Bilateral cleft lip repair with simultaneous premaxillary setback and primary limited rhinoplasty / 대한악안면성형재건외과학회지

BACKGROUND: Functional closure of the orbicularis oris muscle and esthetic reconstruction of nasolabial components are impossible in patients with severely deformed premaxilla. Here, we review a surgical strategy for patients with unremedied premaxilla retrospectively. RESULTS: Vomerine ostectomy and premaxillary setback with nasolabial repair were performed in 12 patients with bilateral cleft lip and palate. The mean age of patients was 21.7 months. The extent of ostectomy varied between 3 and 11 mm. There were no serious complications from defective perfusion to the premaxilla or the philtral flap. The follow-up period ranged from 2 to 25 months. Proper positioning of the premaxilla and satisfactory nasolabial esthetics were achieved in all patients. CONCLUSIONS: We performed nasolabial repair after premaxillary setback without jeopardizing the premaxillary segment or the philtral flap. Our surgical strategy could be recommended in poor socio-economic circumstances due to the cost effectiveness of limiting the number of surgeries.

Amniotic constriction band: a report of two cases with unique clinical presentations

Amniotic constriction band is a rare clinical entity with varied manifestations that range from a combination of congenital malformations to isolated malformations that are unique to each patient. The etiology of this entity remains unknown. Herein, we highlight two cases of amniotic constriction band that presented to our unit with unique clinical characteristics. To the best of our knowledge, an isolated circumferential band of scarring on the face with ocular involvement, as demonstrated by the first case, and a combination of bilateral complete cleft lip and palate with bilateral microphthalmia, auto-amputation of the right thumb, and a constriction band on the left thumb, as demonstrated by the second case, are extremely rare presentations of amniotic constriction band that were not previously reported in the literature and therefore necessitate a special mention. We discuss potential etiologies for these cases and review the existing literature on this entity.

Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on superior border of bilateral nostril / 中华医学美学美容杂志

Objective To introduce the method of lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril.Methods We adopted the method of using the skin cartilaginous tissue flaps on the superior border of bilateral nostril associated with alar cartilages reduction to lengthen the columella in 40 patients with severe secondary bilateral cleft lip nasal deformity.All patients were followed up for 5-28 months,with an average period of 15.3 months.The treatment outcomes were evaluated by a questionnaire in postoperative follow-up.Results All the 40 patients had achieved satisfactory lengthening of columella and there were no major complications.The questionnaire results showed 36 patients with excellent and 4 patients with good.Conclusions Lengthening the columella of severe secondary bilateral cleft lip nasal deformity by using skin cartilaginous tissue flaps on the superior border of bilateral nostril is a relatively simple and safe method with good effect.

Bilateral cleft lip and palate, hypertelorism with agenesis of corpus callosum.

Agenesis of corpus callosum (ACC) can have various development abnormalities spectrum. These include delay in milestones to complex neuropsychiatric manifestations. Following case report highlights the case of a young infant presenting with associated features including bilateral cleft lip and palate and hypertelorism. The kid was refused treatment at several centers owing to the central nervous system abnormality. This case reports highlight the ACC as a comorbid diagnosis in cleft lip and palate patient with hypertelorism perhaps owing to ignorance and fear of this apparently innocuous congenital malformation.

Clinical study of staged surgery technique in repairing bilateral mixed cleft lip / 安徽医科大学学报

8 cases of children with bilateral mixed cleft lip were repaired by two staged surgeries .Results showed that the incision of the two staged surgeries was healed in phase Ⅰ.After the second -staged surgery, the height of bilateral lips was almost symmetrical, the bilateral nostrils had good symmetry and the red lip had natural form .The research shows that the operational effect of the repair for bilateral mixed cleft lip is good by two staged surgeries . The method can be accepted by the children 's family, it is worth promoting.

Repair of bilateral cleft lip and nose by the Mulliken method: a case report

The simultaneous surgical correction of bilateral cleft lip and nasal deformity has become a more common surgical technique that has greatly changed conventional strategies for secondary nasal correction. Mulliken has been known as one of the earliest proponents for the synchronous repair of bilateral cleft lip and nasal deformity, and he emphasized the responsibility of the treating surgeon to evaluate nasolabial growth by comparing anthropometric measurements with age-matched normal patients. Good outcomes from this surgical method have been reported in clinical cases worldwide. Herein, we describe the management of two cases of bilateral cleft repair, following the principles and methods established by Mulliken. We also provide a relevant review of the literature.

