1
|
Fell M, Breakey W, Benitez BK, Mueller AA, Chong DK. The Preservation Technique for Incomplete Unilateral Cleft Lip Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6172. [PMID: 39296618 PMCID: PMC11410330 DOI: 10.1097/gox.0000000000006172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/24/2024] [Indexed: 09/21/2024]
Abstract
The incomplete unilateral cleft lip shares many of the same phenotypic characteristics as a complete unilateral cleft lip, but key differences include an intact nasal sill, a relative excess of skin in the lateral lip element, and favorable skeletal support. Surgical techniques for incomplete unilateral cleft lips should be tailored to the specific anatomical characteristics, be simple and reliable to perform, and minimize the risk of secondary deformity. Here we describe the "preservation technique" for incomplete unilateral cleft lip reconstruction. The modified design from the anatomical subunit approximation technique uses a nasal sill flap and obviates the need for nasal sill and lateral lip excision. Tissues of the lip are opened out and reorientated to maximize the anatomical advantage.
Collapse
Affiliation(s)
- Matthew Fell
- From the Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia
| | - William Breakey
- From the Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Benito K Benitez
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas A Mueller
- Oral and Cranio-Maxillofacial Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David K Chong
- From the Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
2
|
Balumuka D, Daly GE, Krakauer K, Burch S, Jedrzejewski B, Johnson A, Howell LK, Wolfswinkel EM. Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting. Cleft Palate Craniofac J 2024:10556656241256917. [PMID: 38778553 DOI: 10.1177/10556656241256917] [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: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP). DESIGN/SETTING Retrospective university hospital single center study. PATIENTS Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded. INTERVENTIONS Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis. MAIN OUTCOME MEASURE The need for ABG. RESULTS Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG. CONCLUSION GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.
Collapse
Affiliation(s)
- Darius Balumuka
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Gwendolyn E Daly
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kelsi Krakauer
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Samantha Burch
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Breanna Jedrzejewski
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia Johnson
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Lori K Howell
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Parham MJ, Simpson AE, Moreno TA, Maricevich RS. Updates in Cleft Care. Semin Plast Surg 2023; 37:240-252. [PMID: 38098682 PMCID: PMC10718659 DOI: 10.1055/s-0043-1776733] [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: 12/17/2023]
Abstract
Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.
Collapse
Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Arren E. Simpson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S. Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
5
|
Maan ZN, Berkowitz RL. Invited Discussion on: Ideal Reference Lines for Assessment of Facial Asymmetry in Rhinoplasty Patients. Aesthetic Plast Surg 2022; 46:329-331. [PMID: 34676430 DOI: 10.1007/s00266-021-02602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - R Laurence Berkowitz
- Rhinoplasty Society, Aesthetx, 3803 S. Bascom Ave., Ste. 100, Campbell, CA, 95008, USA.
| |
Collapse
|
6
|
How to Get Consistently Good Results in Cleft Lip Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3677. [PMID: 34262838 PMCID: PMC8274742 DOI: 10.1097/gox.0000000000003677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/11/2021] [Indexed: 11/26/2022]
Abstract
This article serves as a practical guide for plastic surgeons focusing on repair of primary cleft lip and nasal deformity. We discuss the key anatomic disruption present in cleft lip and nasal deformity and the goals of primary repair. In addition, our preferred surgical technique for unilateral and bilateral cleft lip and nasal deformity is summarized along with technical pearls and pitfalls.
