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Hsieh TY, Gengler I, Tollefson TT. Rhinoplasty for Patients with Cleft Lip-Palate: Functional and Aesthetic Concerns. Otolaryngol Clin North Am 2024:S0030-6665(24)00114-2. [PMID: 39244461 DOI: 10.1016/j.otc.2024.07.017] [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: 09/09/2024]
Abstract
Cleft lip and palate, the most common congenital orofacial anomalies, result in complex nasal deformities due to deficient bony maxilla, dentoalveolar arch, teeth, and soft tissues. This article explores nasal deformities in patients with cleft lip and palate, surgical techniques and considerations in cleft rhinoplasty, particularly focusing on nasal valves in both unilateral and bilateral cases. Unilateral cleft lip deformities include asymmetry of the nasal tip, flattened nostril, and displaced caudal septum, while bilateral cleft lip deformities present a wider and flatter nose with complex nasal features.
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Affiliation(s)
- Tsung-Yen Hsieh
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Isabelle Gengler
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Travis T Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California Davis Medical Center, University of California Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
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Park JJ, Laspro M, Arias FD, Rodriguez Colon R, Chaya BF, Rochlin DH, Staffenberg DA, Flores RL. Characterizing Cleft Rhinoplasty Across Skeletal Maturity: A Systematic Review of Terminology and Surgical Techniques. Cleft Palate Craniofac J 2024; 61:1315-1323. [PMID: 37050895 DOI: 10.1177/10556656231169479] [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: 04/14/2023] Open
Abstract
OBJECTIVE The purpose of this study is to assess cleft rhinoplasty terminology across phases of growth. DESIGN/SETTING A systematic review was performed on cleft rhinoplasty publications over 20 years. INTERVENTIONS Studies were categorized by age at surgical intervention: infant (<1 year); immature (1 to 14 years); mature (>15 years). MAIN OUTCOME MEASURES Collected data included terminology used and surgical techniques. RESULTS The 288 studies included demonstrated a wide range of terminology. In the infant group, 51/54 studies used the term "primary." In the immature group, 7/18 studies used the term "primary," 3/18 used "secondary." In the mature group, 2/33 studies used the term "primary," 16/33 used "secondary," 2/33 used "definitive," 5/33 used terms such as "mature," "adult," and "late," and 8/33 did not use terminology. SURGICAL TECHNIQUE ASSESSMENT DEMONSTRATED cleft rhinoplasty at infancy used nostril rim or no nasal incision, immature rhinoplasty used closed and open rhinoplasty incisions; and mature rhinoplasty used a majority of open rhinoplasty. Infant and immature cleft rhinoplasty incorporated septal harvest or spur removal in <10% of cases, whereas these procedures were common in mature rhinoplasty. No studies in infants or immature patients used osteotomies or septal grafts, common techniques in mature rhinoplasty. CONCLUSIONS Current terminology for cleft rhinoplasty is varied and inconsistently applied across stages of facial development. However, cleft rhinoplasty performed at infancy, childhood, and facial maturity are surgically distinct procedures. The authors recommend the terminology "infant," "immature," and "mature" cleft rhinoplasty to accurately describe this procedure within the context of skeletal growth.
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Affiliation(s)
- Jenn J Park
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Matteo Laspro
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Fernando D Arias
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | | | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Danielle H Rochlin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, USA
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Saito T, Lo CC, Tu JCY, Hattori Y, Chou PY, Lo LJ. Secondary Bilateral Cleft Rhinoplasty: Achieving an Aesthetic Result. Aesthet Surg J 2024; 44:NP365-NP378. [PMID: 38314894 DOI: 10.1093/asj/sjae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Secondary rhinoplasty in patients with bilateral cleft lip poses ongoing challenges and requires a reliable method for achieving optimal outcomes. OBJECTIVES The purpose of this study was to establish a safe and effective method for secondary bilateral cleft rhinoplasty. METHODS A consecutive series of 92 skeletally matured patients with bilateral cleft lip and nasal deformity were included. All had undergone secondary open rhinoplasty, performed by a single surgeon with a bilateral reverse-U flap and septal extension graft, between 2013 and 2021. Medical records of these 92 patients were reviewed to assess the clinical course. A 3-dimensional (3D) anthropometric analysis and panel assessment of 32 patients were performed to evaluate the aesthetic improvement, with an age-, sex-, and ethnicity-matched normal control group for comparisons. RESULTS The methods showed statistically significant improvement in addressing a short columella (columellar height), short nasal bridge (nasal bridge length), de-projected nasal tip (nasal tip projection, nasal dorsum angle), poorly defined nasal tip (nasal tip angle, dome height, and panel assessment), and transversely oriented nostrils (columellar height, alar width, nostril type). Importantly, these improvements were accompanied by a low complication rate of 4%. However, upper lip deficiency over the upper lip angle and labial-columellar angle remained without significant improvement. CONCLUSIONS In this study we described effective secondary rhinoplasty, which was composed of a bilateral reverse-U flap and septal extension graft, with acceptable outcome. The 3D anthropometric analysis and panel assessment clarified that our rhinoplasty procedure could bring the nasal morphology in these patients closer to the normal data. LEVEL OF EVIDENCE: 3
