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Denadai R, Araujo KM, Campos RL, Lo CC, Seo HJ, Sato N, Tu JCY, Chou PY, Lo LJ. Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept. Cleft Palate Craniofac J 2024:10556656241247625. [PMID: 38646778 DOI: 10.1177/10556656241247625] [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: 04/23/2024] Open
Abstract
OBJECTIVE To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. DESIGN Retrospective single-surgeon (RD) study. PATIENTS Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. INTERVENTIONS Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. MEAN OUTCOME MEASURES Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. RESULTS The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. CONCLUSION The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.
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Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | | | | | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Junior Chun-Yu Tu
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Evolving Trends in Unilateral Cleft Lip Repair Based on Continuous Certification by the American Board of Plastic Surgery. J Craniofac Surg 2021; 33:502-505. [PMID: 34320588 DOI: 10.1097/scs.0000000000008016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The American Board of Plastic Surgery (ABPS) began collecting data from unilateral cleft lip (UCL) corrections in 2011 as a component of the continuous certification process. We evaluated these data to understand practice patterns in UCL repair, in the United States, and whether these practice patterns had changed over the past 9 years. METHODS Tracer data for UCL correction were reviewed from its inception in October 2011 through 2016 and compared to UCL cases between 2017 and March 2020. Trends in practice patterns were evaluated against literature reviews meant to coincide with the ABPS continuous certification data. RESULTS A total of 520 cases were included from October 2011 to March 2020. Median age of UCL repair was 4 months and 66% of patients were male. Fifty-one percent of cases presented with a complete cleft lip. There was a decrease in postoperative adverse events when data from 2011 to 2016 was compared to 2017 to 2019 (P = 0.020). Revisions were the most common postoperative adverse event (2%). There was a decrease in nasoalveolar molding from 25% to 12% (P < 0.001) and 56% of total cases underwent a concurrent primary cleft rhinoplasty. The rate of gingivoperiosteoplasty at the time of primary cleft lip repair also fell (9% versus 1%; P < 0.001). CONCLUSIONS This article reviews tracer data obtained by the ABPS for UCL repair. The American Board of Plastic Surgery tracer data provides a national, cleft lip-specific database with longer follow-up times than other large databases.
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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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A Global Evaluation of Surgical Techniques and Results of Unilateral Cleft Lip Repairs. J Craniofac Surg 2020; 31:2276-2279. [DOI: 10.1097/scs.0000000000006813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sitzman TJ, Carle AC, Lundberg JN, Heaton PC, Helmrath MA, Trotman CA, Britto MT. Marked Variation Exists Among Surgeons and Hospitals in the Use of Secondary Cleft Lip Surgery. Cleft Palate Craniofac J 2020; 57:198-207. [PMID: 31597471 PMCID: PMC6957675 DOI: 10.1177/1055665619880056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify child-, surgeon-, and hospital-specific factors at the time of primary cleft lip repair that are associated with the use of secondary cleft lip surgery. DESIGN Retrospective cohort study. SETTING Forty-nine pediatric hospitals. PARTICIPANTS Children who underwent cleft lip repair between 1999 and 2015. MAIN OUTCOME MEASURE Time from primary cleft lip repair to secondary lip surgery. RESULTS By 5 years after primary lip repair, 24.0% of children had undergone a secondary lip surgery. In multivariable analysis, primary lip repair before 3 months had a 1.22-fold increased hazard of secondary surgery (95% confidence interval [CI]: 1.02-1.46) compared to repair at 7 to 12 months of age, and children with multiple congenital anomalies had a 0.77-fold decreased hazard of secondary surgery (95% CI: 0.68-0.87). After adjusting for cleft type, age at repair, presence of multiple congenital anomalies, and procedure volume, there remained substantial variation in secondary surgery use among surgeons and hospitals (P < .01). For children with unilateral cleft lip repaired at 3 to 6 months of age, the predicted proportion of children undergoing secondary surgery within 5 years of primary repair ranged from 4.9% to 21.8% across surgeons and from 4.5% to 24.7% across hospitals. CONCLUSIONS There are substantial differences among surgeons and hospitals in the rates of secondary lip surgery. Further work is needed to identify causes for this variation among providers.