Collapse
|
7
|
Yim GH, Taylor CJ. More is less?! Reducing dog ear deformities for transposition flaps on the scalp. Ann R Coll Surg Engl 2020; 102:543-544. [PMID: 32159377 DOI: 10.1308/rcsann.2020.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G H Yim
- Derriford Hospital, Plymouth, UK
| | | |
Collapse
|
8
|
Unilateral Cleft Lip Nasal Deformity: Foundation-Based Approach to Primary Rhinoplasty. Plast Reconstr Surg 2020; 144:1138-1149. [PMID: 31688761 DOI: 10.1097/prs.0000000000006182] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cleft lip results in disruption of the nasal foundation and collapse of tip structures. Most approaches to primary rhinoplasty focus on correction of lower lateral cartilages; however, recurrent deformity is common, and secondary revision is frequently required. The authors describe an alternate approach that focuses on the foundation to "upright the nose," without any nasal tip dissection. This study assessed changes with surgery and with growth. Secondary goals were to compare methods of sidewall reconstruction and septoplasty and to identify predictors of relapse. METHODS Consecutive patients undergoing repair (n = 102) were assessed. Images were captured preoperatively, postoperatively, and at 5 years of age (when available) using three-dimensional stereophotogrammetry. Standard anthropometric and contemporary shape-based analysis (volume ratio, dorsal deviation, and alar-cheek definition) was performed to assess longitudinal changes. Images of age-matched normal control subjects were used for comparison. RESULTS Significant changes in anthropometric and morphometric measurements occurred following surgery. Postoperative form was similar to controls immediately after surgery and at 5 years. Nasal corrections were satisfactory, and only two patients have elected to undergo revision. When subjects were grouped according to cleft type, we found the same trends. When comparing different methods of nasal sidewall reconstruction or septoplasty, we found no differences. Alveolar cleft width was a significant predictor of worse preoperative and postoperative form. CONCLUSIONS Significant nasal correction can be achieved by means of reconstruction of nasal foundation, without nasal tip dissection. Preservation of tissue planes may allow for easier secondary revision, if necessary. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
9
|
Hoghoughi MA, Habibagahi R. Novel Technique to Repair Unilateral Cleft Lip: Separated Multiple Y-to-V-Plasty under Magnification. World J Plast Surg 2019; 8:213-218. [PMID: 31309059 PMCID: PMC6620809 DOI: 10.29252/wjps.8.2.213] [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: 11/12/2022] Open
Abstract
BACKGROUND Various techniques have been used for cleft repair such as the straight-line closure, the rotation advancement technique and the anatomic subunit approach which are famous new approaches gained popularity. However, these methods have several advantages and disadvantages and sometimes are difficult to adopt. In this study, we described our novel technique, known as separated multiple Y-to-V-plasty, in treatment of several cases of unilateral cleft lip. METHODS Plastic surgeons usually try to avoid straight closure of the wound, especially in areas where they need to stretch, move and enhance the length of the wound in some stages of the procedure. Since the lip is a dynamic and active structure and is constantly moving, the use of straight-line incision and closure in that area is in conflict with this basic concept. RESULTS In our newly introduced technique, we avoided a straight-line closure along the skin and mucosa for the repair of the unilateral cleft lip. This issue is of utmost importance in cases with severe loss of lip height and discrepancy. CONCLUSION To acquire a natural and balanced shape in unilateral cleft lip repair, we recommended the novel Y-to-V-plasty technique as an effective method for severe unilateral cleft lip with enormous discrepancy.
Collapse
Affiliation(s)
- Mohammad Ali Hoghoughi
- Department of Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Raha Habibagahi
- Department of Biomaterials, Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Burianova I, Kulihova K, Vitkova V, Janota J. Breastfeeding After Early Repair of Cleft Lip in Newborns With Cleft Lip or Cleft Lip and Palate in a Baby-Friendly Designated Hospital. J Hum Lact 2017; 33:504-508. [PMID: 28604150 DOI: 10.1177/0890334417706062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Goals of treatment of orofacial cleft are to improve feeding, speech, hearing, and facial appearance. Early surgery brings faster healing, better cosmetic effect, and fewer complications. Breastfeeding rates after early surgery are unknown. Early repair of the cleft lip may influence breastfeeding rates. Research aim: The aim of this study was to evaluate breastfeeding after early repair of the cleft lip in a Baby-Friendly designated hospital. The rate of breastfeeding in newborns with cleft lip was compared to cleft lip and palate. METHODS This was a retrospective cohort study. The study group included infants with cleft lip and cleft lip and palate operated on in the first 2 weeks of life. Newborns and their mothers were supported by a team promoting breastfeeding. RESULTS One hundred four infants (70 boys and 34 girls) were included. Isolated cleft lip was present in 56 (53.8%) infants, and cleft lip and palate in 48 (46.2%). Forty-four (78.6%) of the infants with a cleft lip were breastfed, 3 (5.4%) received human milk via bottle or syringe, and 9 (16.0%) were formula fed. Three (6.2%) of the infants with a cleft lip and palate were breastfed, 31 (64.6%) received human milk via bottle or Haberman feeder, and 14 (29.2%) were formula fed. CONCLUSION The rate of breastfeeding in patients following early surgery of the cleft lip was high and comparable to the general population. The rate of breastfeeding in babies with cleft lip and palate after early repair of the cleft lip remained low.
