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Ho Nguyen CT, La TN, Nguyen DV. Three-Dimensional Evaluation of Nasolabial Morphology After Applying Presurgical Nasoalveolar Molding in Primary Unilateral Cheiloplasty Using the Modified Millard Technique. Cleft Palate Craniofac J 2024; 61:1532-1537. [PMID: 37198916 DOI: 10.1177/10556656231175554] [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: 05/19/2023] Open
Abstract
OBJECTIVE To compare the soft tissue measurements of the upper lip and the nose on the cleft side and the noncleft side before surgery, immediately after cheiloplasty and two months after surgery. DESIGN Descriptive clinical study with one group, prospective. SETTING Department of Odonto-Stomatology, Children's Hospital 1, at Ho Chi Minh City - Vietnam. PATIENTS 31 patients with a unilateral complete cleft lip participated in this study, 30 patients were evaluated at the time two months after surgery. INTERVENTIONS Interventions include PNAM and cheiloplasty by modified Millard technique. MAIN OUTCOME MEASURES Patients proceed to acquire 3D images of lips and nose, define landmarks and measure dimensions. There are 11 evaluators to be compared, p < 0.05 was considered statictical significance. RESULTS After two months of surgery, on cleft side and noncleft side, the lengths of the upper lip were 10.87 ± 0.80 and 11.92 ± 0.78 (mm), the widths of the upper lip were 16.06 ± 1.10 and 16.40 ± 1.02 (mm), the heights of the nostril were 4.85 ± 0.44 and 5.93 ± 0.43 (mm), the lengths of columella were 4.08 ± 0.37 and 4.93 ± 0.38 (mm), and the widths of the nostril were 9.07 ± 0.37 and 8.37 ± 0.40 (mm). CONCLUSION Cheiloplasty by modified Millard technique on the patients who used PNAM showed that after two months of surgery, the morphology of the upper lip and nose has a slight disproportion with the nasolabial measurements of the cleft side being smaller than on the noncleft side.
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Affiliation(s)
- Chon T Ho Nguyen
- Department of Maxillofacial Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuyen N La
- Department of Odonto-Stomatology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Dau V Nguyen
- Department of Odonto-Stomatology, Children's Hospital 1, Ho Chi Minh City, Vietnam
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Rizzo MI, Cajozzo M, Bucci D, Pistoia A, Palmieri A, Rajabtork Zadeh O, Palmieri G, Spuntarelli G, Zama M. 25-year Follow-up of Primary Tibial Periosteal Graft for Hard Palate Repair in Cleft Lip and Palate: Outcomes, Concerns and Controversies. Cleft Palate Craniofac J 2024; 61:476-482. [PMID: 36250335 DOI: 10.1177/10556656221132043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE This study evaluates long-term outcomes in adults with Unilateral and Bilateral Cleft Lip and Palate (UCLP/BCLP) treated during the period 1992 to 1995 with tibial periosteal graft in primary repair. DESIGN Retrospective study. SETTING Department of Plastic and Maxillofacial Surgery, Children's Hospital Bambino Gesù (Italy). PATIENTS The study included 52 patients with non-syndromic BCLP/UCLP who met the inclusion criteria. INTERVENTIONS All patients underwent a standardized surgical protocol using a tibial periosteal graft as primary repair of the hard palate. MAIN OUTCOME MEASURE(S) Long-term outcomes on maxillary growth, residual oronasal fistula, and leg length discrepancy. RESULTS About <2% of patients showed oral-nasal communication. Mean value of maxillary depth was 86° ± 4.5°. The lower value for maxillary retrusion was 76.8° in relation to the Frankfurt plane. At the x-ray control, 12.2% of patients showed leg discrepancy with a difference of always <2 cm. CONCLUSIONS The rate of maxillary retrusion obtained was the same if compared to other techniques. Tibial periosteal graft reduces the risk of fistula and the need for reintervention after secondary bone graft. The study did not observe negative impacts on leg growth after 25 years.