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Affiliation(s)
- Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA
- Department of Surgery, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
| | - Adam C. Carle
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Pamela C. Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Michael A. Helmrath
- Division of Pediatric and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Carroll-Ann Trotman
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Maria T. Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Brons S, Meulstee JW, Loonen TG, Nada RM, Kuijpers MA, Bronkhorst EM, Bergé SJ, Maal TJ, Kuijpers-Jagtman AM. Three-dimensional facial development of children with unilateral cleft lip and palate during the first year of life in comparison with normative average faces. PeerJ 2019; 7:e7302. [PMID: 31392092 PMCID: PMC6677122 DOI: 10.7717/peerj.7302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate. METHODS Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children's reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed. RESULTS Assessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5-5 mm posterior to those in the average controls. CONCLUSION In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.
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Affiliation(s)
- Sander Brons
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jene W. Meulstee
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tom G.J. Loonen
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rania M. Nada
- Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
| | - Mette A.R. Kuijpers
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewald M. Bronkhorst
- Department of Dentistry, Section of Preventive and Curative Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefaan J. Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thomas J.J. Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Adetayo AM, Adetayo MO, Adeyemo WL, James OO, Adeyemi MO. Unilateral cleft lip: evaluation and comparison of treatment outcome with two surgical techniques based on qualitative (subject/guardian and professional) assessment. J Korean Assoc Oral Maxillofac Surg 2019; 45:141-151. [PMID: 31334102 PMCID: PMC6620301 DOI: 10.5125/jkaoms.2019.45.3.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. Materials and Methods This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. Results Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. Conclusion Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.
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Affiliation(s)
- Adekunle Moses Adetayo
- Department of Surgery, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria.,Dental Unit, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Modupe Olushola Adetayo
- Department of Biochemistry, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Wasiu Lanre Adeyemo
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Olutayo O James
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
| | - Michael O Adeyemi
- Oral and Maxillofacial Surgery, Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Nigeria
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Abstract
BACKGROUND When treating a patient with a unilateral cleft lip, the goal is to try and achieve a result that is the least perceivable at conversational distance. The result should be a balanced and symmetric lip with scars that are hidden or are placed in natural anatomical lines. Several methods have been described to repair the lip. The most popular repairs at present are the rotation-advancement or its modifications and the various versions of the straight-line repair. METHODS In the author's unit, a method has evolved entitled the symmetric philtral column repair. In this method, the author attempts to achieve a philtral column that mirrors the philtral column on the normal side, producing a balanced appearing lip. This method has been used for the past 14 years in over 500 patients. RESULTS The results have been satisfying, with a lip revision rate of 6 percent. CONCLUSIONS The symmetric philtral column repair of a unilateral cleft lip is an effective and safe repair. The repair is easy to understand and produces results that minimize the stigmata of a cleft lip deformity.
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Nakajima Y, Yuzuriha S, Nagai F, Fujita K, Noguchi M. Oronasal Transfixion Suture to Prevent Uplifted Nasal Floor Deformity in Cleft Lip and Palate Patients: A 5-Year Follow-Up. Cleft Palate Craniofac J 2018; 56:390-394. [PMID: 29719157 DOI: 10.1177/1055665618774027] [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: 11/15/2022] Open
Abstract
OBJECTIVE In unilateral cleft lip and palate, the reconstructed nasal floor is sometimes uplifted regardless of the reconstructive method used. We used a 5-0 absorbable anchoring suture, the oronasal transfixion suture (ONT suture), to fasten the reconstructed nasal floor to the orbicularis oris muscle to prevent this deformity. This study was performed to evaluate the effects of the ONT suture. DESIGN Blind retrospective study of photography and chart review. SETTING Shinshu University Hospital, tertiary care, Nagano, Japan. Private practice. PATIENTS Ninety-three consecutive patients with unilateral complete cleft lip and palate who had undergone primary nasolabial repair in our department and affiliated hospitals between 1999 and 2011 participated in this study. Finally, 45 patients were included. INTERVENTIONS The ONT suture was put in place at the time of primary nasolabial repair. MAIN OUTCOME MEASURE The height of the nasal floor was evaluated on submental view photographs at 5 years old. RESULTS The ONT suture was applied in 21 patients. The height of the nasal floor on the cleft side was significantly closer to that on the noncleft side with the ONT suture than without the ONT suture ( P = .008). CONCLUSIONS The ONT suture is effective to prevent uplifted nasal floor deformity on the cleft side// in unilateral complete cleft lip and palate at the time of primary nasolabial repair.
