A Reconstruction of Upper Lip using Abbe Flap

Reconstruction of upper lip defects presents a challenge to the facial plastic and reconstructive surgeons. Flatness, shortness, and retrusion of the upper lip of cleft patients are caused by a combination of the initial maxillary hypoplasia, the subnormal maxillary growth, and the lack of upper lip soft tissue. Although the routine use of Abbe flaps has been questioned, various modifications of the flap have been used for the repair of deficient upper lip soft tissue. Between 1991 and 2000, the author performed a variety of Abbe flaps in 10 patients. The patients consisted of 5 males and 5 females (3 unilateral clefts, 3 bilateral clefts, 2 cancers and 2 traumas). Mean age at the time of the procedures was 28.5 years (from 16 to 48 years). The pedicles of the flaps were divided 10 to 14 days postoperatively. The follow-up period ranged from 9 to 27 months (mean=17 months). To evaluate the outcome of Abbe flaps objectively, an anthropometic ratio was measured in preoperative and postoperative photographs. This values were compared with the values found in non-cleft patients. Each patient showed a more natural contour of the upper lip. We have found that Abbe flaps were clinically useful, and our results were functionally and cosmetically acceptable. This study indicates that the lips are in better harmony postoperatively than they were preoperatively.

Surgical Correction of Microform Cleft Lip by Small Triangular Flap

Cleft lip is one of the most common major facial malformation. The defect of the midline tissue on the upper lip is due to failure of the contact and fusion between mesenchymal tissues of the lip. Microform cleft lip is defined as the cleft of the lip with the minor degree of the deformity on the lip and the nose. The hallmarks of the microform cleft lip are a small notching of the vermilion, a vertical congenital fibrous band extending from the vermilion to the nostril floor, and a displaced alar cartilage on the cleft side. The surgical methods of microform cleft lip include Rose-Thomson straight line closure and Millard Rotation- advancement repair. Although those methods repaired the functional impairment effectively, they failed to achieve the cosmetic improvement because of the long incision scar on the upper lip. The authors applied Tennison's small triangular flap to the microform cleft lips of the 10 patients from July 1998 to January 2001. We excised the scar on the notch of the vermilion with minimal incision using Tennison's small triangular flap and repaired the discontinuity of orbicularis oris musculture. The asymmetric nostrils were also corrected appropriately. We followed up each case with constant intervals and could get good results esthetically without shortening of the upper lip and the contracture of the scar band.

Development and Clinical Application of Critical Pathway for Cleft Lip and Palate

Objectives of this study is to determine the effect of a critical pathway on hospital stays and outcomes after cleft lip and palate repair. During a period of eleven months from March 2000 to January 2001, twenty six cases to applied by critical pathway for cleft lip and palate were followed up. Comparisions were made between the precritical pathway and postcritical pathway groups. The results of this study showed that expenses of treatment for cleft lip and palate was reduced to 20%, 30% respectively, after critical pathway. After critical pathway, hospital stays for cleft lip and palate was reduced to from 7 days to 4 days, from 9 days to 6 days, respectively. Postoperative complications was not increased. Patient satisfactions was increased because of the detailed explanations and reduced hospital stays. Conclusively, significant decreases in length of hospital stay are seen, and cost reductions can be realized after critical pathway.