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Affiliation(s)
- Maria Ida Rizzo
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Cajozzo
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Daria Bucci
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Angelica Pistoia
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Annapina Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | - Oriana Rajabtork Zadeh
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giancarlo Palmieri
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giorgio Spuntarelli
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Zama
- Plastic and Maxillofacial Surgery Unit, Cleft and Craniofacial Center, Bambino Gesù Children's Hospital, Rome, Italy
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Wei H, Xu X, Wan T, Yang Y, Zhang Y, Wu Y, Liang Y. Correction of narrow nostril deformity secondary to cleft lip: indications for different surgical methods and a retrospective study. Front Pediatr 2023; 11:1156275. [PMID: 37206975 PMCID: PMC10188927 DOI: 10.3389/fped.2023.1156275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background Cleft lip and/or palate (CLP) can lead to severe nasolabial deformities that significantly affect the appearance of the patient. Among all types of nasolabial deformities, narrow nostril deformities are the most troublesome, causing poor and unstable surgical outcomes. The purpose of this study was to develop an algorithm for surgical method selection for revision of narrow nostril deformities secondary to CLP based on retrospective clinical data. Materials and methods Patients with narrow nostril deformities secondary to CLP were enrolled in the study. Before surgery, patients' clinical data were collected and the width of the nasal floor and the length of the alar rim were measured. Surgical methods were determined according to the measurements. After surgery, a nostril retainer was applied for 6 months to consolidate and maintain the nostril shape. The surgical method and postsurgical changes were recorded for the final summary of the algorithm to select surgical methods for narrow nostril deformities. Results The data from 9 patients were analyzed. According to the width of the nasal floor and the length of the alar rim, correct surgical methods were determined. Four patients received nasolabial skin flaps to widen the soft tissue of the nasal floor. Three patients received upper lip scar tissue flaps to treat the narrow nasal floor. For the short alar rim, free alar composite tissue flap or narrowing of the nostril of the noncleft side was recommended. Conclusion The width of the nasal floor and the length of the alar rim are critical elements to consider when selecting the correct surgical method for revising narrow nostril deformities secondary to CLP. The proposed algorithm provides a reference for selecting surgical methods in future clinical practice.
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Affiliation(s)
- Hongpu Wei
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xiaofeng Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yusheng Yang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yong Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
| | - Yilai Wu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
| | - Yun Liang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
- Correspondence: Yong Zhang Yilai Wu Yun Liang
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Xu Y, Zeng N, Li J, Zheng Q, Shi B. Growth patterns of the nasolabial region following unilateral cleft lip primary repair. Front Pediatr 2023; 11:1136467. [PMID: 36994436 PMCID: PMC10040551 DOI: 10.3389/fped.2023.1136467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 03/31/2023] Open
Abstract
Surgical correction is the optimal way of repairing a congenital cleft lip. Patients with this condition often undergo initial surgical treatment at an early age and achieve an acceptable outcome. However, their levels of satisfaction will decrease in later stages of life as facial growth and development will inevitably cause changes in long-term outcomes, especially in the nasolabial region. Therefore, it is important for surgeons to understand nasolabial development after primary treatment and tailor their surgical techniques appropriately. This review focuses on the growth patterns of the nasolabial region after primary repair, so as to provide references for operative strategy.
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Abstract
BACKGROUND A novel technique for primary unilateral cleft lip repair with scarless Cupid's bow peaks is described. This technique focuses on the curvature of the Cupid's bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid's bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon. METHODS The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid's bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid's bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty. RESULTS The Noordhoff point was kept as the peak of the Cupid's bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid's bow, was well maintained. CONCLUSION The present technique allows for the fashioning of a reliable intended peak of the Cupid's bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.
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Yamanishi T, Kondo T, Kirikoshi S, Otsuki K, Uematsu S, Nishio J. Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip. J Oral Maxillofac Surg 2021; 79:2126-2133. [PMID: 34161809 DOI: 10.1016/j.joms.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery. METHODS Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019. RESULTS We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P = .012, r = 0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P = .00074, r = 0.57); thus, the shorter the red lip, the higher was the oral commissure. CONCLUSIONS The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.
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Affiliation(s)
- Tadashi Yamanishi
- Chief Director, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan.
| | - Takahide Kondo
- Research Fellow, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan; Chief Clinician, Dentistry, Osaka International Cancer Institute, Osaka, Japan
| | - Shoko Kirikoshi
- Resident, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan; PhD Candidate, Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Koichi Otsuki
- Chief Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Setsuko Uematsu
- Deputy Director, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Juntaro Nishio
- Special Advisor, Department of Oral and Maxillofacial Surgery, Osaka Women's and Children's Hospital, Osaka, Japan
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The Unilateral Cleft Lip Nasal Deformity: Revisions within 20 Years after Primary Correction. Plast Reconstr Surg 2021; 147:1379-1387. [PMID: 33973939 DOI: 10.1097/prs.0000000000007998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As patients grow older, the unilateral cleft lip nasal deformity becomes more noticeable than the repaired lip. The authors assessed nasal revisions over 20 years of the senior author's management of unilateral complete cleft lip. METHODS One hundred patients who underwent primary two-stage nasolabial correction of unilateral complete cleft lip between 1991 and 2001 were reviewed. RESULTS The median patient age was 21 years at the time of analysis. Only 13 percent of patients did not require nasal revision after primary nasolabial repair. One to two nasal revisions were undertaken in 65 percent of patients. The extent of nasal maneuvers during primary labial repair was associated with the number of revisions. Recently treated patients had fewer revisions. Female patients were more likely to undergo several revisions. Of patients who had semiopen suspension sutures at primary repair, 61 percent had this maneuver repeated two or more times. In contrast, patients who had closed suspension sutures at primary repair underwent more nasal revisions and later required more nasal maneuvers. Nasal revision before skeletal maturity was significantly associated with another nasal revision after completion of skeletal growth. Twenty-seven percent of patients eventually required an aesthetic or functional rhinoplasty in adulthood. CONCLUSIONS Patients with a severe initial nasal deformity require multiple revisions. Semiopen suspension sutures are associated with fewer revisions. Revision of the nasal cartilages or alar base can often be performed in the intermediate phase, in combination with other operations. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Tangco I, Bhandari K, Yao CF, Liu AWC, Chen PKT, Lu TC. Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis. Ann Plast Surg 2021; 86:S41-S45. [PMID: 33438954 DOI: 10.1097/sap.0000000000002704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. METHODS From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. RESULTS A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. CONCLUSIONS The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.