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Affiliation(s)
- Yuta Nakajima
- 1 Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunsuke Yuzuriha
- 1 Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Fumio Nagai
- 1 Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kenya Fujita
- 2 Department of Plastic Surgery, Nagano Children's Hospital, Nagano, Japan
| | - Masahiko Noguchi
- 2 Department of Plastic Surgery, Nagano Children's Hospital, Nagano, Japan
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Mishra RK, Agarwal A. White Roll Vermilion turn down flap in primary unilateral cleft lip repair: A novel approach. Indian J Plast Surg 2015; 48:178-84. [PMID: 26424983 PMCID: PMC4564503 DOI: 10.4103/0970-0358.163057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim: Numerous modifications of Millard's technique of rotation – advancement repair have been described in literature. This article envisions a new modification in Millard's technique of primary unilateral chieloplasty. Material and Methods: Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard's repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion. Result: With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid's bow with no vermilion notching of the lips. Conclusion: WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.
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Affiliation(s)
- R K Mishra
- Department of Plastic Surgery, Sushrut Institute of Plastic Surgery, Lucknow, Uttar Pradesh, India
| | - Amit Agarwal
- Department of Plastic Surgery, Sushrut Institute of Plastic Surgery, Lucknow, Uttar Pradesh, India
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Yildirim V, Kaiser J, Hemprich A, Winter K, Pausch NC. Dependence of columella development on the technique used for primary cleft lip closure. Oral Maxillofac Surg 2015; 19:165-175. [PMID: 25351139 DOI: 10.1007/s10006-014-0472-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Primary cleft lip closure can be achieved by use of different types of surgery. The procedures of Millard, Veau, and Delaire are among the techniques most frequently performed worldwide. The factors which affect development of the columella have not been studied, however. SETTING University Hospital of Leipzig, Germany, Department of Oral, Craniomaxillofacial and Facial Plastic Surgery. PATIENTS, PARTICIPANTS In a comparative, retrospective, non-randomised study, we obtained anthropometric details from photographs of 120 unilateral and bilateral cleft patients after cleft lip closure by use of the techniques of Millard or Veau (n = 60) and Delaire (n = 60). Length and shape of the columella was assessed twice-first at the age of 10 months and again at the age of 10 years. Anthropometric characteristics of columella morphology and development were compared between the two groups. RESULTS At the age of 10 months, the ratio of nasal height to width (interalar distance) was significantly different for unilateral and bilateral cases, and results were better for the Delaire groups (p = 0.001 unilateral and p > 0.001 bilateral). This effect was no longer apparent at 10-year follow up. Another index which tended to indicate better results in the Delaire groups was the nasal width index. In the summary of the anthropometric values investigated, however, differences between the Millard or Veau group and the Delaire group were marginal. CONCLUSION Cleft lip closure by the technique of Millard for unilateral cleft lips and of Veau for bilateral cases is neither better nor worse than Delaire cheiloplasty for unilateral and bilateral clefts.