Pre-surgical infant orthopedics with the nasoalveolar molding (NAM) device for unilateral and bilateral cleft lip and palate: Case series

Management of infants born with cleft lip and palate entails an interdisciplinary team effort that begins from infancy to adulthood. The goal of pre-surgical infant orthopedics is to reduce the severity of the cleft deformity before surgery. However, traditional methods do not address the deformity of the nasal cartilages and alveolar ridges simultaneously. The Nasoalveolar Molding (NAM) technique takes advantage of the malleability of immature nasal cartilage and its ability to maintain a permanent correction of its form. The NAM device is used to actively mold the alar dome, nasal cartilages, premaxilla, and alveolar ridges into a more normal anatomic form and position. It permits non-surgical elongation of the columella through application of tissue expansion principles. This results in better facial aesthetics and may help reduce the extent, number and cost of surgeries. The three cases presented illustrate the application of the NAM device for the pre-surgical infant orthopedics in unilateral and bilateral cleft lip and palate patients treated at the Philippine Children's Medical Center-Pediatric Dentistry Division (PCMC-PDD).

Simultaneous repair of bilateral complete cleft lip nose: ten-year follow-up results / 中华医学美学美容杂志

Objective To explore the method to correct nasal deformity of the bilateral complete cleft lip and to eveluate the benefits of this teachnique.Methods Sixteen patients with the bilateral complete cleft lip were consecutively chosen to correct the nasal deformity of the bilateral complete cleft lip.We performed an open approach to facilitate alar cartilage manipulation while repairing the bilateral complete cleft lip,and elevated the prolabial flap for reconstructing the continuity of orbicularis oris musele artery by anatomizing and protecting the prolabial-columellar artery.Nasal columella length and wideth,nasal wideth,ratio of nasal length to face length,ratio of nasal wideth to the distence of nasolabial angle were analyzed after a minimum of 10 years after surgery.These were compared with those in a normal,age-matched control group.Results Appreance of nose and lip of 16 patients after surgery were satisfying and long-term results were good by following-up for 10 years.Columellar length and ratio of nasal length to face length were not significantly different from that of the control group.Nasal wideth,columella wideth,tip projetion and nasolabial angle were all significantly greater in the cleft group than the normal (P＜0.05).Conclusions Prolabial flap manipulation is a safe approach by using anatomizing the columellar-labial artery.This teachnique is effective and yields good long-term results.

Labio leporino bilateral: tratamiento quirúrgico / Bilateral cleft lip: surgical treatment

En este trabajo presentamos nuestra experiencia en el tratamiento quirúrgico de un paciente con Labio Leporino Bilateral con seguimiento postoperatorio de 3 años. El tratamiento incluye disecar delicadas estructuras anatómicas labiales y realinear elementos distorsionados y teniendo como meta conseguir una apariencia facial y succión normales.

In this paper we present our experience in the surgical treatment of a patient with Bilateral Cleft Lip with 3 years of postoperative control. The treatment includes to dissect delicate anatomical structures of the lip and thus achieve a realignment of the distorted elements andto reach a normal facial appearance and mouth suction.

Formation of Cupid's Bow and Vermilion Tubercle using Inferior-Based Lip Skin Flap in a Secondary Bilateral Cleft Lip Deformity

The author presents a new method for the formation of Cupid's bow and the vermilion tubercle by using the inferior-based lip skin flap in a secondary bilateral cleft lip deformity. The length of the flap includes the entire length of the previous upper lip scar. Both skin flaps are elevated and turned down toward the central part of the vermilion. The distant portion of the turned-down skin flaps are deepithelialized and trimmed according to the new shape of Cupid's bow. The deepithelialized portions of both flaps are buried under the central vermilion mucosa in order to create the vermilion tubercle.

Functional treatment for severe bilateral cleft lip with improved straight line closure / 实用口腔医学杂志

Objective: To explore the operation method and clinical effect of treatment for bilateral cleft lip with improved straight line closure. Methods: On the basis of straight line closure, the vermilion and anterior lip pear were repaired with the muscle-vermilion labial flap of lateral lip. In order to close nasal floor, flap-C from lateral wall of anterior lip and flap-G from nasal wing base were designed, meanwhile, nasal mucosa flap-D and flap-H from two sides of nasal base fissure were designed. The function of the orbicularis oris was repaired by cutting off the anomaly adhesion of the orbicularis oris. Results: The post-operational upper lip was thickened together with good shape and vermilion color, there was no obvious dynamic abnormality, nasal floor was closed well. Conclusion: The improved straight line closure can obtain good shape of lip, reduce the whistling deformities, oronasal fistula and dynamic abnormality.

