3D finite element analysis of the influence of upper lip pressure on the maxilla for patients with unilateral alveolar cleft / 口腔疾病防治

Objective @#To investigate the biomechanical effects of upper lip pressure on the maxilla in patients with a unilateral alveolar cleft and provide evidence for clinical diagnosis and treatment. @*Methods @#A 3D finite element maxillary model was generated based on cone beam CT (CBCT) data from an 11-year-old female patient with a unilateral alveolar cleft. Two different kinds of upper lip pressure, postsurgery pressure and normal pressure, were applied to the model. The displacement and stress of each reference node were compared and analyzed. @*Results @# By loading upper lip pressure, the maxillary alveolar crest rotated toward the defect and was displaced downward and backward. The displacement of the noncleft side was greater than that of the cleft side and it decreased gradually from the anterior to the posterior. The stress was concentrated on the anterior portion of the alveolar crest. The stress on the noncleft side was greater than that on the cleft side and it decreased gradually from the anterior to the posterior. The maximum stress was concentrated on the palate around the defect. The displacement and stress in the postsurgery group were greater than those of the normal group (P<0.05). @*Conclusion @#By loading upper lip pressure, the maxilla demonstrated asymmetry three-dimensionally. The adverse effects on the maxilla could be mitigated by reducing the upper lip pressure.

Importance of various skin sutures in cheiloplasty of cleft lip

Last week, after our receiving online journal regarding Journal of the Korean Association of Oral and Maxillofacial Surgeons, we found a recently published original article by Alawode et al., entitled “A comparative study of immediate wound healing complications following cleft lip repair using either absorbable or non-absorbable skin sutures”. Although this clinical article was well written and provided a great deal of information regarding the suture materials in the cleft lip repair, I would like to add a few additional comments based on the importance of skin suture during cheiloplasties in the primary cleft lip or secondary revision patients with representative figures.

Application of a new kind of dressing in an infectious wound care after cheiloplaty:a case report / 中国实用护理杂志

Objective To research the application of a new kind of dressing in infectious wounds care after cheiloplasty. Methods Moist wound healing therapy was applied in treating one patient with wound infection after cheiloplasty, different novel dressings were selected and the operating mode of integrated medical care was adopted for treatment. Results The wound was healing by second intention after treatment, and such treatment was associated with comfortable patient experience during dressing change, short treatment time, mild scar, excellent overall therapeutic effects, high patient and family member satisfaction. Conclusions The application of novel dressing has provided a new treatment scheme for clinical treatment of wound infection after cheiloplasty.

Regional anesthesia for maxillofacial surgery in developing countries

Regional anesthesia in the maxillofacial region is safer and more efficient than general anesthesia when its indications are carefully considered. In addition, the majority of medical institutions in developing countries are not well equipped for proper anesthesia and elective surgery. In this review, we describe regional anesthesia and cutaneous nerve divisions in the maxillofacial region. In addition, we summarize detailed regional anesthetic techniques adapted for representative cleft lip cases in developing countries.

Application of multimodal analgesia of ropivacaine combined with dezocine in cheiloplasty of children and evaluation on its postoperative analgesia efficacy / 吉林大学学报(医学版)