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Park H, Kim H, Hwang YJ, Park SH. Poly Lactic-co-Glycolic Acid Absorbable Plate Graft for Secondary Rhinoplasty in Asian Patients with Unilateral Cleft Lip Nose Deformity. Cleft Palate Craniofac J 2024; 61:592-598. [PMID: 36604781 DOI: 10.1177/10556656221148899] [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: 01/07/2023] Open
Abstract
INTRODUCTION In secondary cleft lip and nasal deformity (CLND) correction, structural grafts are commonly used to control the nasal tip and restore the symmetry of the ala. However, the septal cartilage in Asians often weak and small. Biocompatible absorbable materials are alternatives to autologous grafts. This study assessed the surgical outcomes and complications of poly lactic-co-glycolic acid (PLGA) plate grafts in secondary CLND correction. METHODS This study was retrospectively analyzed for patients who underwent secondary rhinoplasty for unilateral CLND correction between March 2015 and November 2020. Using open rhinoplasty, the PLGA plate was grafted as a columellar strut. Clinical photographs taken at the initial (T0) and follow-up visits (T1: short-term, T2: long-term) were analyzed and anthropometric parameters, such as nostril height and width, dome height, and tip height, were measured. RESULTS Twenty-four patients were included in this study. The mean T1 and T2 periods were 1.0 ± 0.4 and 15.5 ± 3.1 months, respectively. The nostril height ratio increased from 0.78 ± 0.12 at T0 to 0.88 ± 0.08 at T1 and 0.86 ± 0.09 at T2 (p < 0.001; Relapse ratio -2.6 ± 6.7%). The tip height ratio increased from 0.60 ± 0.07 (T0) to 0.66 ± 0.05 (T2) (Relapse ratio -3.7 ± 3.0%). CONCLUSIONS The PLGA plate graft provided stable nasal tip projection and alar symmetry without major complications. It can be a good option for patients lacking available septal and concha cartilages or apprehensive of additional scarring.
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Affiliation(s)
- Hojin Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Haneul Kim
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yong-Jae Hwang
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ha Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Korea
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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.
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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
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Tse RW, Sitzman TJ, Allori AC, Ettinger RE, Fisher DM, Bezuhly M, Samson TD, Beals SP, Matic DB, Mercan E. Measuring the Unilateral Cleft Lip Nasal Deformity: Lateral Deviation of Subnasale Is a Clinical and Morphologic Index of Unrepaired Severity. Cleft Palate Craniofac J 2023:10556656231202173. [PMID: 37787163 DOI: 10.1177/10556656231202173] [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: 10/04/2023] Open
Abstract
OBJECTIVE Objective measurement of pre-operative severity is important to optimize evidence-based practices given that the wide spectrum of presentation likely influences outcomes. The purpose of this study was to determine the correlation of objective measures of form with a subjective standard of cleft severity. DESIGN 3D images were ranked according to severity of nasal deformity by 7 cleft surgeons so that the mean rank could be used as the severity standard. PATIENTS 45 patients with unilateral cleft lip and 5 normal control subjects. INTERVENTIONS Each image was assessed using traditional anthropometric analysis, 3D landmark displacements, and shape-based analysis to produce 81 indices for each subject. MAIN OUTCOME The correlation of objective measurements with the clinical severity standard. RESULTS Lateral deviation of subnasale from midline was the best predictor of severity (0.86). Other strongly-correlated anthropometric measurements included columellar angle, nostril width ratio, and lateral lip height ratio (0.72, 0.80, 0.79). Almost all shape-based measurements had tight correlation with the severity standard, however, dorsum deviation and point difference nasolabial symmetry were the most predictive (0.84, 0.82). CONCLUSIONS Quantitative measures of severity transcend cleft type and can be used to grade clinical severity. Lateral deviation of subnasale was the best measure of severity and may be used as a surrogate of uncoupled premaxillary growth; it should be recorded as an index of pre-operative severity with every cleft lip repair. The correlation of other measures evaluated clarify treatment priorities and could potentially be used to grade outcomes.
