. METHODS Review of prospectively collected PHD measurements taken at time of surgery for all children undergoing unilateral cleft lip repair in Scotland born Jan 2017-December 2020. Data was collected using Microsoft Excel and analysed using embedded statistical software. RESULTS 102 consecutive patients with unilateral lip involvement were identified from the national database. 94 had prospectively documented PHD (92.2%). The majority of patients had an isolated cleft lip (51.1%). Incomplete clefts presented more frequently (52.1%) than complete clefts (47.9%). Mean PHD for the whole cohort was 3.91mm (standard deviation 1.01mm, range 1-6mm). The difference in mean PHD (in-complete versus complete) was 1.1mm (3.4 vs. 4.5, p < 0.001). For lip only versus lip and palate the difference in mean PHD was 1.0mm (3.4 vs. 4.4, p < 0.001). CONCLUSIONS This single country consecutive cohort review of PHD in children undergoing unilateral cleft lip repair statistically supports the anecdote that patients with an incomplete cleft lip and isolated cleft lip have lesser asymmetry at presentation. This study presents a consecutive cohort with a greater range of PHD than has previously been reported in the literature.
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Affiliation(s)
- C M Rivers
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, UK of Great Britain and Northern Ireland
| | - D Drake
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, UK of Great Britain and Northern Ireland
| | - M F Devlin
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, UK of Great Britain and Northern Ireland
| | - Cjh Russell
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, UK of Great Britain and Northern Ireland
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Reynolds JI, Gschwendtner E, Figueroa A, Smith M, Johnson BP, Polley J. The Asymmetry Within: A Renewed Look at Cupids Bow in Unilateral Cleft Lip. J Craniofac Surg 2024; 35:1096-1100. [PMID: 38743277 PMCID: PMC11147722 DOI: 10.1097/scs.0000000000010282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
The purpose of this study is to analyze the angular variations within Cupid's bow in patients with unoperated unilateral cleft lip (UCL). Angular features of Cupid's bow were quantified in standardized presurgical photographs of children with UCL by 5 medical professionals specializing in craniofacial anomalies. The peaks and valley of Cupid's bow were identified. A cleft side (CSA) and a noncleft side angle (NCSA) were delineated and measured by each expert. The data was pooled, and the angles were analyzed for symmetry. Cupid's bow asymmetry was defined as a difference between NCSA and CSA ≥3°. Of the 37 patients studied, 29 were found to have asymmetry of Cupid's bow with an average angle difference of 8.0° (95% CI: 6.6°-9.5°). Within this group,15 patients were found with acute asymmetry and 14 with obtuse asymmetry. Geometric analysis was performed on an example of a patient with acute asymmetry to demonstrate how correction of asymmetry can be considered during surgical repair. There is an asymmetry that exists in the Cupid's bow of a significant number of patients with unoperated UCL. This finding not only adds to our understanding of UCL but may also have important implications when selecting the method/technique of surgical repair.
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Affiliation(s)
- Jacob I Reynolds
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI
| | | | | | - Mathew Smith
- Munson Health Cleft and Craniofacial Center
- Munson Health Great Lakes Plastic Surgery Center, Traverse City
| | - Brian P Johnson
- Department of Biomedical Engineering, Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI
| | - John Polley
- Munson Health Cleft and Craniofacial Center
- Munson Health Great Lakes Plastic Surgery Center, Traverse City
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Mabrouk MM, Abdullateef KS, Abdelsattar AH, Elbarbary M, Kaddah S, Mohamed W. Comparative Study between Modified Millard and White Roll Vermilion Flap Techniques in Unilateral Lip Repair: A Randomised Controlled Study. Afr J Paediatr Surg 2024; 21:18-27. [PMID: 38259015 PMCID: PMC10903735 DOI: 10.4103/ajps.ajps_20_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cleft lip and palate, which affects 0.5-1.6 out of every 1000 live births, is the most prevalent congenital defect of the head and neck. Several approaches, including quadrangular flaps, triangular flaps and rotation-advancement procedures, White Roll Vermilion Turn Down Flap (WRV flap) from the lateral lip element were employed by Mishra to modify Millard's technique to create the vermilion and white roll on the medial lip segment. This study aimed to use the anthropometric measurements taken pre- and post-operation to evaluate quantitative assessment of modified Millard technique compared with WRV flap technique in unilateral cleft lip (UCL) repair. MATERIALS AND METHODS Prospective, randomised controlled study recruited infants scheduled for UCL repair. Infants aged 3-6 months, either complete or incomplete deformity. A total of 42 patients were randomized in 1:1 ratio to undergo either WRV flap technique (group A) or modified Millard technique (group B) and another control included 21 age-matched healthy children. We compared WRV flap procedure to Modified Millard's procedure in terms of both qualitative (another surgeon's opinion) and quantitative (anthropometric) evaluation. RESULTS Vertical lip length and philtral lip height significantly longer in Millard group (B) than WRV flap group (A) in immediate postoperative assessment and nasal width was significantly wider in WRV flap group (A) than Millard group (B) in 3-month post-operative assessment. The lip shape, the vermilion shape was better in Millard technique than WRV flap technique; however, this was statistically insignificant. However, no major difference in the overall results between the WRV flap and Millard rotation-advancement repairs. CONCLUSION Anthropometric measurement of surgical outcome evaluates the surgical technique used and helps to compare between cleft and non-cleft side showing the degree of deformity and we used subjective assessment to analyse facial aesthetics. Overall results demonstrate no significant differences between modified Millard technique and WRV flap technique.