Collapse
Affiliation(s)
| | | | - Veronika Vitkova
- 1 Thomayer Hospital Prague, Prague, Czech Republic.,2 Institute of Pathological Physiology, First Faculty of Medicine, Charles University
| | - Jan Janota
- 1 Thomayer Hospital Prague, Prague, Czech Republic.,2 Institute of Pathological Physiology, First Faculty of Medicine, Charles University.,3 Department of Pediatrics and Adolescent Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| |
Collapse
|
11
|
Liang S, Shapiro L, Tse R. Measuring Symmetry in Children With Cleft Lip. Part 3: Quantifying Nasal Symmetry and Nasal Normalcy Before and After Unilateral Cleft Lip Repair. Cleft Palate Craniofac J 2016; 54:602-611. [PMID: 27580380 DOI: 10.1597/16-035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this project was to develop objective computer-based methods to measure nasal asymmetry and abnormality in children undergoing treatment of unilateral cleft lip (UCL) and to determine the correlation of these measures to clinical expectations. PARTICIPANTS Thirty infants with UCL undergoing cleft lip repair; 27 children with UCL aged 8 to 10 years who had previously undergone cleft lip repair; 3 control infants; 3 control children aged 8 to 10 years. INTERVENTIONS To measure nasal symmetry, we used a process of depth mapping and calculated the Depth Area Difference. To measure abnormality, we used the reconstruction error from Principle Component Analysis (PCA) that was based upon characteristics of a dataset of over 2000 images of normal control subjects. MAIN OUTCOME MEASURES Depth Area Difference and PCA Reconstruction Error for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed. RESULTS Significant differences in Depth Area Difference and PCA Reconstruction Error were found between cleft types and found before and after surgery. Nasal symmetry and normalcy scores for infants with UCL approached those of controls after surgery, and there was a strong correlation with ranked cleft severity. For older children, measures of nasal symmetry and abnormality were better than infants prior to repair but worse than infants following UCL repair. CONCLUSIONS Our computer-based 3D analysis of nasal symmetry and normalcy correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.
Collapse
|
12
|
Wu J, Liang S, Shapiro L, Tse R. Measuring Symmetry in Children With Cleft Lip. Part 2: Quantification of Nasolabial Symmetry Before and After Cleft Lip Repair. Cleft Palate Craniofac J 2015; 53:705-713. [PMID: 26720522 DOI: 10.1597/15-220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The first part of this study validated an automated computer-based method of identifying the three-dimensional midfacial plane in children with unrepaired cleft lip. The purpose of this second part is to develop computer-based methods to quantify symmetry and to determine the correlation of these measures to clinical expectations. PARTICIPANTS A total of 35 infants with unrepaired unilateral cleft lip and 14 infant controls. INTERVENTIONS Six computer-based methods of quantifying symmetry were developed and applied to the three-dimensional images of infants with unilateral cleft lip before and after cleft lip repair and to those of controls. MAIN OUTCOME MEASURE Symmetry scores for cleft type, changes with surgery, and individual subjects ranked according to cleft severity were assessed. RESULTS Significant differences in symmetry scores were found between cleft types and found before and after surgery. Symmetry scores for infants with unilateral cleft lip approached those of controls after surgery, and there was a strong correlation with ranked cleft severity. CONCLUSIONS Our computer-based three-dimensional analysis of nasolabial symmetry correlated with clinical expectations. Automated processing made measurement convenient. Use of these measures may help to objectively measure cleft severity and treatment outcome.
Collapse
|