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Li L, Liao L, Zhong Y, Li Y, Xiang L, Li W. Variation trends of the postoperative outcomes for unilateral cleft lip patients by modified Mohler and Tennison-Randall cheiloplasties. J Craniomaxillofac Surg 2016; 44:1786-1795. [PMID: 27720276 DOI: 10.1016/j.jcms.2016.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate postoperative variation trends of unilateral cleft lip by stages, and to analyze influential factors of nasolabial symmetry. MATERIALS AND METHODS A total of 145 patients with unilateral cleft lip were treated by the modified Mohler or Tennison-Randall technique, and received routine anti-scarring treatment postoperatively. Photogrammetry was applied to respectively measure 5 indices by stages preoperatively, the first week (1 w), the third month (3 m), the sixth month (6 m), and the first year (1 y) postoperatively. Then we calculated the symmetry ratio and drew line charts. Student t tests were used for any group differences; linear regression analysis was used to examine which postoperative stage correlated best with the preoperative stage; cluster analysis was used to classify the severity of the cleft according to preoperative SRsn-cphi, which was used to predict the operative difficulty and to select an appropriate technique. RESULTS The Mohler technique yielded a more symmetric result. With the Tennison-Randall technique, the alar base was more lateral and downward, and the lip height on cleft side seemed longer. A stable effect emerged around 1 year after surgery with both techniques. Conspicuous scars appeared at 3 months, most scars gradually fade at 6 months, and the total evolution took around 1 year. Scars from the Mohler technique fluctuated across a larger range. Preoperative SRsn-cphi of the two techniques had statistical significance and was adopted as the basis for cluster analysis. The critical value was 0.670. The Mohler technique attained an almost identical effect in each interval, whereas the Tennison-Randall technique was better in the interval that SRsn-cphi <0.670. CONCLUSIONS Preoperative SRsn-cphi can be the evaluation index of severity; the modified Mohler technique is more broadly applicable to differences in severity than is the Tennison-Randall technique.
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Affiliation(s)
- Liqi Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Lishu Liao
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuxiang Zhong
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Yuangui Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Li Xiang
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China
| | - Wanshan Li
- Oral Department, Children's Hospital, Chongqing Medical University, Chongqing, PR China.
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Symmetry in nasolabial area of UCCL patients one year after primary lip repair with modified Millard technique. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S11-8. [DOI: 10.1016/j.tripleo.2011.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 07/13/2011] [Accepted: 08/12/2011] [Indexed: 11/23/2022]
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Assessment of deformities of the lip and nose in cleft lip alveolus and palate patients by a rating scale. J Maxillofac Oral Surg 2011; 11:38-46. [PMID: 23449402 DOI: 10.1007/s12663-011-0298-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Labial and nasal deformities have always been a fundamental problem in the treatment of cleft lip, alveolus and palate patients. The primary surgical treatment of nasolabial area is of paramount importance in order to obtain both an esthetical correction of the deformity and a progressive and a balanced development of mid-face. In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analyzed and the relevant role of the perinasal, perioral muscular balance and the inborn dislocation of the alar cartilages are presented. PATIENTS AND METHODS 50 CLAP patients were analyzed, 40 UCLP and 10BCLP. The lip repair was done by modification of Millard's technique. The severity of the cleft appearance was evaluated pre and post operatively, according to a pre-agreed visual rating scale. There are 4° of severity of the deformity pre operatively (mild, moderate, severe and very severe) and post operatively 5 categories of outcome (excellent,very good, good, satisfactory and poor), depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. RESULTS In the 40 UCLP patients, 8 excellent, 10 very good, 16 good and 6 satisfactory results were obtained following primary cheiloplasty. In 10 BCLP patients 1 very good, 7 good, 1 satisfactory and 1 poor result were obtained. CONCLUSIONS During the primary repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. Abnormalities in the insertion of the nasolabial muscles with their abnormal function contribute to the cleft nose deformities. Therefore the reconstruction not only the orbicularis muscle but also of the paranasal muscles is therefore important for a symmetrical growth of the nose. Separate suture of intrinsic orbicularis oris provide a better shape to the vermillion. The position of the alar cartilage plays an important role for the symmetry of the nose. It is necessary to place the alar base symmetrically in three dimensions.
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Abstract
BACKGROUND The purpose of this study was to assess and compare nasal symmetry in patients who underwent correction of a complete unilateral cleft lip using the Afroze incision without and with primary septoplasty using a standardized two-dimensional photographic analysis. METHODS A prospective cohort study of 190 consecutive patients with complete unilateral cleft lip and alveolus with cleft palate treated with or without septoplasty using the Afroze incision technique was conducted at a high-volume center. Eighty-two patients operated on without primary septoplasty and 76 patients operated on with primary septoplasty were evaluated. Nasal symmetry was compared between patients using two-dimensional photographic analysis. Ratios between the cleft side and the non–cleft side for five parameters were used to assess symmetry: alar base–to–interpupillary line distance, columella-to–Cupid's bow distance, nostril gap area, nostril width, and nostril height. The Mann-Whitney U test was used to calculate differences between the two groups. RESULTS Patients operated on with primary septoplasty showed more nasal symmetry compared with patients operated on without septoplasty. This difference was statistically significant for columella-to–Cupid's bow distance, nostril gap area, and nostril height (p = 0.008, p < 0.001, and p < 0.001, respectively) and for the distance between alar base and the alar base–to–interpupillary line distance (p = 0.145) the difference was present but not statistically significant. For nostril width, no difference was found (p = 0.850). CONCLUSION Patients treated with primary septoplasty showed better results in terms of nasal symmetry when analyzed using two-dimensional photographic analyses.