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Affiliation(s)
- Raymond W Tse
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Russell E Ettinger
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David M Fisher
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, IWK Health Center, Halifax, NS, Canada
| | - Thomas D Samson
- Division of Plastic Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Stephen P Beals
- Phoenix Children's Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Damir B Matic
- Division of Plastic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Ezgi Mercan
- Division of Craniofacial and Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
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Çerçi Özkan A, Bilgili AM, Kozanoğlu E. Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty. Aesthetic Plast Surg 2023; 47:1513-1524. [PMID: 36323963 DOI: 10.1007/s00266-022-03153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes. MATERIALS AND METHODS Balance between AP nostril diameters was accomplished by reduction of the AP diameter of the nostril at the non-cleft side by medial crural reduction and augmentation of the AP diameter of the nostril at the cleft side by three-parted mini-flap reconstruction at the soft triangle. The cleft-side AP diameter length was divided by the non-cleft-side AP diameter length of the same preoperative, per-operative and 1-year postoperative base view photographs of each patient, and "nostril balancing ratio" was obtained. The more this ratio was near to "one," the more the AP nostril diameters were equal. RESULTS Seventy-eight unilateral-cleft rhinoplasty were performed between January/2019 and May/2022. Forty-two of them required nostril AP diameter equalization. Twenty-nine patients were female, thirteen were male. Thirty-three of them were operated for a primary cleft rhinoplasty. Nine of them for secondary cleft rhinoplasty. Mean age was 28 years (22-39 years). Mean follow-up was 25 months (6-40 months). The preoperative, per-operative and postoperative mean "nostril balancing ratios" were 0.714 (0.621-0.813), 0.743 (0.721-0.752) and 0.971 (0.943-0.976), respectively. CONCLUSION Balancing AP diameter symmetry with MCO at the non-cleft side and three-parted mini skin flap reconstruction at the cleft side may provide the satisfactory results. Three mini-flaps at the soft triangle may remold the nostril apex in an oval shape, which may result in a better shape symmetry. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Aret Çerçi Özkan
- Plastic Reconstructive and Aesthetic Surgery, Zuhuratbaba, İncirli Avenue, Bayrak Apartment, İncirli-Bakırköy, Istanbul, Turkey.
| | - Ahmet Mert Bilgili
- Cyprus International University School of Health Sciences, Nicosia, Cyprus
| | - Erol Kozanoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Martin SV, Van Eeden S, Swan MC. Secondary surgery techniques to optimise functional and aesthetic outcomes in orofacial clefting. Br Dent J 2023; 234:899-905. [PMID: 37349438 DOI: 10.1038/s41415-023-6001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
Although the goal of primary surgery is to avoid the need for secondary surgery, in a proportion of patients this is not always possible. Secondary, or revisional, surgery is frequently undertaken in patients with orofacial clefts and may present a complex and challenging problem for the multidisciplinary team. There are a broad range of functional and aesthetic issues that secondary surgery might aim to address. These include palatal fistulae (that may be symptomatic for air, fluid or food), velopharyngeal insufficiency (typically manifesting with decreased intelligibility or nasal regurgitation), suboptimal cleft lip scars (that can significantly impact upon the psychosocial wellbeing of the patient), and nasal asymmetry (that is frequently accompanied by nasal airway concerns). Unilateral and bilateral clefts are each associated with a characteristic nasal deformity that requires a tailored surgical approach. Suboptimal maxillary growth in repaired orofacial clefts may impact negatively on both appearance and function; surgical correction through orthognathic surgery can be transformational for the patient. The general dental practitioner, cleft orthodontist and restorative dentist all play a critical role in this process.
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Affiliation(s)
- Serena V Martin
- Cleft Fellow, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom
| | - Simon Van Eeden
- Consultant Cleft and Maxillofacial Surgeon, Alder Hey Children´s Hospital and Aintree University Hospital, Liverpool, L14 5AB, United Kingdom
| | - Marc C Swan
- Consultant Cleft and Plastic Surgeon, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom.
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Totonchi A. Invited Discussion on: Application of Diced Autologous Rib Cartilage for Paranasal Augmentation in Cleft Nose. Aesthetic Plast Surg 2021; 45:1176-1177. [PMID: 33483781 DOI: 10.1007/s00266-020-02071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ali Totonchi
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, 44109, USA.
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Pagan AD, Sterling DA, Andrews BT. Cartilage Grafting Outcomes in Intermediate and Definitive Cleft Rhinoplasty. Cleft Palate Craniofac J 2020; 58:974-983. [PMID: 33356509 DOI: 10.1177/1055665620980228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare cartilage grafting outcomes in intermediate versus definitive cleft rhinoplasty. DESIGN A retrospective chart review was conducted. The χ2 and Fisher exact tests were used for statistical analyses. Results were considered statistically significant at P < .05. PARTICIPANTS All subjects who underwent revision cleft rhinoplasties between July 2011 and June 2019 were included. Subjects with syndromic conditions were excluded. RESULTS A total of 46 subjects with a cleft nose deformity underwent 65 rhinoplasty procedures. The ages averaged 17 years (range 5-50) with 34 (73.9%) males and 12 (26.1%) females. In the intermediate group, 6 (28.6%) subjects required cartilage grafting as part of 6 cleft rhinoplasties, whereas 15 (71.4%) subjects underwent a total of 26 cleft rhinoplasties that did not require grafting. In the definitive group, 18 (76%) subjects required cartilage grafting over 21 cleft rhinoplasties, whereas 7 (24%) subjects underwent a total of 9 cleft rhinoplasties where cartilage grafting was not required. The difference between the number of subjects requiring cartilage grafting in the intermediate versus the definitive group was statistically significant (P = .007). Ear concha and nose were the most frequently used cartilage donor sites, with no observed complications. CONCLUSIONS Cartilage grafting was significantly more common in the definitive rhinoplasty group. Intermediate cleft rhinoplasty during the 5- to 13-year age period was effective, with a low-risk profile. In our experience, ear concha and nose were the preferred cartilage donor sites, with effective results and an excellent safety profile.