Rehabilitación temprana de los maxilares en pacientes con labio y paladar hendido bilateral utilizando un dispositivo ortopédico dinámico intraoral, cinta adhesiva labial y gingivoperiosteoplastia: estudio piloto experimental / Early maxillary rehabilitation of bilateral cleft lip and palate patients using an intraoral dynamic orthopedic appliance, lip tape adhesion and gingivoperiosteoplasty: experimental pilot study

Introducción: el objetivo fue corroborar la respuesta ortopédica de los componentes alveolares al dispositivo ortopédico dinámico intraoral propuesto en el estudio piloto realizado por el mismo grupo investigador, combinado con la utilización de una cinta adhesiva sobre el labio y la gingivoperiosteoplastia (GPP) en una población colombiana. Métodos: denueve pacientes con LPHB entre los cinco y diez meses de edad, se seleccionaron seis pacientes, cuatro hombres y dos mujeres. Se les implantó el dispositivo dinámico y la cinta adhesiva durante un promedio de 3,5 semanas. Después de obtener el resultado ortopédico se les realizó la GPP y la rinoqueiloplastia primaria. Se obtuvieron modelos maxilares antes y después del tratamiento ortopédico, donde se tomaron medidas directamente con un calibrador digital y se compararon entre sí. Se evaluó la formación ósea cualitativamente con tomografías computarizadas, seis meses después de realizada la GPP. Se les hizo análisis estadístico descriptivo. Resultados: en todos los pacientes se logró retracción óptima de la premaxila. Cuatro de los seis pacientes requirieron expansión anterior. Hubo neoformación ósea en los ocho sitios donde se realizó la GPP. Conclusiones: el uso del dispositivo ortopédico dinámico y la cinta adhesiva sobre el labio permite disminuir las discrepancias entre los segmentos maxilares enpacientes con LPHB. La gingivoperiosteoplastia hecha en este esquema de tratamiento actúa como un procedimiento osteoinductor que propicia la neoformación ósea. Se corroboraron los hallazgos del estudio piloto realizado por el mismo grupo investigador y representa una opción terapéutica para pacientes con LPHB en nuestra comunidad.

Introduction: the purpose of this study was to corroborate the orthopaedic alveolar results of dynamic orthopaedic devices used in the pilot study by the same research group, combined with the use of an adhesive tape over the lip and gingivoperiostioplasty in a Colombian population. Methods: 6 patients with complete bilateral cleft lip and palate, 4 males and 2 females were selected out of 9 patients between five and ten months of age. The dynamic orthopaedic device and the adhesive tape were used during an average time of 3.5 weeks. After obtaining the orthopaedic result, the gingivoperiostioplasty and rhinoplasty were performed. Comparisons between before and after treatment casts were analyzed with an electronic digital calliper. The boneformation was evaluated with a dental CT scan after a period of 6 months. Descriptive statistical analysis was used. Results: every patient after orthopaedic treatment retracted the premaxilla, four of the six patients studied required anterior alveolar expansion. There was bone formation in the 8 sites where the gingivoperiostioplasty was performed. Conclusion: the use of the dynamic orthopaedic device and the adhesive tape over the lip decreased the discrepancies in maxillary segments of bilateral cleft lip and palate patients. The gingivoperiosteoplasty performed in this protocol serves as an osteo-inductor suitable for bone formation. This study corroborates the pilot study by the same research group and represents a practical option for the treatment in cases with protrusion of the premaxilar in our community.

Repair of bilateral cleft lip and nose : Principles and methods of mulliken

Secondary Correction of Wide Philtral Deformity in the Bilateral Cleft Lip

PURPOSE: Deformities after bilateral cleft lip repair usually involve the philtrum and the central upper lip, which presents as wide philtrum, wide Cupid's bow, whistling deformity and prominent prolabium. The object of this study is to introduce a simple method to correct such deformities of bilateral cleft lip, that is the redo-operation following the modified Millard's method. METHODS: We present 2 patients with secondary deformities of the philtrum and central upper lip after bilateral cleft lip repair. A simple design was used to excise the excessive skin and mucosa of the central upper lip, and the philtrum and Cupid's bow were restored to the standard average width of Korean population. RESULTS: The wide central upper lip and philtrum were successfully restored to the appropriate width(10-12mm) and shape. Also the border of the red vermilion was aligned properly resulting in a good contour of the upper lip. Both patients were satisfied with the results. CONCLUSION: In patients with wide philtral deformities, our simple method can be utilized for a satisfying result.