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Campbell A, Costello BJ, Ruiz RL. Cleft lip and palate surgery: an update of clinical outcomes for primary repair. Oral Maxillofac Surg Clin North Am 2010; 22:43-58. [PMID: 20159477 DOI: 10.1016/j.coms.2009.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. In the United States, current estimates place the prevalence of cleft lip and palate or isolated cleft lip at approximately 1 in 600. There is significant phenotypic variation in the specific presentation of facial clefts. Understanding outcome data is important when making clinical decisions for patients with clefts. This article provides an update on current primary cleft lip and palate outcome data.
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Affiliation(s)
- Andrew Campbell
- Division of Craniofacial and Cleft Surgery, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3471 Fifth Avenue, Suite 1112, Pittsburgh, PA 15213, USA
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Kulewicz M, Dudkiewicz Z. Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study. Int J Oral Maxillofac Surg 2010; 39:122-8. [PMID: 20083389 DOI: 10.1016/j.ijom.2009.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 10/05/2009] [Accepted: 12/16/2009] [Indexed: 11/15/2022]
Abstract
This study compared craniofacial morphology between three groups of children with complete unilateral cleft lip and palate, treated with different surgical protocols. The study included 66 10-year-old children (42 boys and 20 girls) with a complete unilateral cleft lip and palate (22 patients in each of the three groups). Children aged 7 months underwent one-stage surgery, performed by a single surgeon. During surgery, the soft and hard palate and the lip underwent correction. The difference between the groups depended on the hard palate closure. Group I patients had the mucoperiosteal flap elevated on both sides of the cleft. Group II patients had the mucoperiosteal flap elevated on the non-cleft side, and had only a minimal 2-3mm mucoperiosteal flap elevated on the cleft side. Group III patients had mucoperiostium elevated from the septum vomer to create a single-layered caudally pedicled flap, and had only a minimal 2-3mm palatal flap elevated on the cleft side. Craniofacial morphology was defined using lateral cephalometric analysis. Significant craniofacial morphological differences were identified between groups I, II and III. Group III demonstrated the most favourable morphology. This indicates that the technique of hard palate closure has significant influence on craniofacial growth and development.
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Fudalej P, Katsaros C, Bongaarts C, Dudkiewicz Z, Kuijpers-Jagtman AM. Nasolabial esthetics in children with complete unilateral cleft lip and palate after 1- versus 3-stage treatment protocols. J Oral Maxillofac Surg 2009; 67:1661-6. [PMID: 19615579 DOI: 10.1016/j.joms.2009.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 04/04/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Facial esthetics play an important role in social interactions. However, children with a repaired complete unilateral cleft lip and palate usually show some disfigurement of the nasolabial area. To date, few studies have assessed the nasolabial appearance after different treatment protocols. The aim of the present study was to compare the nasolabial esthetics after 1- and 3-stage treatment protocols. MATERIALS AND METHODS Four components of the nasolabial appearance (nasal form, nasal deviation, mucocutaneous junction, and profile view) were assessed by 4 raters in 108 consecutively treated children who had undergone either 1-stage closure (Warsaw group, 41 boys and 19 girls, mean age 10.8 years, SD 2.0) or 3-stage (Nijmegen group, 30 boys and 18 girls, mean age 8.9 years, SD 0.7). A 5-grade esthetic index of Asher-McDade was used, in which grade 1 indicates the most esthetic and grade 5 the least esthetic outcome. RESULTS The nasal form was judged the least esthetic in both groups and graded 3.1 (SD 1.1) and 3.2 (SD 1.1). The nasal deviation, mucocutaneous junction, and profile view were scored from 2.1 (SD 0.8) to 2.3 (SD 1.0) in both groups. The treatment outcome after the Warsaw and Nijmegen protocols was comparable. Neither overall nor any of the 4 components of the nasolabial appearance showed intercenter differences (P > .1). CONCLUSIONS The nasolabial appearance after the Warsaw (1-stage) and Nijmegen (3-stage) protocols was comparable. The technique of lip repair (triangular flap in Warsaw and Millard rotation advancement in Nijmegen) gave comparable results for the esthetics of the nasolabial area.
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Affiliation(s)
- Piotr Fudalej
- Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland.
