Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Repair of Unilateral Cleft Lip and Nose: Mulliken's Modification of Rotation Advancement

편측 구순열비의 교정술: Rotation Advancement 원칙에 근거한 Mulliken의 방법

  • Jung, Young-Soo (Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry) ;
  • Lee, Gyu-Tae (Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry) ;
  • Jung, Hwi-Dong (Department of Oral and Maxillofacial Surgery, Oral Science Research Center, Yonsei University College of Dentistry) ;
  • Mulliken, John B. (Department of Plastic and Oral Surgery, Children's Hospital Boston)
  • 정영수 (연세대학교 치과대학/치의학전문대학원 구강악안면외과학교실, 구강과학연구소) ;
  • 이규태 (연세대학교 치과대학/치의학전문대학원 구강악안면외과학교실, 구강과학연구소) ;
  • 정휘동 (연세대학교 치과대학/치의학전문대학원 구강악안면외과학교실, 구강과학연구소) ;
  • Received : 2012.02.14
  • Accepted : 2012.03.20
  • Published : 2012.03.30
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Abstract

This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.

모든 환자들은 구순접합술을 시행 받았고 구순 및 구개열 유아들은 악정형장치인 Latham을 사용하였다. 수술의 기술적 변화들은 앞서 설명하였다. Columella 부위의 높은 rotation과 releasing incision은 내측 입술 부위를 충분히 길게 해주고, advancement flap이 phitral column 상방으로 최소로 침범되게 하여 균형적인 입술을 만들 수 있다. 또한 구륜근을 외번시켜 philtral ridge를 형성하고, 작은 unilimb Z-plasty을 구순측 Cupid's bow handle 높이에 맞게 시행 후, vermilion-cutaneous junction에서부터 상방으로 cutaneous closure 시행한다. 변위된 alar cartilage는 nostril rim incision을 통해 동측 upper lateral cartilage에 매달며, Alar base는 anterior-caudal septum의 위치, sill의 설정 그리고 외측 vestibular web 제거를 포함하여 3차원적으로 설계하여 치료해야 한다. 이번에 소개한 Mulliken의 치료법이 환자들과 외과의사들에게 많은 도움이 되기를 바란다.

Keywords

References

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