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OBJECTIVES@#The long-term effect of muscular force balance reconstruction technique combined with intranasal fixation for correcting secondary nasolabial deformity after unilateral cleft lip was evaluated. The aim was to provide a basis for further improving the surgical treatment effect of secondary nasolabial deformity of acleft lip.@*METHODS@#A total of 40 patients aged 4-28 years with secondary nasal deformity and unilateral cleft lip were selected as research subjects. The two-dimensional photo measurement analysis method was used in comparing the surgical results before and immediately after the operation (7 d) and 1 year after the operation.@*RESULTS@#Columellar angle, nostril height ratio (NHR), alar rim angle, alar rim angle ratio, and nostril shape (NS) increased dimmediately after the operation, whereas alar base width ratio (ABWR) and nostril width ratio decreased (NHR) immediately after the operation (P<0.01). The ABWR, NHR, and NS immediately after the operation were not significantly different from those 1 year after the operation (P>0.05).@*CONCLUSIONS@#Muscular force balance reconstruction technique combined with intranasal fixation is effective in the repair of unilateral secondary nasolabial deformity, and stable results can be obtained 1 year after surgery.
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Humans , Cleft Lip/surgery , Nose/abnormalities , Rhinoplasty/methods , Treatment OutcomeABSTRACT
Objective:To evaluate the short time outcome about repairing of lateral incomplete cleft lip with two different treatments: new rotation advancement technique and Tennison technique.Methods:Twenty-seven cases of lateral incomplete cleft lip were repaired by the two different treatments, and 12 indexes were employed to evaluate the short time outcome of post-operation.Results:All the patients who were treated with the new rotation advancement technique and Tennison technique in this study obtained satisfactory lip and nasal symmetry immediately. There was no significant difference between the two techniques in the treatment of the patients with unilateral incomplete cleft lip.Conclusions:Though the new rotation advancement technique does not show the obvious improvements about repairing of lateral incomplete cleft lip, invisible incision and keeping the nostril sill will definitely benefit the patients because of reducing the risk of more scars.
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OBJECTIVES@#Short-term outcome evaluation for the correction of unilateral cleft lip deformity with a new technique.@*METHODS@#Forty-four patients with unilateral cleft lip deformity were included in the study and in which the orbicularis oris muscle was reconstructed to achieve the optimal force balance of reconstructed orbicularis oris. The photometric two-dimensional indexes, including the philtrum oblique angle and asymmetry ratios (lip height, lip width, vertical distance from the white roll to the vermilion bottom at the Cupid's bow point, and vertical distance from the Cupid 's bow points to facial midline), were employed to measure and evaluate the outcome.@*RESULTS@#Several indexes showed statistically significant difference, and they included the philtrum oblique angle, asymmetry ratio of the lip height, and asymmetry ratio of the vertical distance from the white roll to the vermilion bottom at Cupid ' s bow points (@*CONCLUSIONS@#The results suggested that the new muscle reconstruction technique can significantly improve the short-term outcome of the correction of unilateral cleft lip deformity.
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Humans , Cleft Lip/surgery , Facial Muscles/surgery , Lip , Mouth Mucosa , Plastic Surgery ProceduresABSTRACT
OBJECTIVES@#This study aimed to compare the postoperative outcome of the new and classical muscular reconstruction technique combined with nasal internal-fixation method for secondary deformity post unilateral cleft lip repair. A rationale is provided for the further surgical improvement of secondary deformities.@*METHODS@#Sixty patients aged 4-18 years with secondary unilateral cleft lip-nose deformity were involved in this research. The deformities of 28 patients were repaired using the muscular force balance technique through nasal internal fixation method, and 32 were repaired using classical muscular reconstruction technique. Two-dimensional analysis was used to evaluate the nose-lip morphology of pre- and post-operative patients through standardized photographs seven days after surgery.@*RESULTS@#Compared with preoperative nasal morphology in the muscular force balance technique group, the 7-days postoperative results of this group showed the significantly improved short-term outcomes in the correction of columellar deflection, alar rim angle, nasal shape, and the symmetry of alar base width, nostril width, nostril height, alar rim angle (@*CONCLUSIONS@#The new muscular reconstruction technique with nasal internal-fixation method has a significant effect on nasal repair.
