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Rivers CM, Skimming C, Chong D, Drake D, Russell CJH, Devlin MF. Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity. Cleft Palate Craniofac J 2024; 61:1233-1237. [PMID: 36872622 DOI: 10.1177/10556656231161981] [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: 03/07/2023] Open
Abstract
METHODS Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. RESULTS 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/- palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. CONCLUSIONS HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.
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Affiliation(s)
- C M Rivers
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, Scotland
| | - C Skimming
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, Scotland
| | - D Chong
- Division of Plastic Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - D Drake
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, Scotland
| | - C J H Russell
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, Scotland
| | - M F Devlin
- National Cleft Surgical Service for Scotland, Royal Hospital for Children, Glasgow, Scotland
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2
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Galarza LI, Sudduth JD, Rose AM, Moss CA, Humphries LS, Hoppe IC. The Fisher Subunit Anatomical Approach for Cleft Lip Revisions: An Evolution and Case Series. Ann Plast Surg 2024; 92:S379-S381. [PMID: 38856999 DOI: 10.1097/sap.0000000000003955] [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: 06/11/2024]
Abstract
ABSTRACT Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.
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Affiliation(s)
| | - Jack D Sudduth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
| | - Alexandra M Rose
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
| | - Clayton A Moss
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Mississippi Medical Center
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3
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Chen Y, Wang X, Wu J, Zeng W, Yang K, Sun Y, Xiong X, Meng X, Li W, Yi Z, Fang B. A New Algorithm for Secondary Repair of Unilateral Cleft Lip Nasal Deformity. Laryngoscope 2024; 134:1648-1655. [PMID: 37991199 DOI: 10.1002/lary.31167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Following primary surgery for unilateral cleft lip palate (UCLP), cleft lip nasal deformities (CLNDs) (nasal asymmetry, collapsed nasal alae, and a widened alar base) are generally inevitable and often require secondary rhinoplasty. However, reconstructing a cleft nose with an alar tissue deficiency remains challenging for rhinoplasty surgeons. METHODS The manifestations of common deformities are described herein, and a secondary rhinoplasty technique for unilateral CLNDs using a nasolabial flap (NLF) has been proposed for patients with alar tissue deficiency. Secondary rhinoplasties were performed in 12 patients with unilateral CLNDs between 2020 and 2021 using a NLF. Photogrammetric measurements were performed preoperatively and postoperatively. A total of 12 flaps were successfully transferred. Ten patients were followed up for >1 year. RESULTS Significant postoperative decreases in nasal alar width were measured in both the base view (p < 0.050) and the frontal view (p < 0.050). Despite the additional facial scars that occurred in some cases, all patients were satisfied with the aesthetic effects. CONCLUSIONS The NLF achieved satisfactory results in secondary rhinoplasty of unilateral CLND for patients with nasal tissue deficiencies in whom the surgeon weighed the potential benefits over postoperative scarring. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1648-1655, 2024.
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Affiliation(s)
- Yunzhu Chen
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Jingjing Wu
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Weiliang Zeng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Kai Yang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Yang Sun
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Xiang Xiong
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Xianxi Meng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Wenbo Li
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Zhongjie Yi
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Bairong Fang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, PR China
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Hamdan US, Najjar W, Younan RA, Ridgell L, Hussein S, Azizzadeh K, Melhem AM, Haddad M. A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities. J Craniofac Surg 2024:00001665-990000000-01279. [PMID: 38231191 DOI: 10.1097/scs.0000000000009967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024] Open
Abstract
Secondary cleft lip (CL) deformities are commonly encountered in cleft management. Various attempts have been made to create a classification system that can comprehensively encapsulate residual CL deformities after primary repair. The aim of this study is to reinforce valid classification systems and to introduce a new classification subtype (Type V Revision). A longitudinal retrospective analysis was done in 35 outreach programs in 4 countries (Ecuador, Lebanon, Peru, and El Salvador) between 2015 and 2023. Two hundred sixty-nine patients, between the ages of 9 months and 45 years, with residual CL deformities after primary lip repair, were classified into one of the 5 classification types. Patients with syndromes were excluded from the study. Patients received one of 5 revision types depending on their initial preoperative evaluation and intraoperative analysis of anatomic involvement. The mean age at surgery was 12.86 years. Twenty-five patients received type I revision, 29 patients received type II revision, 81 patients received type III revision, 106 patients received type IV revision, and 28 patients received type V revision. As the surgical complexity advanced from type I to V, there was a gradual increase in the average surgical time. The Congruence between preoperative and postoperative revision types was substantial. Residual CL defects cause a significant burden on both the patient and cleft care provider. This classification system, with the newly introduced type V revision, enhances and eases the categorization and management of secondary CL deformities.
