ABSTRACT
The facial morphology of 2 groups of complete unilateral cleft lip and palate children (n = 75), ranging in age from 4 to 7 years old, were retrospectively studied cephalometrically before the beginning of the orthodontic treatment. Each group was submitted to a different surgical protocol. The control group was comprised of 53 children (33 males and 20 females) and was treated according to the surgical protocol of the Hospital for Rehabilitation of Craniofacial Anomalies (HRCA) from the University of São Paulo, in Bauru, Brazil. Lip repair was performed between 3 months and 27 months of age (mean age of 9 months) and palate repair between 12 months and 44 months of age (mean age of 19 months). The experimental group was comprised of 22 children (12 males and 10 females). They were treated with Malek's surgical protocol, modified at the HRCA, with lip and soft palate repair at 5.5 months of age on average and hard palate repair at 20 months of age on average. The cephalometric results did not show any difference, suggesting that both surgical protocols have the same influence on facial growth, at least during the age range studied. Therefore, palate repair in 2 surgical times with earlier closure of the soft palate (Malek's protocol) did not cause greater restriction to the midface growth.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Maxillofacial Development , Oral Surgical Procedures/methods , Age Factors , Cephalometry , Child , Child, Preschool , Cleft Lip/physiopathology , Cleft Palate/physiopathology , Female , Humans , Male , Palate, Hard/surgery , Sex Factors , Treatment OutcomeABSTRACT
This paper presents the author's experience with thin (3-mm) tongue flaps used to close large anterior palatal fistulas. This technique was used successfully in 12 patients with fistulas following surgery for cleft palate. One forked flap and one mushroom-shaped flap that were used to close irregularly shaped fistulas are described. All flaps survived, and there was a partial recurrence of one fistula in only one patient. The results of this series confirm that the thin tongue flap is a safe and reliable technique for the closure of large palatal fistulas even when tailored to fit irregularly shaped defects.
Subject(s)
Fistula/surgery , Palate/surgery , Surgical Flaps/methods , Adolescent , Adult , Child , Humans , Mouth Diseases/surgery , Postoperative Complications/epidemiology , Tongue/surgeryABSTRACT
Results obtained in 70 cleft lip and palate patients who were assessed using the V.L.S. classification are presented. Of these 70 patients, 24 (34%) had had a Millard repair, 13 (19%) a straight line repair, and 33 (47%) had had a repair incorporating a Z-plasty. Both the Millard repair and the Z-plasty repair were associated with a lip of equal height in 54% of patients, whilst in the straight line repair group, 69% of patients had lips of equal height. A long lip was more often associated with the Z-plasty type repair group (27%) of patients, and short lips were more associated with Millard type repair (33%), and straight line repair (31%). Irrespective of the technique used, a notch at the site of the scar was the most common defect found at the vermilion. Wideness and irregularity were the most common unaesthetic features of the scar.
Subject(s)
Cleft Lip/surgery , Facial Asymmetry/classification , Postoperative Complications/classification , Surgery, Plastic/methods , Adolescent , Adult , Child , Child, Preschool , Cicatrix , Esthetics , Humans , Treatment OutcomeABSTRACT
A classification designed to be used as a simple and reproducible method to evaluate the residual lip deformities following unilateral cleft lip repair is presented. It was developed by analysing the appearance of the upper lips of 81 patients referred to the author with repaired unilateral clefts. The assessment of each lip was divided into 3 separate components: the vermilion (V), the lip itself (L), and the scar (S), and the resulting classification was termed the V.L.S. classification.