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Affiliation(s)
- Mohamed M Mabrouk
- Department of Pediatric Surgery, Cairo University Children Specialized Hospital, Giza, Egypt
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Abdullateef KS, Nagaty MAM, Fathy M, Elmenawi KA, Aboalazayem A, Abouelfadl MH. The Outcomes of Modified Millard Technique Versus Tennison-Randall Technique in Unilateral Cleft Lip Repair: A Comparative Trial. Afr J Paediatr Surg 2024; 21:12-17. [PMID: 38259014 PMCID: PMC10903732 DOI: 10.4103/ajps.ajps_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND This study aimed to use anthropometric measurements taken pre- and post-operation to evaluate quantitative assessment of modified Millard technique compared with Tennison-Randall technique in unilateral cleft lip (UCL) repair. MATERIALS AND METHODS Prospective randomised controlled study recruited infants scheduled for UCL repair. Infants aged 2-6 months, either complete or incomplete deformity. A total of 68 patients were randomised in 1:1 ratio to undergo either modified Millard technique (Group I) or Tennison-Randall technique (Group II). RESULTS Group I had significantly longer operative time than Group II (85.7 ± 7.4 vs. 68.7 ± 8.8 min, respectively; P < 0.001). Group I has less post-operative wound infection, wound dehiscence and wound scarring than Group II, but Group II has less post-operative lip notch. In Group I, greater increases in post-operative horizontal lip length and vertical lip height were observed, compared to Group II, without statistically significant difference. Group I showed a greater reduction in nasal width and total nasal width than Group II, without statistically significance. Group II had a greater increase in philtral height. However, only post-operative Cupid's-bow width was significantly different between two groups (P = 0.041). CONCLUSION Overall results demonstrate no significant differences between modified Millard technique and Tennison-Randall technique.
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Affiliation(s)
| | | | - Mohamed Fathy
- Department Pediatric Surgery, Minia University, Minya, Egypt
| | | | - Abeer Aboalazayem
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Mohamed H. Abouelfadl
- Department of Pediatric Surgery, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
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Mustafa K, Fatima S, Ashith MV, Goyal JN, Varshini A, Aftab A. Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation. J Maxillofac Oral Surg 2023; 22:930-937. [PMID: 38105833 PMCID: PMC10719181 DOI: 10.1007/s12663-023-02039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success. Aim To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip. Methods 100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard's rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12 months post-operatively on a 1:1 standard photograph. Results Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V. Conclusion In our study, group V, i.e., modified Millard's repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.
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Affiliation(s)
- K. Mustafa
- A Unit of Kanachur Institute of Medical Sciences, Kanachur Institute for Craniofacial Anomalies, Mangalore, Karnataka India
| | - Shehzana Fatima
- Department of Maxillofacial Surgery, Dubai Health, Dubai, UAE
| | - M. V. Ashith
- Department of Orthodontics and Dentofacial Orthopedics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Karnataka Manipal, 576104 India
| | - Jay Nandkishor Goyal
- Department of Oral and Maxillofacial Surgery, ACPM Dental College, Dhule, Maharashtra India
| | - Amrutha Varshini
- Department of Oral and Maxillofacial Surgery, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Nitte (Deemed to be University), Mangalore, India
| | - Aafreen Aftab
- Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh India
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Wang X, Liao L, Li Y, Tang S, Li W. Clinical Application of a Resembling Rectangular Flap on Lateral Lip in Unilateral Cheiloplasty: A Modified Millard's Technique. J Craniofac Surg 2023; 34:1666-1671. [PMID: 37220718 PMCID: PMC10445623 DOI: 10.1097/scs.0000000000009373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE This clinical study aimed to design and utilize a modified rotation-advancement technique (MRAT) with a resembling rectangular flap on the lateral lip for primary unilateral cheiloplasty and evaluated its postoperative outcomes. MATERIALS AND METHODS A retrospective study was conducted on patients with a unilateral cleft lip who had undergone initial cheiloplasty with MRAT. The postoperative outcomes were assessed for nasolabial symmetry by photogrammetry. Repeated measures of ANOVA and two independent samples t tests were applied for statistical analysis. RESULTS Twenty patients with unilateral cleft lip met the inclusion criteria. Postoperatively, the patients had well-shaped nasal sill and centered nasal columella. In addition to, the bilateral symmetrical ratios noticeably improved ( P <0.001). Simultaneously, the postoperative outcomes were independent of the cleft type and height differences of the two peaks ( P >0.05). CONCLUSIONS Unilateral cheiloplasty using the present MRAT can better preserve the nasolabial structure and symmetry. The postoperative scar is concealed and simulates a normal philtral ridge.