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Humans , Cleft Lip/surgery , Nose/surgery , Postoperative Period , Rhinoplasty , Treatment OutcomeABSTRACT
Objective@#This study is to investigate the outcome of unilateral cleft lip repairment using trilobate flap and nasal-labial muscle tension system reconstruction.@*Methods@#From January 2015 to December 2017, 264 children with unilateral cleft lip were performed cheiloplasty. For all the patients, trilobate flap was adopted. The tension lines group among nasal-labial muscles were reconstructed following a three-dimensional pattern. Long-term results were evaluated using postoperative photos. Three measurements were collected, to compare the nasolabial contour on the cleft side and noncleft side.@*Results@#Six to 12 months follow-up was completed in 112 patients. Asymmetry percentage of lip height was (2.98±1.65)%, while nostril width ratio was 1.02±0.05, and nostril height ratio was 0.94±0.04. Aesthetic contour of vermillion and philtrum were satisfied.@*Conclusions@#Trilobate flap technique combined with the reconstruction of nasal-labial muscle tension system have reliable effect on unilateral cleft lip repair. With proper application, satisfactory and stable outcomes can be achieved.
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OBJECTIVES: The outcomes of the treatment of unilateral cleft lip can vary considerably due to variations in repair techniques. The aim of this study was to evaluate and compare treatment outcomes of surgical repair of unilateral cleft lip using either the Tennison–Randall or Millard technique based on (qualitative) parent/subject and professional assessments. MATERIALS AND METHODS: This was a prospective, randomized, controlled study conducted at Lagos University Teaching Hospital between January 2013 and July 2014. A total of 56 subjects with unilateral cleft lip presenting for primary surgery who satisfied the inclusion criteria were recruited for the study. Subjects were randomly allocated to surgical groups A or B through balloting. Group A underwent cleft repair with the Tennison–Randall technique, while group B underwent cleft repair with the Millard rotation advancement technique. Surgical outcome was assessed using qualitative evaluation by the guardian/subject and independent assessors based on a modified form of the criteria described by Christofides and colleagues. RESULTS: Of the 56 subjects enrolled in this study, 32 were male, with a male to female ratio of 1.3:1. Fifteen of the guardians/subjects in the Tennison–Randall group were most bothered about the lower part of the residual lip scar, while 12 guardians/subjects in the in the Millard group were most bothered about the upper part of the scar. More noses were judged to be flattened in the Millard group than in the Tennison–Randall group. Assessors observed a striking disparity in scar transgression of the philtral ridges between the two groups. CONCLUSION: Essentially, there were no major difference in the overall results between Millard rotation-advancement and Tennison–Randall repairs. Both Millard and Tennison–Randall's techniques require significant improvements to improve the appearance of the scar on the upper part and lower part of the lip, respectively.
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Female , Humans , Male , Cicatrix , Cleft Lip , Evaluation Studies as Topic , Hospitals, Teaching , Lip , Nose , Prospective Studies , Strikes, Employee , Treatment OutcomeABSTRACT
Objective To explore the comprehensive approach and efficacy of secondary unilateral cleft rhinoplasty by using autologous costal cartilage grafts.Methods Secondary rhinoplasty was performed in 28 patients with unilateral cleft-lip nasal deformity.The costal cartilage was harvested through a mini-invasive incision.Septal deviation was corrected,and nasal tip framework was reconstructed with the autologous costal cartilage through direct transcolumellar incision.Diced cartilage fragments were used to augment the depressed alar base.Nasolabial muscles were repositioned to restore the balance of muscular tension system.Results The appearance of the nasal deformity was greatly improved in all the 28 cases postoperatively by follow-up from 3 to 12 months.Increased stability and symmetry of the nasal tip,along with the improvement of nasal breathing function was achieved and sustained effectively.Conclusions Definitive secondary unilateral cleft rhinoplasty using autologous costal cartilage grafts provides good aesthetic and functional results.
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Objective To observe the clinical effects of unilateral cleft lip repairmen via improved Millard technique. Methods 64 cases of patients with unilateral cleft lip were collected from July 2014 to June 2015. The traditional Millard technique was improved by moving traditional fixed point of columella nasi to close with the lateral nasal columella roots,and the moving range was adjusted according to the nasal columella deformity and nostril size. Meanwhile ,the nasal floor and the alar basal incisions were not designed. Instead ,fully free of affected side orbicularis oris muscles were applied to making apposition suture with the healthy side. Results It showed that anatomic form of the upper lip and the philtral column of patients ,whose unilateral cleft lips were repaired by the improved Millard technique,were normal,and both sides of the lip peak were basically symmetrical after 1 ~ 12 month(s)follow-up. Conclusions Compared with the traditional Millard technique,the improved technique could bring a better effect on appearance of the patients. And it will be one of the ideal repairing techniques for unilateral cleft lip.