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Affiliation(s)
- Angel D Pagan
- School of Medicine, 6650Ponce Health Sciences University, Ponce, PR, USA
| | - David A Sterling
- Department of Plastic & Reconstructive Surgery, 21638University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian T Andrews
- Department of Plastic & Reconstructive Surgery, 21638University of Kansas Medical Center, Kansas City, KS, USA
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Bonanthaya K, Jalil J. Management of the Nasal Deformity in the Unilateral Cleft of the Lip and Nose. J Maxillofac Oral Surg 2020; 19:332-341. [PMID: 32801524 DOI: 10.1007/s12663-020-01412-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Abstract
Cleft rhinoplasty is a demanding, technique-sensitive procedure. Part art, part science; it poses several probing questions to the surgeon. The unilateral cleft nasal deformity is a distinct entity because the pursuit of symmetry in the unilateral cleft nose makes the repair much more challenging. The advent of nasoalveolar moulding, the gaining popularity of primary (early) nasal repair and greater refinements in secondary (definitive) rhinoplasty techniques have contributed to better nasal results in unilateral cleft repair. Yet, some obstacles remain. This paper aims to discuss the anatomy of the unilateral cleft nose, enumerate aims and objectives of repair at every stage, and to demonstrate the evolution and varied rationale of management of nasal deformities in the unilateral cleft lip and nose.
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Affiliation(s)
| | - Jazna Jalil
- Maxillofacial Surgery, Bhagwan Mahaveer Jain Hospital, Bangalore, India
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12
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Hsieh TY, Dedhia R, Del Toro D, Tollefson TT. Cleft Septorhinoplasty: Form and Function. Facial Plast Surg Clin North Am 2018; 25:223-238. [PMID: 28340653 DOI: 10.1016/j.fsc.2016.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nasal deformity associated with typical cleft lip can cause aesthetic and functional issues that are difficult to address. The degree of secondary nasal deformity is based on the extent of the original cleft deformity, growth over time, and any prior surgical correction to the nose or lip. Repair and reconstruction of these deformities require comprehensive understanding of embryologic growth, the cleft anatomy, as well as meticulous surgical technique and using a spectrum of structural grafting. This article reviews cleft lip nasal deformity, presurgical care, primary cleft rhinoplasty, and definitive cleft septorhinoplasty with a focus on aesthetics and function.
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Affiliation(s)
- Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Raj Dedhia
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Drew Del Toro
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Travis T Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
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13
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Chen HC, Yen CI, Yang SY, Hsiao YC. How to Prevent Costal Cartilage Graft Warping in Secondary Correction of Cleft Lip Nasal Deformity. Plast Surg (Oakv) 2017; 26:55-60. [PMID: 29619361 DOI: 10.1177/2292550317740690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Autologous costal cartilage dorsal onlay graft is widely used for dorsum and radix augmentation in secondary cleft lip nasal rhinoplasty. The most common drawback of costal cartilage dorsal onlay graft is warping. The purpose of this article is to describe our chimeric autologous costal cartilage graft technique, which prevents warping significantly. "Chimeric" means the combination of 2 different tissues (bone and cartilage) to make a single dorsal onlay graft. Patients and Methods From June 2011 to June 2014, 16 cleft lip patients who underwent rhinoplasty and needed dorsal onlay grafts with costal cartilage graft using the chimeric autologous costal graft method were identified. All patients were operated by the corresponding author. Patients' nasal profiles were documented and photographed preoperatively and postoperatively. Result There were 5 males and 11 females with ages ranging from 20 to 52 years (averaging 29.5 years). There were 14 unilateral and 2 bilateral cleft lips. The average follow-up time was 12.1 months. Six patients received revision surgery, including 1 (6%) warping and 5 (30%) revisions. All patients were harvested rib cartilage graft as cartilage donor and there was no complication with the donor site. Conclusion From the clinical observation of all patients during the follow-up period, this technique is effective for preventing cartilage warping.
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Affiliation(s)
- Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shih-Yi Yang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
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Makhambetova EA, Rusetsky YY, Reshetov IV, Karapetyan LS, Makhambetova DE. [Aesthetic and functional rehabilitation of a patient presenting with the consequences of congenital cleft lip and palate performed taking into consideration the specific ethnic features of the external nose (a case report)]. Vestn Otorinolaringol 2017; 81:82-85. [PMID: 28091484 DOI: 10.17116/otorino201681682-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article demonstrates the method for reconstructive rhinoplasty used to treat a patient who underwent multiple cheiloplastic surgical interventions taking into consideration ethnic characteristics of the external nose. The operative technique involved the formation of lower lateral cartilage on the side of deformation and medial crura support, dorsum augmentation, and tip projection with the use autological cartilage and an implant. As a result, a significant improvement of the nose function was achieved in the combination with the good aesthetics outcome of the surgery.