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Abdurrob A, Shumrick CM, Scott AR, Marston AP. Longitudinal Anatomic Analysis of Primary Cleft Lip Rhinoplasty Outcomes. Facial Plast Surg Aesthet Med 2023; 25:425-430. [PMID: 36976783 DOI: 10.1089/fpsam.2022.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: The unilateral cleft lip deformity is associated with nasal deformities with secondary functional and aesthetic challenges. Objectives: Compare the change in nasal symmetry before and incrementally after primary endonasal cleft rhinoplasty concurrent with lip repair. Methods: This is a retrospective chart review of infants undergoing unilateral cleft lip repair. Data collection included demographics, surgical history, and pre- and postoperative alar and nostril photographs analyzed with Image J. Statistical analysis was done using linear and multivariable mixed effect models. Results: Twenty-two patients with a near even gender distribution (46% female) and primarily left-sided cleft lips underwent unilateral lip repair at a mean age of 3.9 months (median 3.0, range 2-12). Mean pre- and postoperative alar symmetry ratios were 0.099 (standard error [SE] 0.0019) and -0.0012 (SE 0.0179), with zero representing perfect symmetry and negative values indicating overcorrection. These values at 1, 2-4, 5-7, 8-12, 13-24, and 25+ months were 0.026, 0.050, 0.046, 0.052, 0.049, and 0.052 (SE range: 0.0015-0.0096), respectively, demonstrating stability of the alar symmetry 4 months postrepair. Conclusions: In this study, patients who underwent an overcorrective primary cleft rhinoplasty concurrent with lip repair had an initial regression of symmetry within the first 4 months postoperatively, followed by observed stabilization.
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Affiliation(s)
- Abdurrahman Abdurrob
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher M Shumrick
- Department of Otolaryngology Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andrew R Scott
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alexander P Marston
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Hughes EB, Tatum SA. Current trends in unilateral cleft lip repair. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00065. [PMID: 37144507 DOI: 10.1097/moo.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers. There is much room for growth, with new and exciting technologies on the horizon to improve upon cosmesis, functionality, and the operative experience.
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Affiliation(s)
- Evan B Hughes
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Elayah SA, Sakran KA, Alkebsi K, Younis H, Yang M, Liang X, Alkhutari AS, Li Y, Shi B. Primary unilateral incomplete cleft lip repair by a modified rotational advancement technique. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 124:101325. [PMID: 36336298 DOI: 10.1016/j.jormas.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to describe a modified technique for primary unilateral incomplete cleft lip repair together with postoperative outcomes assessment. STUDY DESIGN A Retrospective study. PARTICIPANTS AND SETTING Photos of 64 consecutive patients with nonsyndromic primary unilateral incomplete cleft lip were reviewed. Of the 64 participants for the study sample, 32 patients had received Millard rotational advancement technique (RA), while the other 32 had modified rotational advancement technique (MRA) with preserving the nasal sill intact. It was conducted at a university-affiliated tertiary hospital between 2013 and 2021. MAIN MEASURES The lip measures were represented by lip height and width, vermillion height, midline-philtrum angle, and angle of Cupid's bow peaks. The nasal measures involved columella length and angle, nostril height and width, and ala width. Both descriptive and comparative data analyses were calculated. RESULTS Symmetrical lip height, lip width, philtrum angle, Cupid's bow, as well columellar length, and alar width were obtained following the MRA technique. No significant difference was found between the MRA and RA groups concerning the preoperative lip height, Cupid's bow angle, columellar length and angle. However, the postoperative lip height, width and columellar length were greater in MRA group than RA group (P= .001, 0.004 and 0.002, respectively). On the other hand, the MRA group had significantly smaller columellar and Cupid's bow peaks angles than RA group (0.53±0.36 vs 1.21±0.91 and 1.34±1.84 vs 3.14 ± 2.97, respectively). CONCLUSIONS The MRA technique has obtained satisfactory lip and nasal outcomes in terms of lip height, lip width, philtrum angle, Cupid's bow, columellar length, and alar width while keeping the nasal sill intact.
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Jorge PK, Chagas NV, Ambrosio ECP, Carrara CFC, Valarelli FP, Machado MAAM, Oliveira TM. Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate. BRAZILIAN JOURNAL OF ORAL SCIENCES 2022. [DOI: 10.20396/bjos.v21i00.8666343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) – children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) – children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) – children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C’), anterior length of dental arch (I-CC’), and total length of the dental arch (I–MM’), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.
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Cho J, Oh TS. Curved-line cleft lip repair in unilateral complete cleft lip patients: Comparative analysis of lip dimensions after cheiloplasty. J Craniomaxillofac Surg 2022; 50:561-568. [DOI: 10.1016/j.jcms.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
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Falzoni MMM, Ambrosio ECP, Jorge PK, Sforza C, de Menezes M, de Carvalho Carrara CF, Valarelli FP, Soares S, Machado MAAM, Oliveira TM. 3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques. Clin Oral Investig 2021; 26:1975-1983. [PMID: 34665341 DOI: 10.1007/s00784-021-04177-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. MATERIALS AND METHODS The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1 year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). RESULTS At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). CONCLUSION This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. CLINICAL RELEVANCE Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.