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Affiliation(s)
- Ladi Doonquah
- Section of Otorhinolaryngology, Department of Surgery, University Hospital of the West Indies, Kingston, Jamaica; Private Practice, Oral and Maxillofacial Surgery, Suite 230, 3490 Piedmont Road, Atlanta, GA 30305, USA
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Powar RS, M Patil S, Kleinman ME. A geometrically sound technique of vermilion repair in unilateral cleft lip. J Plast Reconstr Aesthet Surg 2007; 60:422-5. [PMID: 17349599 DOI: 10.1016/j.bjps.2005.11.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2004] [Revised: 11/17/2005] [Accepted: 11/27/2005] [Indexed: 11/22/2022]
Abstract
In unilateral cleft lip, there is always a deficiency of vermilion on the medial side of the cleft, which can be augmented by techniques using excess vermilion from the lateral side of the cleft, like the use of a simple V-advancement flap. We developed a modification of Noordhoff's lateral vermilion flap that preserves the parallel relationship of the muco-vermilion line and the white roll but improves results in unilateral cleft lip patients. In a study of 30 patients undergoing surgical repair of complete unilateral cleft lip, we found that this method offers a superior alternative to the straight-line repair. This geometrically sound technique for vermilion reconstruction offers the cleft surgeon a simple and effective method for augmenting total lip height and creating a normal appearing Cupid's bow.
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Affiliation(s)
- Rajesh S Powar
- Department of Plastic and Reconstructive Surgery, KLE Society Hospital and Medical Research Centre, Nehru Nagar, Belgaum 590 010, Karnataka, India.
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Rullo R, Carinci F, Mazzarella N, Festa VM, Farina A, Morano D, Carls F, Gombos F. Delaire's cheilorhinoplasty: unilateral cleft aesthetic outcome scored according to the EUROCLEFT guidelines. Int J Pediatr Otorhinolaryngol 2006; 70:463-8. [PMID: 16157390 DOI: 10.1016/j.ijporl.2005.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 07/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of our study is to evaluate, in accordance with EUROCLEFT guidelines, the aesthetics of nasolabial area in a sample of complete unilateral cleft of lip and palate patients (UCLP), after surgical correction with Delaire' technique. METHODS Twenty-two UCLP patients (16 males and 6 females, 9 right and 13 left side clefts) were enrolled in this retrospective study. Patients were operated at 7 (mean value) months of age by a single surgeon. Frontal and sub-mental photos for each baby were recorded at 8.5 (mean value) years of age, and evaluated twice, by three independent maxillofacial surgeons. A five-point scale (EUROCLEFT guidelines) was used. Nonparametric analysis (Kruskal-Wallis test) was applied to detect differences in medians obtained in studied groups. RESULTS Kruskal-Wallis test showed no statistical significant differences among evaluations of three surgeons and between the first and the second evaluation of the same surgeon. The global appearance of the upper lip and nose was scored with a mean value of 2 (i.e. good). The sample was then divided into two subgroups, according with patient' age; the aesthetics and the symmetry of the nose resulted better in elder patients (i.e. subgroup A, mean period of observation=10.2 years), whereas upper lip achieved better results in younger patients (i.e. subgroup B, mean period of observation=4.9 years). CONCLUSIONS EUROCLEFT guidelines are a useful method to evaluate--aesthetically and over time--cleft lip and palate patients, treated with a single surgical procedure. We hypothesize that Delaire technique could progressively improve aesthetics and symmetry of the nose, throughout the growth of the patient.
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Affiliation(s)
- Rosario Rullo
- Dental Clinic, Second University of Naples, Via De Crecchio, 80138 Napoli, Italy.
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Swennen G, Berten JL, Schliephake H, Treutlein C, Dempf R, Malevez C, De MA. Midfacial morphology in children with unilateral cleft lip and palate treated by different surgical protocols. Int J Oral Maxillofac Surg 2002; 31:13-22. [PMID: 11936395 DOI: 10.1054/ijom.2001.0177] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to compare cranio-facial, particularly midfacial morphology, in two groups of children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centres (Hannover. Germany and Brussels, Belgium) following different surgical treatment protocols. A total of 62 children (40 males; 22 females) with non-syndromic UCLP were included in this study at approximately the age of 10. The Hannover group comprised 36 children, who had repair of the lip at a mean age of 5.83 +/- 1.16 months, followed by repair of the hard and soft palate at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months. respectively. The Brussels group consisted of 26 children who underwent surgical treatment according to the Malek protocol: the soft palate was closed at a mean age of 3.04 +/- 0.20 months, followed by simultaneous repair of the lip and hard palate at a mean age of 6.15 +/- 0.68 months. Midfacial morphology was evaluated by means of cephalometric analysis according to Ross. The children in the Hannover UCLP group did not differ significantly from those in the Brussels group in the anteroposterior dimension of the midface. However, the maxillary plane was significantly more open in the Brussels group due to less posterior vertical maxillary development.
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Affiliation(s)
- G Swennen
- Department of Oral and Maxillofacial Surgery, Medical University, Hannover, Germany.
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Prahl-Andersen, D.D.S., Ph.D B. Dental Treatment of Predental and Infant Patients with Clefts and Craniofacial Anomalies. Cleft Palate Craniofac J 2000. [DOI: 10.1597/1545-1569(2000)037<0528:dtopai>2.0.co;2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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