Cleft rhinoplasty columellar lengthening: Comparison of techniques

Nasal deformity in bilateral cleft lip and palate (BCLP) correction is highly challenging. Several solution has been proposed. The aim of the present study is to assess qualitatively and quantitatively the results of Cronin's flap, Fork flap, and Abbe's flap for BCLP rhinoplasty at a follow-up period. Materials and Methods: Records of all BCLP rhinoplasty performed between 2010 and 2016, fulfilling inclusion and exclusion criteria were collected. From records, qualitative improvement and previously described methods of quantification of columella length were performed. These collected data were analyzed with descriptive statistics, Chi-square tests, and one-way analysis of variance tests. P ≤ 0.05 was taken as statistically significant. Results: Forty-eight cases fulfilled the criteria of which 31 patients had Abbe's flap, 9 Cronin, and 8 forked flaps. The mean age of the study population was 20.33 ± 4.94 years in 21 females and 27 males with a mean follow-up of 15.3 ± 2.3 months. The success of the lengthening of columella at immediate postoperative period as compared to the preoperative columella length was not statistically different (P = 0.176) between the three flaps, while the same was statistically different at 1-year period (P = 0.031). The extent of change was very minimal for the Abbe flap with a high degree of statistical significance (P = 0.000). At 1-year postoperative period, 83.9% (n = 26) of Abbe flap patients felt their nose to be good after surgery while the same was 55.6% (n = 5) in Cronin flap design and 37.5% (n = 3) in forked flap design (P = 0.007). Discussion and Conclusion: Abbe flap gave the best results under most of the common BCLP rhinoplasty, and a flap choice algorithm for choice of flap was arrived based on this experience.

Clinical efficacy of different operative techniques for reconstruction of vermilion tubercle after primary repair of cleft lip / 中华医学美学美容杂志

Objective To evaluate the clinical repair effects of the reconstruction of different vermilion tubercle after primary cleft lip repair.Methods According to the tight lip deformity and dif ferent degrees of defect of the vermilion tubercle and exposing the gums and the crown of the anterior incisors,178 patients after primary repair of the cleft lip from Department of Oral and Maxillofacial Surgery of Xiangya Hospital,Central South University were classified into the tight lip deformity and four grades of whistling deformities.According to different deformities and defects,the different operative techniques were used as follows:classic Abbé flap and modified Abbé flap were used for tight lip deformity;the bilateral advanced myomucosal flaps of lip were used for the grade Ⅰ;modified Abbé flap was used for repairing the grade Ⅱ and the grade Ⅲ whistling deformities;for grade Ⅳ whistling deformity,we mainly used classic Abbé flap.The follow-up after operation was performed,all patient's Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip were observed.The scarring of the upper lip was also observed.Results The follow-up after operation was performed from six months to ninteen years,all the 187 patient's anatomical structures of the upper lip were nearly normal after recovery.The all patients showed an obvious Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip.The relation of the upper lip and lower lip was harmonious.The scarring of the upper lip was not obvious 2 years after operation.Conclusions The different repair methods are chosen to repair different deformity and defect that has an important clinical value.

Transoral Cross-Lip (Abbé-Estlander) Flap as a Viable and Effective Reconstructive Option in Middle Lower Lip Defect Reconstruction

The Abbé-Estlander flap surgery is a cross-lip procedure that is valuable in repairing a defect on the lower lip using a full-thickness flap, consisting of the skin, muscle and mucosa, from the upper lip. As usefulness and practicality of the flap in reconstruction of lower lip surgical defects in Asian ethnicity have not been documented, the authors present a case of successful lower lip reconstruction with a staged, Abbé-Estlander lip switching flap with commissuroplasty as an illustrative example. A 71-year-old male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1.5×2 cm across its long and short axes. Wide excision of the tumor was followed by delineation of the triangular Abbé-Estlander flap from the upper lip, in which the medial hinge point of the base was chosen as the pedicle. Then, the flap elevation was carried out from the lateral commissure and then was transferred into the lower lip defect. Three weeks later, commissuroplasty was performed to correct the rounding at the new commissure. The patient is currently performing his daily activities with no apparent compromise in orbicularis oris strength or oral continence. Given the size of the primary defect and the flap-to-defect ratio of size, the degree of microstomia was acceptable. Even with other myriad of reconstructive options at surgeons' disposal, the Abbé-Estlander lip-switching flap is a reliable, and less morbid method of lower lip reconstruction for Asian surgical candidates. The authors illustrate an exemplary case in which a relatively large lower lip defect was successfully repaired using an upper lip flap of a significantly smaller size in an Asian subject of advanced age, without any remarkable long term sequelae which have traditionally been associated with the trans-oral lip switching flap technique.

Retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap.

Background: The Abbe’s flap is most commonly used to repair the full thickness defects of the lip that do not involve the commissure. The Abbe flap was first introduced to correct the secondary deformity of bilateral cleft lip. By this pedicled flap, we are able to equalize the disparity which existed between the tight upper lip and excessive lower lip. Aims to study retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap. Methods: 29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery. 29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery. Results: Out of 29 patients with secondary cleft deformities 12 were male and 17 were female. Average follow up period was 3 years. Multiple variables of the nose and the lips were used to assess the aesthetic outcome of Abbe’s flap. Conclusion: As per the subjective retrospective analysis of our study we have come to the conclusion that Abbe’s flap is a work horse for correction of shortage of tissue for the secondary cleft lip deformities. Uniform satisfactory outcome was obtained with a more natural contour and more satisfactory proportion of both lips.

Clinical application of modified Abbe flap in repair of moderate defects of the upper lip / 中华医学美学美容杂志

Objective To evaluate the application of modified Abbe flap in repairing moderate defects of the upper lip and time point to divide the pedicle.Methods Classic Abbe flap was modified in its design,pedicle cutting and dividing time,which was used to repair moderate defect of the upper lip in 12 cases.Surgery was divided into two phases:one with modified Abbe flap surgery was performed for the combined nasal deformity repair simultaneously,and then the pedicle was divided 9days after surgery.Results 12 patients underwent modified Abbe flap.No vascular complications were found in these flaps.Upper lip shape was well and satisfactory functional recovery,corresponding improvement in nasal appearance.Conclusions The surgery that the modified Abbe flap with the pedicle is divided 9 days after surgery is very simple.On one hand,it greatly improves the patient's appearance and function of the upper lip,improve the overall shape of midface,on the other hand,dividing pedicle time is significantly shorter than in the past,specially reducing the suffering of patients and duration.It is particularly suitable for unilateral and bilateral cleft lip of the upper lip on secondary moderate deformities and combined nasal deformities.

Correction of secondary cleft-lip nasal deformity by using Abbe flap: Report of 4 cases

Vermilion Reconstruction with Mucosal Island Flap

The purpose of this article is to review the method using the mucosal island flap for the reconstruction of upper and lower lip defect and introduce its versatile applications and advantages. This flap is based on the inferior labial artery as the axial pedicle and is composed of musosa only, excluding muscle to give a sufficient rotation arc of the flap. Mucosal island flap is effective for the reconstruction of vermilion, because the mucosa of the flap is similar to the lip, with its color and texture matched well. Four patients with various large defects of vermilion underwent the reconstruction with mucosal island flaps. Two patients were presented with venous malformations and others were admitted with lip deformities caused by traffic accident or operation for basal cell carcinoma. Elevation of flap is simple and safe in maintenance with the interdental wire fixation to prevent the pedicle from being stretched and, primary closure is available in donor site under local anesthesia. Therefore, mucosal island flap can be recommended as an effective and reliable method for the reconstruction of over one-third defect of vermilion.

Abbe Flap to Correct Tight Upper Lip Resulting from Secondary Deformities of Unilateral and Bilateral Cleft Lip

An Abbe cross-lip flap can be used when there is a deficiency of upper lip tissue and a disproportion between the upper and lower lip. This flap is particularly useful when reproduction of a central fullness or pout in the upper lip is desired. It should be designed to mimic the missing or deformed philtrum. A total of 21 cases of tight upper lip resulting from secondary deformities of unilateral and bilateral cleft lip were treated using the Abbe cross-lip flap(11 cases were unilateral and 10 cases were bilateral). In conclusion, advantages of Abbe cross-lip flap are as followings: 1)It is very efficacious to correct the tight upper lip 2)Widening of upper lip and simultaneous narrowing of lower lip can correct a disproportion between the upper and lower lip. 3)Central flap can recreate a philtrum like effect. 4)There was no significant scar problems in lower lip donor site. 5)In case of combined maxillary retrusion, best results were obtained after orthodontic and/or orthognatic treatment.