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Affiliation(s)
- Maiara Miyuki Matsui Falzoni
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Eloá Cristina Passucci Ambrosio
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Karine Jorge
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Faculty of Medicine and Surgery, Universita' Degli Studi Di Milano, Milan, Italy
| | - Márcio de Menezes
- Department of Restorative Dentistry, School of Health Science, State University of Amazonas, Manaus, Brazil
| | | | | | - Simone Soares
- Department of Prosthodontics, School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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Abstract
ABSTRACT The understanding of cleft lip etiology and approaches for surgical repair have evolved over time, allowing for improved ability to restore form and function. The variability of cleft lip presentations has necessitated a nuanced surgical approach with multidisciplinary cleft care. The earliest documentation of unilateral cleft lip repair predates the 19th century, with crude outcomes observed before the advent of curved incisions and advancement flaps. In the 20th century, straight line, quadrilateral flap, and triangular flap repairs were introduced to mitigate post-repair surgical scarring, increase lip length, and restore the symmetry of the Cupid's bow. Towards the latter part of the century, the development of rotation-advancement principles allowed for improved functional and aesthetic outcomes. Future technical improvements will continue to address the goals of lip and nasal symmetry, muscular continuity, precise scar concealment, and improved patient satisfaction in an increasing range of cleft phenotypes and during subsequent years of growth.
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14
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Alkebsi K, Li C, Shi B, Abotaleb BM, Telha WA, Sakran KA, Li Y. Modified Rotational Advancement Technique for Primary Unilateral Complete Cleft Lip Repair. Facial Plast Surg Aesthet Med 2021; 24:357-362. [PMID: 34516779 DOI: 10.1089/fpsam.2021.0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Importance: Leveling Cupid's bow while maintaining lip height and width in unilateral complete cleft lip patients with improved nose outcomes is a significant challenge for surgeons. Objective: This study aimed to measure the symmetry of the nasal and labial anthropometric points after using this modified cleft lip repair technique. Design, Setting, and Participants: In this retrospective study, 72 consecutive nonsyndromic unilateral complete cleft lip patients underwent a modified rotational advancement technique. Photos of at least 1 year follow-up period were collected. Main Outcomes and Measures: The nose measurements included columella length, nostril height and width, ala width, nostril inclination, columella angle, and ala bases angle. The lip measurements included lip height and width, vermillion height; midline-philtrum angle, and angles of Cupid's bow peaks. Descriptive quantitative analysis of the lip and nose measurements, intraclass correlation coefficient, and ANOVA tests were conducted. Results: Well-aligned Cupid's bows with symmetrical lip height and width were obtained with satisfactory aesthetic nasal outcomes. Conclusions: The present technique had leveled the Cupid's bow while preserving the lip height and width, with resultant satisfactory nasal outcomes.
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Affiliation(s)
- Khaled Alkebsi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Chenghao Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bassam Mutahar Abotaleb
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Wael A Telha
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Karim Ahmed Sakran
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb, Yemen
| | - Yang Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Revisiting straight-line repair in unilateral complete cleft lip: a comparison with rotation-advancement repair. Int J Oral Maxillofac Surg 2021; 50:1047-1054. [PMID: 33531269 DOI: 10.1016/j.ijom.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/27/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022]
Abstract
Rotation-advancement repair (RAR) has been the most widely used technique for unilateral cleft lip repair. We recently used a straight-line repair with medial orbicularis muscle lengthening (SLR-ml) technique, based on the hypothesis that it could minimize the postoperative scar appearance without causing s short-lip deformity when muscle reorientation is performed correctly. A retrospective cohort study was conducted on unilateral complete cleft lip patients who underwent cheiloplasty between 2009 and 2017. Two cheiloplasty techniques were compared: RAR and SLR-ml. Outcomes were evaluated by assessing follow-up photographs using three methods: (1) glance impression on a five-point scale, (2) Manchester Scar Scale, and (3) indirect anthropometry. Seventy-one patients were analysed: 41 in the RAR group (28 male, 13 female) and 30 in the SLR-ml group (15 male, 15 female). The glance impression (P=0.506) and Manchester Scar Scale (P=0.347) scores did not differ between the groups. According to the symmetry ratio (cleft side value/non-cleft side value), vertical lip height (P=0.804), horizontal lip length (P=0.881), and Cupid's bow width (P=0.122) did not differ significantly between the groups. The preoperative lip height discrepancy was not correlated with the postoperative vertical lip height. The SLR-ml method can be regarded as a successful tool for symmetric repair of unilateral cleft lip.