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Affiliation(s)
| | - Wassim Najjar
- Global Smile Foundation, Norwood, MA
- Department of Plastic Surgery, University of California Irvine School of Medicine, Orange, CA
| | - Robert A Younan
- Global Smile Foundation, Norwood, MA
- Department of Plastic Surgery, University of California Irvine School of Medicine, Orange, CA
| | | | - Sara Hussein
- Global Smile Foundation, Norwood, MA
- Department of Plastic Surgery, University of California Irvine School of Medicine, Orange, CA
| | - Kylie Azizzadeh
- Global Smile Foundation, Norwood, MA
- Department of Biology, Duke University, Durham, NC
| | - Antonio M Melhem
- Global Smile Foundation, Norwood, MA
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Mario Haddad
- Global Smile Foundation, Norwood, MA
- Department of Plastic Surgery, University of California Irvine School of Medicine, Orange, CA
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Long Y, Yao M, Fu Y, Gao J, Zang J, Song W, Li C, Shi B, Low DW, Li C. Aesthetic evaluation of nasolabial reconstruction using abbe flap in bilateral cleft lip patients with secondary deformities. J Plast Reconstr Aesthet Surg 2023; 84:496-504. [PMID: 37418848 DOI: 10.1016/j.bjps.2023.06.043] [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: 03/15/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The Abbe flap is a common technique frequently utilized in secondary surgery for bilateral cleft lip deformities, but objective indications for the Abbe flap remain unclear, and postoperative aesthetic evaluations are limited. METHODS The study group consisted of 92 bilateral cleft lip patients with secondary deformities aged 7-39 years, and the control group consisted of 33 people aged 19-35 years. Thirteen objective nasolabial aesthetic parameters were selected to evaluate patients' nasolabial aesthetics. RESULTS Minor secondary deformities were characterized by a smaller lip height index than severe deformities, as well as a smaller columellar angle compared with moderate and severe deformities (P < 0.05). For all patients, significant differences were found between preoperative and postoperative values of intercanthal distance/medial upper vermilion height ratio, intercanthal distance/medial upper lip height ratio, lip height index, lip vermilion height index, lip protrusion angle, columellar-labial angle, and nasal tip angle (P < 0.05). For patients with minor deformity, intercanthal distance/philtrum width ratio and intercanthal distance/medial cutaneous upper lip height ratio showed no significant change postoperatively (P > 0.05), and labial protrusion angle was smaller than the control group (P < 0.05). CONCLUSIONS Patients undergoing secondary surgery using an Abbe flap achieved good nasolabial aesthetics. Intercanthal distance/medial upper vermilion height ratio, intercanthal distance/medial upper lip height ratio, lip height index, columellar-labial angle, nasolabial angle, nasal tip angle, and columellar angle are the objective aesthetic indicators for Abbe flap selection. Intercanthal distance/philtrum width ratio, intercanthal distance/medial cutaneous upper lip height ratio, and labial protrusion angle are reference parameters for choosing an Abbe flap for secondary bilateral cleft lip revision.
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Affiliation(s)
- Yifei Long
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Meilin Yao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Yihang Fu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Junjie Gao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Jiaxing Zang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Wenyan Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Chen Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China
| | - David W Low
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chenghao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, People's Republic of China.
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6
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2022. [DOI: 10.1055/s-0042-1742747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractThe unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of 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
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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7
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Depani M, Ferry AM, Grush AE, Moreno TA, Jones LM, Thornton JF. Use of Biologic Agents for Lip and Cheek Reconstruction. Semin Plast Surg 2021; 36:26-32. [PMID: 35706563 PMCID: PMC9192158 DOI: 10.1055/s-0041-1741399] [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: 01/02/2023]
Abstract
The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.
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Affiliation(s)
- Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew M. Ferry
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Andrew E. Grush
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of 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
| | - Lloyd M. Jones
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390-9132
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