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Affiliation(s)
- Vedat Yildirim
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany,
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Cline JM, Oyer SL, Javidnia H, Nguyen SA, Sykes JM, Kline RM, Patel KG. Comparison of the Rotation-Advancement and Philtral Ridge Techniques for Unilateral Cleft Lip Repair. Plast Reconstr Surg 2014; 134:1269-1278. [DOI: 10.1097/prs.0000000000000723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mercado AM, Phillips C, Vig KWL, Trotman CA. The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip. Orthod Craniofac Res 2014; 17:216-25. [PMID: 24846148 DOI: 10.1111/ocr.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 1) To determine the concordance among surgeons on subjective assessments of nasolabial esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in relation to cleft lip revision surgery. SETTING AND SAMPLE POPULATION School of Dentistry at University of North Carolina, Chapel Hill. Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery. MATERIALS AND METHODS Retrospective observational study from a non-randomized clinical trial. Ratings of nasolabial esthetics performed by six surgeons using the Asher-McDade scale at baseline and 12-month follow-up. RESULTS Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were better in the Revision group than in the Non-Revision group, although differences were small. The most prevalent change in the Revision Group was improvement in one or more units on the scale, while 'no change' was most prevalent in the Non-Revision group. Participants in the Revision group were more likely to receive a 'no' in relation to the need for lip or nose revision at the follow-up visit. CONCLUSION There were mild esthetic improvements observed in relation to lip revision surgery, which should be interpreted with caution given the subjectivity of the rating method used.
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Affiliation(s)
- A M Mercado
- College of Dentistry, The Ohio State University, Columbus, OH, USA
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Lip Height Improvement during the First Year of Unilateral Complete Cleft Lip Repair Using Cutting Extended Mohler Technique. PLASTIC SURGERY INTERNATIONAL 2012; 2012:206481. [PMID: 23316354 PMCID: PMC3539341 DOI: 10.1155/2012/206481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023]
Abstract
Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were 24% ± 9% in T1 and 8% ± 6% in T2 (P < 0.01). The average lip height asymmetry in the noncleft individuals was 4.52% ± 1.89%. Conclusion. Since all principles to obtain a symmetrical Cupid's bow were performed, the postoperative pull-up of Cupid's bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery.
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Mosmuller DGM, Griot JPWD, Bijnen CL, Niessen FB. Scoring systems of cleft-related facial deformities: a review of literature. Cleft Palate Craniofac J 2012; 50:286-96. [PMID: 23030761 DOI: 10.1597/11-207] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : There is a need for an internationally agreed objective method of assessing cleft-related deformities in order to compare the results of individual surgeons and different surgical techniques or to determine the optimal timing for primary lip closure. To assess the current methods, an overview of the recent developments in postoperative scoring systems of cleft-related deformities was made. Methods : A Medline search from June 2003 through July 2011 was conducted, and references in the selected articles were checked. This search yielded 428 articles, and after application of the inclusion and exclusion criteria, 40 articles were included in this review. Results : Twenty-five studies used two-dimensional (2D) photographs for the assessment of cleft-related deformities. Fourteen of these studies used a subjective method for the assessment and 11 performed anthropometric measurements. Good reliability has been found for subjective assessments and measurements from 2D photographs. Fifteen studies assessed three-dimensional (3D) imaging. Conclusions : Although there is a wide variety in study design, 3D imaging seems most reliable in assessing cleft-related facial deformities. However, scoring on 2D photographs is easier to perform and more applicable in daily practice because all cleft patients are photographed through the course of their treatment.
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Knežević P, Grgurević L, Uglešić V, Grgurević J. Modified Millard's technique in operations for unilateral cleft lip. J Plast Surg Hand Surg 2012; 46:326-9. [DOI: 10.3109/2000656x.2012.713573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE OF REVIEW To provide a concise review of recent articles on rhinoplasty approaches for cleft nasal deformity and nasal hemangiomas published in 2008-2010. RECENT FINDINGS Cleft nasal deformity rhinoplasty approaches have undergone further refinements as well as new development in techniques and surgical principles to minimize recurrent cleft nasal deformities. There is a paucity of studies addressing cleft septal deformity although there appears to be a greater emphasis on functional outcome in cleft rhinoplasty. Complications from primary cleft rhinoplasty and presurgical nasoalveolar molding were also reported. Similarly, nasal hemangioma rhinoplasty approaches have undergone further modifications with open rhinoplasty and subunit approaches gaining wider acceptance. SUMMARY There are several new studies that compare different rhinoplasty techniques to determine which approaches offer superior surgical outcomes; however, there needs to be a greater acceptance of objective measurements when assessing surgical results to identify a uniform surgical protocol and technique for both cleft rhinoplasty and nasal hemangiomas.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:577-81. [DOI: 10.1097/moo.0b013e328340ea77] [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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