Objective: To discuss the postoperative analgesia efficacy of multimodal analgesia of ropivacaine combined with dezocine, and to illuminate the feasibility of multimodal analgesia in the children undergoing cheiloplasty.Methods:In the randomized, controlled and double blind study, sixty children scheduled for cheiloplasty were randomly divided into ropivacaine group,dezocine group and multimodal analgesia group (n=20). The children in ropivacaine group and multimodal analgesia group were treated with infraobital nerve blockade (1.5 mL 0.25% ropivacaine)before skin incision.The children in dezocine group received the same volume of normal saline. The patients in dezocine group and the multimodal analgesia group received dezocine (0.15 mg·kg-1 )20 min before the end of operation, and the children in ropivacaine group received the same volume of normal saline.The children’s ages and weights,duration of anesthesia and operation, reviving and extubation time,agitation score and incidence,laryngospasm or bronchospasm,CRIES scores at 2,4,6,8,12, and 24 h after operation and adverse reactions were all recorded.Results:There were no significant differences in the age,weight,the duration of anesthesia and operation of the children between three groups (P >0.05).Compared with ropivacaine group,the reviving and extubation time of the children in dezocine group and multimodal analgesia group were increased (P 0.05).There were no laryngospasm or bronchospasm occured in all groups.The CRIES score at 2 h after operation of the children in multimodal analgesia group was the lowest and there were significant differences compared with other two groups (P 0.05).There were no significant differences in the CRIES scores at 8,12,and 24 h after operation between three groups (P > 0.05).Compared with other two groups,the incidence of tachycardia and the cases using analgesic in multimodal analgesia group were the lowest,and there were significant differences compared with other two groups (P < 0.05 ).There was no respiratory inhibition in all groups.Conclusion:The multimodal analgesia of ropivacaine combined with dezocine can effectively prolong the postoperative analgesia duration and reduce adverse reactions, and it can be safely used in the postoperative analgesia in the children undergoing cheiloplasty.

Tratamiento quirúrgico de la hendidura labial en las primeras 24 horas del nacimiento / Surgical treatment of cleft lip in the first 24 hours of birth

OBJETIVO: Evaluar los resultados de la cirugía realizada en las primeras 24 horas de vida en niños con hendidura labial. MÉTODOS: Presentamos una serie de 40 pacientes en los últimos veinte (20) años, operados de hendidura labial bajo anestesia local dentro de las primeras 24 horas de vida. Previo a la intervención quirúrgica evaluamos las condiciones físicas y los análisis de laboratorio del recién nacido, constatándose que no había ningún elemento de importancia en el examen físico ni en las cifras de hematología y química sanguínea, que impidiera la realización de la cirugía. RESULTADOS: Encontramos en los pacientes un estado de relajación que favoreció la realización de la intervención quirúrgica y valores de hemoglobina, que oscilaron entre los 16 y 19,58 g y de glóbulos rojos que sobrepasaron los 5 000 000 x mm³. A todos los pacientes intervenidos se les practicó la evaluación preoperatoria por el neonatólogo quien reportó cifras de peso, talla y circunferencia cefálica dentro de los límites normales. En ninguno de los casos se reportó patología asociada. Desde los 6 meses a los15 años se comprobó un normal crecimiento del labio, de la nariz y de los segmentos maxilares, con un resultado estético y funcional satisfactorio. CONCLUSIÓN: La cirugía del labio hendido en las primeras 24 horas del nacimiento con anestesia local constituye un reto para los cirujanos que se dedican a este tipo de cirugía y su realización precoz tiene múltiples ventajas.

OBJECTIVE: To evaluate the results of the surgery in the first 24 hours of life in children with cleft lip. METHODS: We present a series of 40 patients in the last twenty (20) years, operated for cleft lip under local anesthesia in the first 24 hours of life. Prior to surgery we evaluate the physical conditions and laboratory analysis of the newborn, confirming that there was no element of importance on physical examination or hematology and blood chemistry figures, which contraindicate the completion of surgery. RESULTS: We found in patients in a state of relaxation that favored performing surgery and hemoglobin, which ranged between 16 and 19.58 g of red blood cells exceeded 5 million x mm³. All operated patients underwent preoperative evaluation by the neonatologist who reported figures for weight, length and head circumference within normal limits. In none of the cases associated pathology was reported. From 6 months to age of 15 years old it was found normal growth lip, nose and jaw segments, with satisfactory aesthetic and functional results. CONCLUSION: Cleft lip surgery in the first 24 hours of birth under local anesthesia is a challenge for surgeons who are engaged in this type of surgery and its early implementation has multiple advantages.