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Objective To explore the effect of reconstructing unilateral cleft lip by changing the arc-shaped incision, combined with the 3D reconstruction of upper lip muscles.Methods Twenty unilateral cleft lip patients were treated by using a new surgical operation, the 3D reconstruction of upper lip muscle, to restore normal anatomy and stress of the mucous membrane, muscle and skin.Operation scar was designed for straight line, located on the philtral ridges of the contour line;phitrum and philtral ridges were rebuilt, and postoperative scar reduced.Results A lot of 20 patients had no local infection, hemorrhage, complex crack, and were stage I incision healing.Followed up for 1-8 months postoperatively, the patient's lip bow line continuity was good, with symmetrical shape and good phitrum and philtral ridges;scar was hidden on the philtral ridges of the contour line, and no obvious upper lip scar contracture found through the follow-up period.Conclusions This improved method is simple in the incision design, and less scar hidden on the philtral ridges of the contour line after operation, which can maximize the recovery of the appearance of nose and upper lip with satisfactory effect.It is a feasible improvement method of repairing unilateral cleft lip.
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<p><b>OBJECTIVE</b>This study analyzed the alveolar changes of complete unilateral cleft lip (UCCL) patients after pre-surgical nasoalveolar molding (PNAM) treatment using a three-dimensional method.</p><p><b>METHODS</b>Palate impressions of thirty UCCL patients who underwent PNAM treatment in the Affiliated Stomatology Hospital of Guangxi Medical University were taken pre- and post-PNAM. The plaster impressions were scanned using cone beam computed tomography (CBCT). The DICOM files were exported and 3D models reconstructed in Mimics 15.0. The following parameters were analyzed in SPSS 17.0: cleft alveolar gap width, alveolar arch end width, upper lip frenulum-median plane distance, alveolar shift distance, and length of alveolar section.</p><p><b>RESULTS</b>After PNAM treatment, the cleft alveolar gap width and upper lip frenulum-median plane distance decreased significantly (P<0.05). No statistically significant change was observed in the alveolar arch end width (P>0.05). Alveolar shift distances for both sides increased significantly (P<0.05), and the shift distance of major alveolar sec-tion had a more significant increase than the minor alveolar section. The lengths of the alveolar section of both sides increased significantly (P<0.05) with the length of the major alveolar section increasing more significantly than the minor alveolar section.</p><p><b>CONCLUSIONS</b>The impression-CBCT method supply accurate three-dimensional data of the alveolar process. The PNAM treatment can significantly correct alveolar deformity and improve appearance.</p>
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Humans , Alveolar Process , Cleft Lip , Cleft Palate , Hospitals , Preoperative Care , UniversitiesABSTRACT
Objective To explore the differences between normotrophic and hypertrophic scars of lip after the surgical repair of the unilateral complete cleft lip in density of microvessels and the pattern of angiogenesis.Methods Hypertrophic scars (n=11) and normotrophic scars (n=20) were collected after correction of deformity of the unilateral complete cleft lip,and the tissues were stained with haematoxylin and eosin,and immunostained with anti-CD34 antibody.The structure of scar was observed and the microvessels were counted according to the CD34 expression.Using ImageJ software,the capillary density and length of the major and minor axes were measured,and the major:minor axes ratio was calculated.Results By statistical analysis of the capillary density,the length of the major and minor axes and the major:minor axes ratio were measured;we clarified that there were more capillaries in hypertrophic scars (87.91 ± 5.95)/mm2 than in normotrophic scars (49.84 ± 7.05)/mm2,(P＜0.01),and the length of the major and minor axes of hypertrophic scars (38.36± 26.36)and (17.33±10.45) μm were longer than the normotrophic scars (13.77±9.56)and (9.00± 5.14) μm,(P＜0.05.) The major:minor axes ratio of hypertrophic scars (2.85±0.57) was higher than the normotrophic scars (2.85 ± 0.57) (P＜0.01).Conclusions The significant increase in the density of microvessels and the variation in the pattern and morphology of angiogenesis are related to the formation and development of scar after operation of upper lip.
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Objective:To evaluate the effect of presurgical nasal mode(PNM)combined with nasal diorthosis in the treatment of na-sal deformity and incomplete unilateral cleft lip(IUCL)in infants.Methods:35 infants with IUCL were treated by PNM followed by nasal diorthosis and cheiloplasty.The nasal asymmetry was analysed by measurments of nostrils height,nostrils width and nasal colu-mella angle skewness on the photographs at the initial visit(T0),pre-operation(T1),1 week after operation(T2),1 month after opera-tion(T3)and a year after operation(T4).The other 35 infants with IUCL without PNM treatment were served as the controls.Re-sults:Compared with the controls,the symmetry of nostrils height,nostrils width,nasal columella angle skewness in PNM treated children were significantly improved at T0-T1 and T1-T2(P ＜0.05).there was no significant difference at T2-T3 and T3-T4(P >0. 05).Conclusion:Nasal asymmetry can be improved by presurgical nasal mode treatment followed by preliminary nasal deformity di-orthosis and cheiloplasty.