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Affiliation(s)
| | - Yu Yu Rusetsky
- Research Centre of Children's Health, Moscow, Russia, 119991
| | - I V Reshetov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
| | - L S Karapetyan
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia, 119991
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Jubbal KT, Zavlin D, Olorunnipa S, Echo A, Buchanan EP, Hollier LH. Comparing Plastic Surgery and Otolaryngology Management in Cleft Care: An Analysis of 4,999 Cases. Craniomaxillofac Trauma Reconstr 2017; 10:271-277. [PMID: 29109837 DOI: 10.1055/s-0037-1601429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/20/2016] [Indexed: 10/19/2022] Open
Abstract
Care for patients with cleft lip and palate is best managed by a craniofacial team consisting of a variety of specialists, including surgeons, who are generally plastic surgeons or otolaryngologists trained in the United States. The goal of this study was to compare the surgical approaches and management algorithms of cleft lip, cleft palate, and nasal reconstruction between plastic surgeons and otolaryngologists. We performed a retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program Pediatric database between 2012 and 2014 to identify patients undergoing primary repair of cleft lip, cleft palate, and associated rhinoplasty. Two cohorts based on primary specialty, plastic surgeons and otolaryngologists, were compared in relation to patient characteristics, 30-day postoperative outcomes, procedure type, and intraoperative variables. Plastic surgeons performed the majority of surgical repairs, with 85.5% ( n = 1,472) of cleft lip, 79.3% ( n = 2,179) of cleft palate, and 87.9% ( n = 465) of rhinoplasty procedures. There was no difference in the age of primary cleft lip repair or rhinoplasty. However, plastic surgeons performed primary cleft palate repair earlier than otolaryngologists ( p = 0.03). Procedure type varied between the specialties. In rhinoplasty, otolaryngologists were more likely to use septal or ear cartilage, whereas plastic surgeons preferred rib cartilage. Results were similar, with no statistically significant difference in terms of mortality, reoperation, readmission, or complications. Significant variation exists in the treatment of cleft lip and palate based on specialty service with regard to procedure timing and type. However, short-term rates of mortality, wound occurrence, reoperation, readmission, and surgical or medical complications remain similar.
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Affiliation(s)
- Kevin T Jubbal
- School of Medicine, University of California, La Jolla, California
| | - Dmitry Zavlin
- Division of Plastic Surgery, Houston Methodist Hospital, Houston, Texas
| | - Shola Olorunnipa
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Anthony Echo
- Division of Plastic Surgery, Houston Methodist Hospital, Houston, Texas
| | - Edward P Buchanan
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Larry H Hollier
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Pausch NC, Unger C, Pitak-Arnnop P, Subbalekha K. Nasal appearance after secondary cleft rhinoplasty: comparison of professional rating with patient satisfaction. Oral Maxillofac Surg 2016; 20:195-201. [PMID: 27106142 DOI: 10.1007/s10006-016-0555-4] [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] [Received: 12/09/2015] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare professional rating and patient satisfaction of nasal appearance after secondary cleft rhinoplasty. METHOD We used a cross-sectional study design and enrolled German adults with nonsyndromic unilateral or bilateral cleft lip and/or palate (UCLP and BCLP, respectively) undergoing secondary cleft rhinoplasty from January 2001 to December 2013. The predictor variable was professional rating. The outcome variable was patient satisfaction with postoperative nasal aesthetics. Other study variables included patient age and gender, type of surgery, and patient rating of nasal function. Appropriate descriptive and univariate statistics were computed, and a P value of <0.05 was regarded as statistically significant. Inter-rater reliability was assessed by the use of Cohen's kappa coefficient. RESULTS The study sample consisted of 242 adult cleft patients of mean age of 22.1 ± 9.2 years (range 14-64), including 97 females (40 %) and 176 unilateral clefts (73 %). Most of the patients reported good function (82 %) and good aesthetics (74 %). The main professional rating was good aesthetics (65 %). Analysis of inter-observer reliability revealed significant differences between patient satisfaction and professional assessment (κ = 0.385; P < 0.0001). CONCLUSIONS Although most of the patients were satisfied with the functional and aesthetic results of secondary cleft rhinoplasty, patient self-assessment of nasal appearance differed from professional assessment.