Anthropometric Analysis of Unilateral Cleft Lip Patient

Primary Cleft Lip Repair Using the "Delaire" Technique

Deformities related with cleft lip are not only limited to the cleft site but also extended to all around the nasolabial region. Facial development is composed of several complex processes as the formation, migration, coalescence and interaction of separate fields. When there is a cleft event, it means there are general problems of those processes. As a result facial elements should have displacement, deformation and functional hypotrophy. These also affect the mucocutaneous structures, which result in the typical deformities of cleft lip. Traditional surgical methods are not sufficient of the correction of functional impairments in the cleft lip. Accordingly, there are relatively high possibilities of occurring secondary deformities. The Delaire's method focuses on repair of functional impairment of the cleft. Consequently, it can maintain the initial good surgical result and avoid the unnecessary incision scar. And this method can minimize secondary nasal deformities which can reduce the risk of additional nasal correction. Therefore authors introduce this advantageous the Delaire technique cheliolplasty which it can be widely used for the cleft lip correction in Korea.

Dovetail Cheiloplasty

The widely prevailing Millard's rotation-advancement flap method is characterizes with the upper lip scar on a philtral column and that it is less conspicuous than LeMesurier's or Tennison's metheds. Nowadays, straight line closure methods are employed together with the Millard's. However there are still some problems which are a straight line closure that goes against the principle of plastic surgery, a noticeable scar, tenting of the peak of Cupid's bow, a short lip tendency, and depression of the lip when the muscle contracts. In this respect, we designed two or three small trapezoid skin flaps on the cleft side and the same number of releasing incision lines on the non-cleft side and then let them interdigitate one another. We called it dovetail cheiloplasty. The muscle work was done by suturing one third of the cleft side muscle to the dissected dermis of the non-cleft side skin flap just under the philtral dimple. Our patients had a primary incomplete, a microform type cleft lip or a secondary cleft lip deformity. The result of employing this method showed an inconspicuous scar, a shorter lip, and a natural formation of the philtrum. We believe this method induces the improvement of straight line closure with respect to the quality of scars and the morphology of an upper lip.

Effect of presurgical nasoalveolar molding (PNAM) appliance and cheiloplasty on alveolar molding of complete unilateral cleft lip and palate patients / 대한치과교정학회지

The goal of the present study was to evaluate the effects of PNAM appliance and cheiloplasty on alveolar molding. Samples consisted of 16 unilateral cleft lip and palate infants (10 males and 6 female, mean age=37.0 days after birth, average alveolar cleft gap=10.46 mm), who were treated with PNAM appliances by one orthodontist and rotation- advancement cheiloplasty by one surgeon in Seoul National University Hospital. Average duration of alveolar molding treatment was 13.10 weeks and these patients were recalled at average 8.31 weeks after cheiloplasty. These patients' models were obtained at initial visit (T0, mean age : 37.0+/-27.89 days after birth), after successful alveolar molding (T1, mean age : 119.25+/-40.18 days after birth), and after cheilopasty (T2, mean age : 190.81+/-42.78 days after birth). Seven linear and five angular variables were measured using 1 : 1 photometry and soft ware program(V-ceph. Cybermed, Seoul, Korea). Paired t-test was performed to investigate statistical significance at p < 0.05 level. 1. The posterior parts of alveolar segments were the stable structures during alveolar molding treatment period and after cheiloplasty in infants. 2. The closure of cleft gap during alveolar molding was usually due to backward bending of the whole part of the greater segment. 3. Although forward growth of the greater segment was hindered by alveolar molding, it resumed after cheiloplasty. 4. Increase of anterior inter-segment angle after cheiloplasty was due to the molding effect of the lip scar pressuren