Secondary cheilorhinoplasty of bilateral cleft lip and nose deformities

Correction of Bilateral Cleft Lip Using Modified Noordhoff Technique

PURPOSE: The authors accessed the anthropometric measurements of fourty non-cleft normal a three-month- old infant and using this obtained data as a basic guideline, authors applied the modified Noordhoff technique for the treatment of bilateral cleft lip. METHODS: Over a period of 10 years, a total of 21 bilateral cleft lips were operated. 13 cases of complete and 8 cases of incomplete bilateral cleft lip and palate. In the complete type of bilateral cleft palate, elastic head cap and passive intraoral appliance were applied at 1 to 2 week of age for 2 months duration. The definitive cheiloplasty was performed at 3 months of age using the modified Noordhoff technique. RESULTS: After a follow-up period ranging one to nine years, most patients presented with cosmetically and functionally satisfying results, with an exception of two cases where an undesired peaking effect of the vermilion and dimpling of the vermilion mucosa was encountered. CONCLUSION: Accessing the anthropometric measurements of fourty non-cleft normal three-month-old infant and using this obtained dara as a guideline, the modified Noordhoff technique can be applied to either complete or incomplete bilaterally cleft lip providing more naturally pleasing and cosmetically satisfying scars that lie in harmony with the philtral ridges, lip tubercle positioned just below the vermilion and a distinct white line and Cupid's bow.

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.

Aesthetic correction of secondary nasal deformity following treatment of bilateral cleft lip / 实用口腔医学杂志

objective: To improve the repair technique of secondary nasal deformity following surgical treatment in the patients with bilateral cleft lip. Methods: 12 cases were treated with the operation technique: bilateral vermilion flaps were inserted into prolabial for the enlongation of upper lip and "V Y incision suture" principle was employed to repaire the nasal deformity. Results: Satisfactory results were achieved in all the 12 cases. Conclusion: The technique is feasible in the reconstruction of Cupid's bow, philtrum and correction of nasal and labia deformities.

Correction of Complete Bilateral Cleft Lip with Noordhoff Method: Problems and Solutions

Bilateral cleft lip shows various clinical characteristics and the typical bilateral complete cleft lip usually features prominent premaxilla, short columella, non-protruded nasal tip, flared alar base and asymmetrical alar cartilage. The prolabium is usually short and demonstrate total absence of oricularis oris muscle. Therefore a satisfactory reconstruction of the lip in both the functional and cosmetic aspect is very difficult, especially in philtral column, columella, and nasal portion. Various techniques of cleft lip repair are being developed. The staged repair of bilateral cleft lip, one side and then the other, has been superseded by simultaneous/symmetrical repair of both sides that also included complete muscular closure. And by Mulliken1 and Cutting2,3, simultaneous/symmetrical repair also has been changed to one stage repair of bilateral complete cleft lip together with nasal deformity correction. The authors performed one stage closure by means of Noordhoff method without presurgical orthopedics, which provided simultaneous/symmetrical repair including complete muscular closure and at the same time reproduced the tubercle and Cupid's bow by using both lateral lip segment. There were some problems after surgical repair. First, short or absent columella were inevitably present which could be corrected by columellar lengthening. Secondly in complete cleft lip without cleft palate, there is persistent protruding of the premaxilla and finally resultant scar widening of the cupid's bow and philtral column, which could be corrected by orthognathic surgery. But these procedures are only secondary solutions for correction of already-made deformity. We demonstrated problems and their solutions in the performance of the Noordhoff method and introduced Cutting's presurgical nasoalveolar molding as a fundamental solution2,3.

Analysis of alveolar molding effects in infants with bilateral cleft lip and palate when treated with pre-surgical naso-alveolar molding appliance / 대한치과교정학회지

The goals of this study were 1) to present pre-surgical naso-alveolar molding(PNAM) appliance for bilateral cleft lip and palate treatment and 2) To evaluate the effects of the PNAM appliance on the alveolar molding of the premaxilla and the lateral segments. Subjects consisted of 8 bilateral cleft lip and palate infants (7 males and 1 female, mean age at first visit = 61.6 days after birth) who were treated with PNAM appliances in Department of Orthodontics, Seoul National University Dental Hospital. Average alveolar cleft gap between the premaxilla and lateral segment was 8.09+/- 5.03mm and average duration of alveolar molding treatment was 8.8+/-3.1weeks. These patients' models were obtained at initial visit (T0) and after alveolar molding (T1). 20 linear and 14 angular variables were measured by using photometry and digital caliper. All statistical analyses were performed by Microsoft Excel 97 program. Paired t-test was used to discriminate the effect of alveolar molding by PNAM appliance. 1. Closure of the alveolar cleft gap in bilateral cleft cases by molding therapy was completed successfully. 2. Alveolar molding inhibited outward growth of lateral segments and produced inward bending of lateral segments. 3. By bending the anterior part of the vomer, the premaxilla could be rotated and moved posteriorly via alveolar molding. Conclusion : This appliance can be applied to bilateral cleft lip and palate infants with satisfactory result before cheiloplasty.