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Affiliation(s)
- Niels Christian Pausch
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany.
| | - Carolin Unger
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Poramate Pitak-Arnnop
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Kiel, Kiel, Germany
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Ricketts S, Regev E, Antonyshyn OM, Kiss A, Fialkov JA. Use of the Derriford Appearance Scale 59 to assess patient-reported outcomes in secondary cleft surgery. Plast Surg (Oakv) 2016; 24:27-31. [PMID: 27054135 DOI: 10.4172/plastic-surgery.1000956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Secondary rhinoplasty, one of the final procedures in addressing the stigma of the cleft lip and palate (CLP), has both functional and aesthetic objectives. The way in which physicians evaluate outcomes in surgery concerning aesthetics is changing. Well-designed patient-reported outcome measures to assess health-related quality of life improvements attributable to surgery are increasingly being used. The Derriford Appearance Scale 59 (DAS-59) is currently the only available validated patient-reported outcome measure that assesses concern about physical appearance. METHODS Twenty patients with CLP presenting between May 2009 and May 2013 for secondary rhinoplasty to Sunnybrook Health Sciences Centre (Toronto, Ontario) were recruited. DAS-59 measures were administered both preoperatively and at least six months after surgery. Pre- and postoperative measures were scored and compared. Item-by-item analysis of the measure was also performed. RESULTS Total scores for this CLP group indicated greater concern about appearance than the general population. Across all subscales of the measure, there was a reduction in scores after secondary rhinoplasty suggesting less patient concern with appearance and a positive effect of surgery on patient quality of life. Item-by-item analysis suggested relatively few items in the measure were driving overall change in total scores. CONCLUSION Comparison of pre- and postoperative scores with the DAS-59 in secondary cleft rhinoplasty suggests there is less concern with appearance after surgery. However, a small number of items within this generic scale contributing to this difference may suggest the need for a more patient specific measure for assessment of surgical outcomes in the cleft population.
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Affiliation(s)
- Sophie Ricketts
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Eran Regev
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Oleh M Antonyshyn
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Alex Kiss
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Jeffrey A Fialkov
- Department of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Lonic D, Pai BCJ, Yamaguchi K, Chortrakarnkij P, Lin HH, Lo LJ. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation. PLoS One 2016; 11:e0152014. [PMID: 27002726 PMCID: PMC4803320 DOI: 10.1371/journal.pone.0152014] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although conventional two-dimensional (2D) methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D) simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method. PATIENTS AND METHODS This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years). All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment. RESULTS 83.3% of 2D plans were modified, mostly concerning yaw (63.3%) and midline (36.7%) adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation. CONCLUSION Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D planning.
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Affiliation(s)
- Daniel Lonic
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Betty Chien-Jung Pai
- Department of Craniofacial Orthodontics, and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kazuaki Yamaguchi
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - Hsiu-Hsia Lin
- Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Nose and Midface Augmentation by Rib Cartilage Grafts: Methods and Outcome in 32 Cases. PLASTIC SURGERY INTERNATIONAL 2015; 2015:849802. [PMID: 26858843 PMCID: PMC4689980 DOI: 10.1155/2015/849802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 11/21/2022]
Abstract
Recession of the midface is a relatively common condition that can have a negative impact on facial and nasal aesthetic appearance, and it poses a challenge to plastic surgeons. In cases with generalized maxillary retrusion and/or malocclusion, bone advancement surgery is required, but in localized cases, mostly seen in cleft lip patients, the quest is for an ideal material and a proper technique that would be used to augment the receding area. Throughout a period of seven years, thirty-two patients with nose and midface retrusion were managed by a construct of rib cartilage grafts designed to compensate the deficiency at the maxillary, piriform, and premaxillary areas. Results were satisfactory for most patients in terms of improved fullness of malar area, improved nasal tip projection and rotation, and improvement of upper lip. The presented technique of rib cartilage grafting is a safe and effective method for nose and midface augmentation.
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20
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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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21
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Cao W, Xi M, Zhou F, Feng YP, Huang L. Lateral crus graft with autologous rib cartilage for cleft lip nostril asymmetry: a report of 35 cases. ACTA ACUST UNITED AC 2014; 34:387-392. [PMID: 24939304 DOI: 10.1007/s11596-014-1288-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/14/2014] [Indexed: 11/26/2022]
Abstract
A surgical technique of lateral crus strut graft to correct the deformity of nostril contour and improve asymmetric nostril shape by autologous rib cartilage was reported. Thirty-five patients (20 males and 15 females), with a mean age of 19 years (range of 16-26 years) were included in this study. All of the patients suffered moderate to severe unilateral cleft lip nostril deformity and underwent surgical technique of lateral crus strut graft by autologous rib cartilage to correct the asymmetric nostril contour from 2010 to 2012. The views of the nostril contour on both sides were reviewed and some parameters were measured at different time points (preoperatively, and 3 months and one year postoperatively) including the long axis and short axis of the nostrils. The differences in nostrils including long axis, short axis, elliptical area and eccentricity on the both sides were compared at different time points. The differences in the long axis and eccentricity of the nostrils on the two sides were decreased significantly between the preoperative view and postoperative view (P<0.05). The surgical technique of lateral crus graft with autologous rib cartilage is effective to correct the abnormal nostril contour and improve the asymmetry for unilateral cleft clip patients.