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Jung S, Chung KH, Chang SY, Ohrmman D, Lim E, Lo LJ. A new technique for perioral muscle reconstruction and lip lengthening in complete unilateral cleft lip. J Plast Reconstr Aesthet Surg 2020; 73:749-757. [DOI: 10.1016/j.bjps.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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17
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Reddy YS, Kumar RVK, Kumar DS, Rajasekhar G, Babu VR, Reddy KS, Purna KP. Bilateral Cleft Lip Repair - Advantages of Pfeifer's Technique. Contemp Clin Dent 2019; 9:530-534. [PMID: 31772458 PMCID: PMC6868638 DOI: 10.4103/ccd.ccd_729_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Context: Primary repair of bilateral cleft lip depends on the sound knowledge of anatomy, identification of landmarks, clinical variation of presentation, surgical expertise of the operator, etc., Herewith, we present the results of 129 cases performed during our study. Aim: To evaluate the advantages of Pfeifer's technique in bilateral cleft lip repair. Design: This was a retrospective analysis of the results of repair. Patients and Methods: The study was carried out on 129 patients using Pfeifer's technique. Pfeifer described a technique which involves changing the lip skin incision to a wavy line, thus making it less conspicuous, using the concept of “morphological order.” The basis of this technique is, a skin incision between two points can be lengthened if both points are joined in a curved or wavelike manner rather than in a straight line. Results: Lip parameters improved by 70% as viewed in frontal profile in terms of white roll match, vermilion match, and Cupid's bow. Nasal parameters improved by 80% as viewed in basal view in terms of alar symmetry, nasal dome and alar base. Conclusions: We found four advantages by strict adherence to the steps in the technique as given in the available literature. This technique is easy to learn and teach with satisfactory results.
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Affiliation(s)
- Yaratha Sivanagendra Reddy
- Department of Oral Maxillofacial Surgery, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
| | | | - Devireddy Sathya Kumar
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Gali Rajasekhar
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Vaka Ramesh Babu
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
| | - Kanubaddy Sridhar Reddy
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Nellore, Andhra Pradesh, India
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Rossell-Perry P. A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique. Indian J Plast Surg 2019; 49:340-349. [PMID: 28216814 PMCID: PMC5288909 DOI: 10.4103/0970-0358.197226] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. Materials and Methods: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. Results: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. Conclusions: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.
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Affiliation(s)
- Percy Rossell-Perry
- Faculty of Human Medicine, Post Graduate Studies San Martin de Porres University, Lima, Peru; Outreach Surgical Center Lima Perú ReSurge International 145 N Wolfe Rd, Sunnyvale, CA 94086, USA
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Comparison of the Fisher Anatomical Subunit and Modified Millard Rotation-Advancement Cleft Lip Repairs. Plast Reconstr Surg 2019; 144:238e-245e. [DOI: 10.1097/prs.0000000000005847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Adetayo AM, Adetayo MO, Adeyemo WL, James OO, Adeyemi MO. Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment. J Korean Assoc Oral Maxillofac Surg 2019; 45:141-151. [PMID: 31334102 PMCID: PMC6620301 DOI: 10.5125/jkaoms.2019.45.3.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. Materials and Methods This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. Results Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. Conclusion Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.
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Affiliation(s)
- Adekunle Moses Adetayo
- Department of Surgery, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria.,Dental Unit, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Modupe Olushola Adetayo
- Department of Biochemistry, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Wasiu Lanre Adeyemo
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Olutayo O James
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Michael O Adeyemi
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
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Abstract
BACKGROUND Numerous methods exist for repairing unilateral cleft lips and mainly focus on cutaneous design to achieve sufficient rotation of the medial (M) cleft lip and produce a natural Cupid's bow and philtrum. However, precise nasal floor reconstruction has not been described in detail. This is the first study to introduce a technique for repairing complete unilateral cleft lips with a focus on nasal floor reconstruction. METHODS In our technique, "Straight-Line Advanced Release Technique (StART)," the nasal floor is considered a 3-dimensional cuboid structure; the M mucosal and lateral (L) mucosal flaps constituted the posterior surface. The M flap became the roof of the orbicularis oris muscle sling and the posterior side of the nasal lining. The B flap met the L lip flap at the superior border of the M flap, and together they formed the roof and anterior surface. The B flap also formed a transitional zone connecting the columella and nasal floor. RESULTS Seventy-two patients with complete unilateral cleft lip were treated from 2003 to 2015. The difference in the height of the nostril sills between the cleft and non-cleft sides was not significantly different from that in control patients (P = 0.472) 1 year postoperatively. Twenty operations for secondary deformities were performed: 8 for nose deformities not involving the nasal floor. The transverse scar at the alar base was concealed within the nostril. CONCLUSIONS Nasal floor reconstruction is important in complete unilateral cleft lip repair. Our technique provides a naturally shaped, symmetrical nasal floor without conspicuous scarring.