Preoperative Nasal Molding and Unilateral Cleft Lip Repair By Mohler'S Technique

Various techniques of unilateral cleft lip repair are being developed. Nowadays, rotation-advancement flap technique is most widely used for the repair of unilateral cleft lip. This procedure places a premium on the conservation of tissue and preservation of natural landmarks. Millard's technique however occasionally can produce a scar that crosses the philtrum obliquely in the upper third of the philtral unit. In Mohler's technique, the marking of the medial segment has been altered in uppermost portion by utilizing tissue from the columellar base. That is to say, cutback on columellar tissue is utilized at approximately 90 degrees. After full-thickness release of the medial lip segment, the C flap is advanced into donor defect of the columellar base and is also used to lengthen the shortened columella. This results in the placement of a scar that will simulate the mirror image of the non-involved phitral column. And another advantage of this technique is the possibility of primary nasal correction including wide dissection of alar cartilage through cutback incision on columellar base without need of additional incision for nasal dissection. In addition, preoperative nasal molding was performed with a special NAM(nasoalveolar molding) appliance by orthodontist during preoperative period. The authors performed 27 cases of the correction of the unilateral cleft lip using this technique between July 2000 and December 2001. All the patients showed satisfactory results by achieving enough rotation of medial lip segment without scar that crosses the philtral column and satisfactory correction of primary nasal deformity.

Anatomical reconstructiion of orbicularis oris muscle in the repair of cleft lip / 实用口腔医学杂志

objective: To design a new technique which might be used to reconstruct the orbicularis oris muscle effectively. Methods: The superficial and deep layers of orbicularis oris muscle on the lateral side of the cleft were dissected and sutured to the correspondent layers on the medial side respectively. A small muscle flap from the medial nasal labial bundle below the columella was rotated laterally and sutured with the nasal bundle on the lateral side in 10 cases of cleft lip. Results: Satisfactory results were obtained in all the cases. The postoperative scar was minimal. The lip appearance was satisfactory at rest as well as in motion. Conclusion: This technique is effective in reconstruction the orbicularis oris muscle of cleft lip.

A Case of Cheilitis Granulomatosa / 대한피부과학회지

Cheilitis granulomatosa, which is a rare inflammatory disorder of unknown origin, was described by Miescher in 1945. A 31-year-old man presented with swelling of both lips without any subjective symptom that had been present for 1 year. The patient had the repeated episodes of upper lip which would resolve in days to weeks that had ended up involving lower lip and eventually persistent. Histopathological study revealed a noncaseating granulomatous inflammation with perivascular lymphocytic infiltration. The patient was treated with systemic steroids and received cheiloplasty. We describe a case of cheilitis granulomatosa improved with systemic steroids and the cheiloplasty.

Individual operation design for unilateral cleft lip repair / 实用口腔医学杂志

Objective:To evaluate the effectiveness of individual operative design for unilateral cleft lip repair.Methods:Individual operation design was applied for the repair of unilateral cleft lip in 40 cases.The operations were conducted according the designs and the secondary nasal deformities were corrected at the same time.One week after operation,dermal sutures were removed,the effects were evaluated by 3 professional doctors.7 labial morphometric lines were measured.The ratio of the line length on healthy side to the correspondence on the cleft side(RLL)were calculated for objective evaluation.Results:First intention was found in all cases,the labial bow of both sides was symmetried after operation.In dynamic state and static state,the effects of the operations were satisfactory.RLL of 0.91-1.10 of the 7 lines was observed in 67.5%-95.0% of the patients.Conclusion:The individual operation design is feasible for unilateral cleft lip repair.

Cleft lip in adults and infants

Cheiloplasty done in infancy has its advantages and disadvantages. It moulds better the defective structures; and in the absence of a cleft palate, nasal twang is avoided. If, however, nasal twang is unavoidable due to the presence of a cleft lip and palate, we still have the psycho-somatic factor to consider. The inferiority complex which invariably accompanies these structural defects disappears more easilyOn the other hand, cheiloplasty done in adults offers the surgeon the advantage of dealing with bigger structures. (Summary)