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Objective To investigate the approach and clinical efficacy of second repair surgery according to the nose and mouth contour design of unilateral cleft lip.Methods Based on the characteristics of anatomy,mechanics and deformity of the cleft lip,we designed a surgical incision of nasolabial contour lines with reference to the horizontal and central vertical lines and the contour.After careful investigation of classic procedures and clinical practice,unilateral cleft lip was repaired by overall stage Ⅱ surgical procedures.Results Application of this surgical method with satisfactory clinical efficacy had been achieved.Conclusions The second stage repair personalized surgical methods of unilateral cleft lip designed according to the nose and mouth contour can achieve maximal correction of malformation and beautiful appearance.
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Objective To design a new vermilion musculomucosal flap to reconstruct the normal appearance of unilateral cleft lip,and to analyze the clinical effects.Methods All patients were repaired with Millard method,and vermilion musculomucosal flap was formed with fixed point method to repair vermilion.Normal function and morphology were recovered by reconstructing lip beads and forming a peak of cupid's bow.Results 78 cases were enrolled in this study.They were followed-up for 6 to 36 months after operation.Except for 6 cases of nasal deformity and 5 mild lift of vermilion of affected side,67 cases obtained satisfied nasolabial form and function,with full decline and symmetry of cupid's bow peak,and well form of nasolabial fold,and natural transition of vermilion,and significance of lip beads,and inconspicuous scars.Conclusions Appling vermilion musculomucosal flap for reconstructing vermilion of unilateral cleft lip has good effect,and it is simple and feasible.It can be a regular surgery method,and is worthy of clinical promotion.
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Objective To explore the clinical methodology and effects of correction of secondary unilateral cleft lip nasaldeformity by anatomical restoration and cartilage of nasal septum.Methods With the Goodman's incision in the columella and nasal vestibule,we cut out the cartilage of nasal septum and built a new support structure of tip to reshape the nasal shape after the adequate anatomical restoration under the magnifier of 2.5 times.Results The operation corrected alanasi collapse skewed columella and nostrils symmetry,etc.21 cases were treated and followed up for a month and fifteen months,showing stablized effect with columella centerno alanasi collapse,symmetric nostril and no recurrence.Conclusions On the base of nasal anatomy,a good therapeutic effect has been archeived by the adequate anatomical restoration,cutting out the cartilage of nasal septum and builting a new support structure of tip to reshape the nasal shape.
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Objective To correct the nasal deformities of cleft lip by expanded-polytetrafluoroe thylene (e-PTFE) combined with autologous nasal septal cartilage.Methods e-PTFE was placed nearby verge of anterior nasal aperture to raise the fundament of nose.Autologous nasal septal cartilage was harvested and combined with e-PTFE to form a sandwich structure.Nasal tip and collapsed nasaI alar were repaired by this method.Results Fifty cases were treated by this method and 42 cases were followed up for about one year.The results were satisfying.The contour of the nose was similar to normal.Only 3 cases were relapsed after one year.Conclusions e-PTFE combined with autologous nasal septal cartilage is an ideal method to correct nasal deformities of cleft lip.
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Objective To explore the clinical methodology and comparative analysis of both autogenous septum cartilagineum nasi or Medpor surgical implant in secondary unilateral cleft lip rhinoplasty.Methods Thirty-six patients with varied secondary nasal deformities of unilateral cleft lip were treated,autogenous septum cartilagineum nasi or Medpor surgical implant were implanted to supply the powerful supporting strength for nasal constructions.An anthropometry method based on the quantitative analysis of the characteristics of nasal deformity was used to evaluate and compare the preoperative and postoperative measure of the patients.Results After 6 to 24 months follow-up,all 36 cases received satisfactory results.20 of them used autologous septum cartilagineum nasi to supply the powerful supporting strength for nasal construcions,and other used Medpor surgical implant.No rejection and exposure of implants were found.The postoperative quantitative measurement results supported that both of the implants could effectively correct nasal deformities.Conclusions Both of the implants could effectively correct nasal deformities of unilateral cleft lip in secondary rhinoplasties.The quantitative measurement is a scientific approach to evaluate the outcome.
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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).
Subject(s)
Humans , Male , Cleft Lip , Nasal Cartilages , Pediatric Dentistry , Orthopedics , Alveolar Process , Tissue Expansion , Esthetics , FungiABSTRACT