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22
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Clinical Application of 3-Dimensional Continuous Suturing Technique for Triangular Wounds. Ann Plast Surg 2018; 81:316-321. [PMID: 29851729 DOI: 10.1097/sap.0000000000001509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although there are numerous skin closure methods, there is no special method for suturing triangular skin wounds. The authors have summarized and modified their experience with a 3-dimensional (3D) continuous suturing technique for triangular wounds. METHODS From December 2015 to September 2017, the 3D continuous suturing technique for triangular wounds has been used in 32 cleft lip repairs (48 surgical triangular incisions) and 11 cases of facial trauma (15 traumatic triangular wounds). The patients, 3 months to 39 years of age, had triangular flaps designed for esthetic purposes or triangular defects secondary to accidents. To evaluate the effectiveness of this technique, the mean follow-up was 7 months (range, 1-15 months). RESULTS The 3D continuous suturing technique for triangular wounds can shorten the suturing time, decrease the number of thread knots, and shorten the time of surgery. All patients healed well and the stitches were removed 7 days postoperatively. The wound on both sides of the triangle was well arranged, with a good appearance and no scar hyperplasia. CONCLUSIONS Our experience showed that the 3D continuous suturing technique for triangular wounds is a time-saving and convenient method and can make the wounds closed tighter, more stable, and reliable. The technique can be applied to any type of triangular wounds or incisions and is not limited to the clinical scenarios described in this article.
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Thiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, Gaßling V, Gehrke G, Gerressen M, Gosau M, Gröbe A, Haßfeld S, Heiland M, Hoffmeister B, Hölzle F, Klein C, Krüger M, Kübler AC, Kübler NR, Kuttenberger JJ, Landes C, Lauer G, Martini M, Merholz ET, Mischkowski RA, Al- Nawas B, Nkenke E, Piesold JU, Pradel W, Rasse M, Rachwalski M, Reich RH, Rothamel D, Rustemeyer J, Scheer M, Schliephake H, Schmelzeisen R, Schramm A, Schupp W, Spitzer WJ, Stocker E, Stoll C, Terheyden H, Voigt A, Wagner W, Weingart D, Werkmeister R, Wiltfang J, Ziegler CM, Zöller JE. Current concepts in cleft care: A multicenter analysis. J Craniomaxillofac Surg 2018. [DOI: 10.1016/j.jcms.2018.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Adetayo AM, James O, Adeyemo WL, Ogunlewe MO, Butali A. Unilateral cleft lip repair: a comparison of treatment outcome with two surgical techniques using quantitative (anthropometry) assessment. J Korean Assoc Oral Maxillofac Surg 2018; 44:3-11. [PMID: 29535963 PMCID: PMC5845966 DOI: 10.5125/jkaoms.2018.44.1.3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/06/2017] [Accepted: 05/07/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The unilateral cleft lip (UCL) repair technique has evolved extensively over the past century into its modern form and has been identified as an important determinant of treatment outcome. The aim of this study was to evaluate and compare treatment outcomes following repair of UCL using either the Tennison-Randall (triangular) technique or the Millard rotation-advancement technique. MATERIALS AND METHODS This was a prospective randomized controlled study conducted at the Lagos University Teaching Hospital between January 2013 and July 2014. A total of 48 subjects with UCL presenting for primary surgery and who satisfied the inclusion criteria were recruited for the study. The subjects were randomly allocated into two surgical groups through balloting. Group A underwent cleft repair with the Tennison-Randall technique, while group B underwent cleft repair with the Millard rotation-advancement technique. Surgical outcome was assessed quantitatively according to anthropometric measurements, using a method described by Cutting and Dayan (2003). RESULTS Our 48 enrolled subjects were evenly divided into the two surgery groups (n=24 for both group A and group B). Twenty-seven subjects were male (56.3%) and 21 were female (43.8%), making a sex ratio of 1.3:1. The Millard group showed a greater increase in postoperative horizontal length and vertical lip height and a greater reduction in nasal width and total nasal width. Meanwhile, the Tennison-Randall group showed better reduction of Cupid's-bow width and better philtral height. CONCLUSION We did not find any significant differences in the surgical outcomes from the two techniques. The expertise of the surgeon and individual patient preferences are the main factors to consider when selecting the technique for unilateral cleft repair.
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Affiliation(s)
| | - Olutayo James
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Wasiu L. Adeyemo
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle O. Ogunlewe
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
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Mbuyi-Musanzayi S, Tshilombo Katombe F, Lukusa Tshilobo P, Kalenga Mwenze Kayamba P, Devriendt K, Reychler H. Anthropometric and aesthetic outcomes for the nasolabial region in 101 consecutive African children with unilateral cleft lip one year after repair using the anatomical subunit approximation technique. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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A Comparative Study of the Aesthetic Outcome of Two Techniques for Unilateral Complete Cleft Lip Repair. Plast Reconstr Surg 2017; 140:757-764. [DOI: 10.1097/prs.0000000000003685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Rodman RE, Tatum S. Controversies in the Management of Patients with Cleft Lip and Palate. Facial Plast Surg Clin North Am 2016; 24:255-64. [DOI: 10.1016/j.fsc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Miachon MD, Leme PLS. Surgical treatment of cleft lip. Rev Col Bras Cir 2016; 41:208-14. [PMID: 25140654 DOI: 10.1590/s0100-69912014000300013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/04/2013] [Indexed: 11/21/2022] Open
Abstract
We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1) the severity of the cleft will indicate the technique presenting more advantages; 2) the different approaches indicate that there is no consensus on the optimal technique; and 3) the surgeon experience contributes to choosing the best option.