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Affiliation(s)
- Wei Cao
- Department of Plastic and Aesthetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Xi
- Department of Plastic and Aesthetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fang Zhou
- Department of Plastic and Aesthetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - You-Ping Feng
- Department of Plastic and Aesthetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Huang
- Department of Plastic and Aesthetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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22
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Fisher MD, Fisher DM, Marcus JR. Correction of the cleft nasal deformity: from infancy to maturity. Clin Plast Surg 2014; 41:283-99. [PMID: 24607195 DOI: 10.1016/j.cps.2014.01.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The cleft nasal deformity remains the most likely stigma of the cleft to remain plainly visible despite vigorous and repeated attempts at correction. This deformity is present at birth, but evolves over time. Certain aspects can be treated early, but some, such as the dorsal and septal deformity continue to develop as facial growth proceeds through adolescence. This article presents a conceptual mechanism and a philosophy of conservative reliable gains starting at the primary operation, with the long-term view of achieving definitive correction at maturity. Cogent planning of longitudinal care of the deformity from infancy leads to solid, predictable results.
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Affiliation(s)
- Mark D Fisher
- Division of Plastic and Reconstructive Surgery, Cleft Palate and Lip Program, Hospital for Sick Children, Suite 5425, 555 University Avenue, Toronto, ON M5G1X8, Canada; Duke Cleft and Craniofacial Center, Duke Children's Hospital, DUMC 3974, Durham, NC 27710, USA
| | - David M Fisher
- Division of Plastic and Reconstructive Surgery, Cleft Palate and Lip Program, Hospital for Sick Children, Suite 5425, 555 University Avenue, Toronto, ON M5G1X8, Canada
| | - Jeffrey R Marcus
- Duke Cleft and Craniofacial Center, Duke Children's Hospital, DUMC 3974, Durham, NC 27710, USA.
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Kaufman Y, Buchanan EP, Wolfswinkel EM, Weathers WM, Stal S. Cleft nasal deformity and rhinoplasty. Semin Plast Surg 2013; 26:184-90. [PMID: 24179452 DOI: 10.1055/s-0033-1333886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The cleft nasal deformity is a complex challenge in plastic surgery involving the skin, cartilage, mucosa, and skeletal platform. Ever since Blair and Brown first described the intricacies of the cleft pathology in 1931, the appropriate approach has been extensively debated in the literature with respect to timing, technique, and extent of surgical intervention. In this article, the authors review the literature and summarize the various modalities for achieving a successful rhinoplasty in the patient with a cleft nasal deformity.
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Affiliation(s)
- Yoav Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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24
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Pitak-Arnnop P, Dhanuthai K, Hemprich A, Pausch NC. Aging rhinoplasty alone fails to create a youthful appearance of the lateral face, but secondary cleft rhinoplasty rejuvenates the nose. Am J Otolaryngol 2011; 32:632-3; author reply 633-4. [PMID: 21041000 DOI: 10.1016/j.amjoto.2010.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/07/2010] [Indexed: 11/27/2022]
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Cohen M, Morris DE, White AD, Patel P. Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities. Indian J Plast Surg 2011; 42 Suppl:S91-S101. [PMID: 19884688 PMCID: PMC2825077 DOI: 10.4103/0970-0358.57195] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The treatment of patients with unilateral cleft lip has undergone significant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treatment protocols, and constant striving for perfection in both aesthetics and function, we have been able to design improved treatment strategies and more accurate surgical techniques so as to achieve overall superior and long-lasting results. In this review article, we present our protocols and experience for functional and aesthetic correction of secondary unilateral cleft lip nasal deformities and a retrospective review of 219 consecutive patients treated at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities. The protocols used in the treatment of 219 consecutive patients at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities were reviewed. In addition, analysis of the most recent 51 consecutive patients who underwent complete clinical and functional evaluation with rhinomanometry followed by correction of the cleft lip nasal deformity was performed. A variety of time-honoured techniques of rhinoplasty were applied in the correction of the residual deformities to achieve symmetry, aesthetic balance, and functional correction of the nose. Follow-up ranged from 5-11 years. Analysis of the data revealed that 39 patients (76.47%) had significant functional and aesthetic improvement; seven patients (13.07%) had significant aesthetic improvement but a modest functional improvement; and five patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that five out of seven patients in the second group had pharyngeal flaps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these flaps because the speech was excellent. The surgical plan is based on the information gained from our extensive clinical evaluation and is tailored to the patient's specific functional and aesthetic needs.