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Affiliation(s)
| | | | - Chuan-Fong Yao
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | | | - Philip Kuo-Ting Chen
- Department of Plastic and Reconstructive Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ting-Chen Lu
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Tan RA, Schipper IE, de Vet HCW, Griot JPWD. The Submental Nasal Appearance Scale for the Assessment of Repaired Unilateral Complete Cleft Lip: A Validation Study. Cleft Palate Craniofac J 2020; 58:637-643. [PMID: 33021103 PMCID: PMC8044622 DOI: 10.1177/1055665620961968] [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: 11/23/2022] Open
Abstract
Objective: To reassess reliability and validity of the Submental Nasal Appearance Scale (SNAS) compared to the preliminary pilot study, for assessment of patient photographs with repaired unilateral cleft lip and palate (UCLP). When utilizing the SNAS, 3 nasal features (1. nasal outline; 2. alar base position; 3. nostril axis) must be graded according to symmetry between the cleft and noncleft side using a 5-point scale with reference photographs for each feature. The mean score calculated from the graded features reflects the overall degree of nasal symmetry, which is considered an important goal when repairing UCLP. Design: Fifty patient photographs were selected and cropped, displaying the submental view. Six raters assessed these photographs using the SNAS and a separate 5-point scale to assess the overall submental appearance. Interrater reliability was determined for both methods and correlation was calculated between these as an indication of construct validity. Setting: Amsterdam UMC, location VUmc, Amsterdam, The Netherlands. Patients: Six- to 9-year-old patients with repaired UCLP. Results: Interrater reliability of 0.73 and 0.48 was found for the SNAS and overall appearance assessment, respectively, while in the pilot study values of 0.79 and 0.69 were found. Correlation of 0.59 and 0.74 was found in the current and pilot study, respectively, between the SNAS and overall appearance assessment. Conclusions: The SNAS is a reliable tool to assess nasal symmetry from the submental perspective. Reliability of the SNAS is higher compared to grading overall appearance, but validity of the SNAS was less well supported.
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Affiliation(s)
- R A Tan
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | - I E Schipper
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - J P W Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
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Nasolabial Revisions in Unilateral Incomplete Cleft Lip: One Surgeon's 28-Year Experience. Plast Reconstr Surg 2020; 145:1477-1485. [PMID: 32195854 DOI: 10.1097/prs.0000000000006831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Repair of unilateral incomplete cleft lip is the surgeon's opportunity to achieve a superior result with few revisions. METHODS This study is a retrospective review of consecutive patients with unilateral incomplete cleft lip, defined as a defect extending 30 to 90 percent of cutaneous labial height, treated between 1985 and 2013 by one surgeon. Rates and types of revisions were collected, and photographs of patients who did not have a revision were reviewed to determine whether a revision was needed. RESULTS One hundred thirty-six patients met inclusion criteria. Fifty-seven percent needed revision of the mucosal free margin; less than 10 percent needed other minor labial revisions. Fifteen percent required a nasal revision, most commonly reelevation of the lower lateral cartilage. Over time, the only statistically significant change in frequency was increased revisions of the free border. CONCLUSIONS Nasal revision rates are low in unilateral incomplete cleft lip compared to complete forms in previously published data by the senior author (J.B.M.). In contrast, labial revisions of the free margin are more common. The reason is that the surgeon became more cognizant of vermilion-mucosal deficiency on the noncleft side and more likely to offer a submucosal flap or dermis-fat graft to level the lip for normal upper incisor show. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Jung S, Chung KH, Chang SY, Ohrmman D, Lim E, Lo LJ. A new technique for perioral muscle reconstruction and lip lengthening in complete unilateral cleft lip. J Plast Reconstr Aesthet Surg 2020; 73:749-757. [DOI: 10.1016/j.bjps.