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Comparison of Outcome of Modified Millard's Incision and Delaire's Functional Method in Primary Repair of Unilateral Cleft Lip: A Prospective Study. J Maxillofac Oral Surg 2015; 15:221-8. [PMID: 27298546 DOI: 10.1007/s12663-015-0816-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 06/27/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another. No one technique of cleft lip repair consistently produces ideal aesthetic and functional results. OBJECTIVES This study was conducted to compare the outcomes attained using two different designs of skin incision used for surgical correction of unilateral cleft lip. MATERIALS AND METHODS Modified Millard's incision and Delaire's functional method techniques were performed and evaluated on 18 patients who received primary unilateral cleft lip repair. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid's bow, lip length, and nostril symmetry and appearance of the alar dome and base. Chi-square and Fisher exact test, Student t test (two tailed, independent) and Student t test (two tailed, dependent) were used for statistical analysis of study parameters at 5 % level of significance. RESULTS Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. The outcome of our surgical methods was good and suggested quantitative changes with progressive diminution of asymmetry of the cleft and non cleft sides. CONCLUSION Lip length improvement was better in case of modified Millard's incision. The Delaire's functional method of cleft lip repair results in improved nasal symmetry due to correction of the abnormal insertions of the underlying musculature.
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Li L, Liao L, Zhong Y, Li Y, Xiang L, Li W. A modified Mohler technique for patients with unilateral cleft lip based on geometric principles--A primary report. J Craniomaxillofac Surg 2015; 43:663-70. [PMID: 25957102 DOI: 10.1016/j.jcms.2015.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/05/2015] [Accepted: 03/23/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Mohler technique is one of the most popular methods to repair unilateral cleft lip (UCL) among the modified Millard methods, but it is still imperfect. We successfully designed a modified Mohler method based on geometric principles and observed its clinical effect. MATERIALS AND METHODS Photogrammetry was performed in 56 patients who underwent UCL repair with the new technique. The symmetry ratios were assessed for sn-cphi, cphi-sbal, ch-sbal, ch-cphi, and vh preoperatively and 1 week after surgery, and were also compared with values in healthy control individuals. RESULTS Preoperatively, all distances on the cleft side were shorter to different degrees. One week after surgery, results showed well-healed wounds with full, symmetric, and continuous vermilion. On the cleft side, the sn-cphi was 6.13% longer than the non-cleft, and the others were shorter (cphi-sbal: 5.904%; ch-sbal: 1.760%; ch-cphi: 6.234%). The symmetry ratios had differences of significance between preoperative values and those 1 week after surgery (p = 0.000, respectively). Moreover, the vermilion height on the cleft side was 1.026% thicker. When compared with the matched control group, with the exception of SRcphi-sbal (p = 0.072) and SRch-sbal (p = 0.139), there were significant differences (p = 0.000, respectively). All distances in the matched control group were not absolutely symmetric. CONCLUSIONS The modified Mohler technique seems widely applicable, marking accurate, and less flexible.
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Affiliation(s)
- Liqi Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China
| | - Lishu Liao
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China
| | - Yuxiang Zhong
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China
| | - Yuangui Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China
| | - Li Xiang
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China
| | - Wanshan Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, 400014, PR China.
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Roussel LO, Myers RP, Girotto JA. The Millard Rotation-Advancement Cleft Lip Repair: 50 Years of Modification. Cleft Palate Craniofac J 2015; 52:e188-95. [PMID: 25642967 DOI: 10.1597/14-276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Since its inception in 1955, Millard's rotation-advancement repair has been one of the most popular techniques used in the care of patients with a cleft lip. Over the past half century, Millard's repair has evolved and laid the foundation for many other repair techniques that have followed in its footsteps. This publication compares Millard's rotation-advancement technique to the various repairs used today. The purpose of this article is to lend perspective as to the impact of Millard repair over the past 50 years in the treatment of cleft lip.