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Affiliation(s)
- Mimis Cohen
- Craniofacial Centre and the Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, USA
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Pausch NC, Pitak-Arnnop P, Herzberg PY, Dhanuthai K, Hemprich A. Secondary cleft rhinoplasty rejuvenates the nose: a suggestion from a panel survey. ACTA ACUST UNITED AC 2011; 111:174-80. [PMID: 20643565 DOI: 10.1016/j.tripleo.2010.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/13/2010] [Accepted: 04/07/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cleft-lip nasal deformity (CLND) affects the overall facial appearance and attractiveness. The CLND nose shares some features in part with the aging nose. OBJECTIVES This questionnaire survey examined: 1) the panel perceptions of the role of secondary cleft rhinoplasty in nasal rejuvenation; and 2) the influence of a medical background in cleft care, age and gender of the panel members on the estimated age of the CLND nose. STUDY DESIGN Using a cross-sectional study design, we enrolled a random sample of adult laypersons and health care providers. The predictor variables were secondary cleft rhinoplasty (before/after) and a medical background in cleft care (yes/no). The outcome variable was the estimated age of nose in photographs derived from 8 German nonsyndromic CLND patients. Other study variables included age, gender, and career of the assessors. Appropriate descriptive and univariate statistics were computed, and a P value of <.05 was considered to be statistically significant. RESULTS The sample consisted of 507 lay volunteers and 51 medical experts (407 [72.9%] were female; mean age ± SD = 24.9 ± 8.2 y). The estimated age of the CLND noses was higher than their real age. The rhinoplasty decreased the estimated age to a statistically significant degree (P < .0001). A medical background, age, and gender of the participants were not individually associated with their votes (P > .05). CONCLUSIONS The results of this study suggest that CLND noses lack youthful appearance. Secondary cleft rhinoplasty rejuvenates the nose and makes it come close to the actual age of the patients.
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Affiliation(s)
- Niels Christian Pausch
- Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany
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Hens G, Picavet VA, Poorten VV, Schoenaers J, Jorissen M, Hellings PW. High patient satisfaction after secondary rhinoplasty in cleft lip patients. Int Forum Allergy Rhinol 2011; 1:167-72. [PMID: 22287367 DOI: 10.1002/alr.20023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/15/2010] [Accepted: 10/11/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We surveyed the subjective outcome of secondary rhinoplasty in cleft lip patients. METHODS Questionnaires were sent to 38 patients who had undergone a secondary rhinoplasty. A total of 30 questionnaires were returned and analyzed. Patients were asked to score their preoperative and postoperative nasal function and form. The validated Rhinoplasty Outcome Evaluation (ROE) questionnaire was supplemented with questions on the subjective burden of the procedure and general satisfaction. In parallel, the objective aesthetic outcome was judged by 2 surgeons using preoperative and postoperative photographs. RESULTS There was a significant subjective improvement in ROE scores (from 39.3 ± 3.1 to 73.1 ± 2.0, p < 0.001), and in specific scores for nasal aesthetical appearance (from 3.6 ± 0.3 to 7.9 ± 0.2, p < 0.0001) and breathing capacity (from 4.9 ± 0.4 to 6.8 ± 0.3, p < 0.01). Subjective improvement in nasal aesthetics was generally evaluated to be better than improvement in nasal breathing. In retrospect, all patients would undergo the procedure again. Patient satisfaction did not correlate with the surgeon's appreciation of the aesthetic outcome of the rhinoplasty. CONCLUSION Patient satisfaction after secondary rhinoplasty in cleft lip patients is high and comparable to that of non-cleft lip rhinoplasty patients.
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Affiliation(s)
- Greet Hens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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28
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Pitak-Arnnop P, Hemprich A, Dhanuthai K, Yildirim V, Pausch NC. Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting. J Craniomaxillofac Surg 2010; 39:319-25. [PMID: 20832328 DOI: 10.1016/j.jcms.2010.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 06/25/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon. OBJECTIVES The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient's self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients' age; (3) patients' gender; and (4) panel perceptions. METHODS Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient's subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P≤0.05 and <0.05 for single- and two-tailed tests of hypothesis, respectively. RESULTS The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings (P>0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics (P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients' age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction. CONCLUSIONS Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Scientific Unit for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany.
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29
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Chaithanyaa N, Rai KK, Shivakumar HR, Upasi A. Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients. J Plast Reconstr Aesthet Surg 2010; 64:27-33. [PMID: 20466610 DOI: 10.1016/j.bjps.2010.03.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE A definitive correction of nasal deformity is best performed by creating symmetry and addressing the nostril/tip/columella complex, which is more easily handled by direct vision. The main objective is to evaluate the nasal changes along with function and also to evaluate the satisfaction outcome of the patients following secondary rhinoplasty. METHODS Ten patients who were admitted to our unit for secondary rhinoplasty procedure involving the cleft lip-palate defects associated with nasal deformities were considered for the study. All the patients were evaluated pre- and postoperatively for aesthetics and function along with patient satisfaction and perception. RESULTS All the operated cases of cleft nasal deformity had a significant improvement in the facial aesthetics and function postoperatively. Clinical evaluation revealed that the post-nasal changes were significant with no nasal obstruction. Statistically, the results were significant (p<0.05). CONCLUSION Although our sample is small, this study would assist in some preliminary conclusions. From our present study, in the view of a distinct deformity of the internal and external nose associated with cleft lip/nose/palate in adolescents or adults, septal rhinoplasty or rhinoplasty alone provides good aesthetics and functional results.
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Affiliation(s)
- N Chaithanyaa
- Department of Oral Maxillofacial and Reconstructive Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India.
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