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Reply: Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity. Plast Reconstr Surg 2020; 145:460e. [PMID: 31985688 DOI: 10.1097/prs.0000000000006455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beware the Alar Base Optical Illusion in Assessment of Unilateral Cleft Lip Nasal Deformity. Plast Reconstr Surg 2019; 143:1157-1162. [PMID: 30921137 DOI: 10.1097/prs.0000000000005480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND After repair of unilateral cleft lip, lateral drift of the alar base is expected and may require revision. Although the alar base appears wider than on the noncleft side, by measurement it could be symmetric or narrow. Is this an optical illusion? METHODS This is a retrospective photographic evaluation of children who underwent repair of unilateral complete cleft lip and palate. On submental standardized photographs, raters judged whether the alar base position was wider, equal to, or narrower than on the noncleft side. The true alar base position was measured by photogrammetry and the frequency of alar base misjudgment was assessed. On control photographs, the cleft side alar base was wider than the noncleft side. On test photographs, the cleft side alar base was narrower than the noncleft side. Possible association between misjudgment and nasal features was also evaluated. Data were analyzed using the Fisher's exact test. RESULTS Three raters assessed 61 patients aged 6 to 9 years and treated between 1995 and 2015. In 77 percent of control photographs, raters correctly judged the cleft side alar base as wider. In 65 percent of test photographs, raters incorrectly judged the alar base position as wider on the cleft side. Asymmetry of nostril outline and a transverse nostril axis were associated with misjudged photographs (p < 0.05). CONCLUSIONS Alar base assessment can be altered by an optical illusion. Simple anthropometry counters this misperception. Measurement should be repeated after correction of the deviated anterocaudal septum and elevation of the lower lateral cartilage. Thereafter, a decision is made on altering the alar base position. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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Al-Rudainy D, Ju X, Mehendale FV, Ayoub A. Longitudinal 3D Assessment of Facial Asymmetry in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 56:495-501. [PMID: 29870280 DOI: 10.1177/1055665618780108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Longitudinal evaluation of asymmetry of the surgically managed unilateral cleft lip and palate (UCLP) to assess the impact of facial growth on facial appearance. DESIGN Prospective study. SETTING Glasgow Dental Hospital and School, University of Glasgow, United Kingdom. PATIENTS Fifteen UCLP infants. METHOD The 3-D facial images were captured before surgery, 4 months after surgery, and at 4-year follow-up using stereophotogrammetry. A generic mesh which is a mathematical facial mask that consists of thousands of points (vertices) was conformed on the generated 3-D images. Using Procustean analysis, an average facial mesh was obtained for each age-group. A mirror image of each average mesh was mathematically obtained for the analysis of facial dysmorphology. Facial asymmetry was assessed by measuring the distances between the corresponding vertices of the original and the mirror copy of the conformed meshes, and this was displayed in color-coded map. RESULTS There was a clear improvement in the facial asymmetry following the primary repair of cleft lip. Residual asymmetry was detected around the nasolabial region. The nasolabial region was the most asymmetrical region of the face; the philtrum, columella, and the vermillion border of the upper lip showed the maximum asymmetry which was more than 5 mm. Facial growth accentuated the underlying facial asymmetry in 3 directions; the philtrum of the upper lip was deviated toward the scar tissue on the cleft side. The asymmetry of the nose was significantly worse at 4-year follow-up ( P < .05). CONCLUSION The residual asymmetry following the surgical repair of UCLP was more pronounced at 4 years following surgery. The conformed facial mesh provided a reliable and innovative tool for the comprehensive analysis of facial morphology in UCLP. The study highlights the need of refining the primary repair of the cleft and the potential necessity for further corrective surgery.
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Affiliation(s)
- Dhelal Al-Rudainy
- 1 Orthodontic Department, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,2 Orthodontic Department, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Xiangyang Ju
- 3 Medical Devices Unit, Department of Clinical Physics and Bioengineering, National Health Service of Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Felicity V Mehendale
- 4 Cleft and Plastic Surgeon, Royal Hospital of Sick Children, Edinburgh, United Kingdom
| | - Ashraf Ayoub
- 5 Oral and Maxillofacial Surgery, Scottish Craniofacial Research Group, Glasgow University Dental Hospital and School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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A New Design for Reconstruction of Nasal Dimensions during the Primary Repair of Unilateral Cleft Lip. Plast Reconstr Surg 2017; 139:1376e-1377e. [PMID: 28403008 DOI: 10.1097/prs.0000000000003379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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