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Feijo MJF, Brandão SR, Pereira RMR, Santos MBDS, Silva HJD. O que ocorre com o ângulo columelar após cirurgia de correção da fissura labial? REVISTA CEFAC 2014. [DOI: 10.1590/1982-021620143513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo avaliar a mudança do ângulo columelar que ocorre após cirurgia de correção para fissura labial. Métodos o estudo foi observacional de caráter descritivo e de corte transversal. Foram avaliadas crianças no primeiro e segundo ano de vida, portadoras de fissura labial unilateral de ambos os sexos, que foram submetidas a cirurgia para correção da fissura. A pesquisa teve um total de 11 crianças participantes. Foi examinada a região nasal e lábio superior da criança e identificados os pontos antropométricos pronasal, subnasal e glabela. Em seguida, foi realizada fotografia para análise fotogramétrica. Foram realizadas fotos no preoperatório e cerca de 4 meses após a cirurgia. As imagens obtidas por fotogrametria foram avaliadas com o programa gráfico Image J,por meio de ferramentas de estudo angular. Resultados a média da medida dos ângulos no pré-operatório foi de 55,41 graus; a média no pós foi de 78,80 graus, percebendo-se uma aproximação ao plano vertical (p<0,0001). Pacientes com fissura lábio-palatina apresentaram variação de 32 graus quando comparadas as medidas pré e pós-operatórias, enquanto que nos pacientes com fissura pré-foramen incompleta e pré-foramen completa foram menores (0,75 e 25 graus respectivamente). Conclusão ocorre verticalização do ângulo columelar após cirurgia de correção da fissura labial. Os pacientes que apresentam maior modificação do ângulo são, justamente, aquelas que apresentam diagnóstico relacionado a deformidades mais complexas.
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Iliopoulos C, Mitsimponas K, Lazaridou D, Neukam FW, Stelzle F. A retrospective evaluation of the aesthetics of the nasolabial complex after unilateral cleft lip repair using the Tennison-Randall technique: a study of 44 cases treated in a single cleft center. J Craniomaxillofac Surg 2014; 42:1679-83. [PMID: 24962045 DOI: 10.1016/j.jcms.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/14/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Among numerous techniques that have been described for lip repair, the Tennison-Randall method has gained popularity over time and is preferred by many surgeons due to the predictability of the outcome. This study aims to evaluate the esthetic outcome reached in the nasolabial region following primary lip repair with the use of this method. MATERIALS AND METHODS Forty-four patients with unilateral cleft lip (with or without alveolar cleft) were assessed retrospectively through a photographic evaluation by two clinicians with regard to the aesthetics of the lip and nose separately as anatomical subunits as well as of the nasolabial region as an anatomical complex. The collected data were statistically analyzed with regard to the cleft subtype and the performance of corrective surgeries for the lip and/or the nose. RESULTS The method was associated with good results, especially when it comes to the appearance of the nose as an anatomical subunit, as well as of the nasolabial region as a complex, regarding cleft lip patients without an alveolar cleft. CONCLUSION The Tennison-Randall technique proved to be a very satisfying method in terms of the esthetic long-term outcome in our patient collective.
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Affiliation(s)
- Christos Iliopoulos
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany.
| | - Konstantinos Mitsimponas
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Dimitra Lazaridou
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Friedrich Wilhelm Neukam
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery (Director: Prof. Dr. Dr. Dr. h.c. Friedrich Wilhelm Neukam), University Hospital of Erlangen, Friedrich Alexander University of Erlangen-Nürnberg, Oestliche Stadtmauerstrasse 27, 91054, Erlangen, Germany
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Late Cutaneous Lip Height in Unilateral Incomplete Cleft Lip Patients Does Not Differ From the Normative Data. J Craniofac Surg 2014; 25:308-13. [PMID: 24406595 DOI: 10.1097/scs.0000000000000521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Chou PY, Luo CC, Chen PKT, Chen YR, Samuel Noordhoff M, Lo LJ. Preoperative lip measurement in patients with complete unilateral cleft lip/palate and its comparison with norms. J Plast Reconstr Aesthet Surg 2012; 66:513-7. [PMID: 23276499 DOI: 10.1016/j.bjps.2012.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/22/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE There is prominent lip asymmetry in patients with unilateral complete cleft lip and palate. Measurement of the lip on cleft and non-cleft sides provides appraisal of the lip deformity and information for planning of surgical correction. The purpose of this retrospective study is to evaluate the degree of lip deformity and to compare it with normative data. MATERIALS AND METHODS From 1983 to 1997, data from a total of 168 patients with unilateral complete cleft lip and palate were collected. There were no other associated craniofacial anomalies in this patient group. The measurement was performed under general anaesthesia by a senior surgeon using a calliper prior to the first lip repair. Corresponding normative data were collected from 2002 to 2003 on 50 patients who had normal facial appearance prior to hernia repair. The measurements included lip height, lip width, philtrum length and vermilion thickness. Comparisons were made between the cleft side and the non-cleft side, as well as between cleft patients and norms. RESULTS Comparisons between the cleft and the non-cleft sides revealed significantly longer lip on the non-cleft side, including lip height from alar base to Cupid's bow, lip width from Cupid's bow to commissure and the vermilion thickness. The lip measurements on the norms were longer than those on the cleft side of the lip, but were similar to the non-cleft side. CONCLUSION A wide variety of tissue growth asymmetry is observed between the non-cleft and the cleft sides, indicating a deficiency of tissue development associated with the cleft deformity. These data can provide a fundamental basis for presurgical orthopaedic treatment, surgical planning, execution of surgery, postoperative assessment and may help to predict treatment outcome.
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Affiliation(s)
- Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kim S. The present and future of craniofacial surgery in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.6.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sukwha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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