• Korean Journal of Cleft Lip And Palate
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• v.8 no.1
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• pp.31-37
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• 2005

In alveolar deformity of cleft patient, the flap design is very important to make the functional and esthetic outcome. Especially in bilateral cleft alveolus with wide defect, deficiency of covering tissue is a greatest problem. Wound dehiscence may develop oronasal fistula of palatal and labial region and loss of the bone graft. We report 2 cases with bilateral cleft alveolus. In both case, bilateral buccal mucosal flap was used for closure of bilateral cleft alveolus with wide defect. The one was operated with iliac bone graft according to secondary grafting method, the other was closed without bone grafting. The patient was 3 years old. So, secondary alveolar bone graft will be required some years later for the establishment of bony continuity and esthetic advantage. In both cases, we found the entire soft tissue closure without the lack of covering flap. In these case, the closure of alveolus defect was accomplished successfully by the use of bilateral buccal mucosal flap. There was no complication, secondary fistula. The most important thing is the tension-free closure of the bilateral buccal mucosal flap. So, we report these cases with literatures.

• The korean journal of orthodontics
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• v.50 no.6
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• pp.383-390
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• 2020

Objective: To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). Methods: The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998-2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using non-parametric statistical analysis. Results: The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. Conclusions: Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

• The korean journal of orthodontics
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• v.31 no.1 s.84
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• pp.51-61
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• 2001

Cleft lip and/or palate (CLP) is one of the most common congenital craniofacial anomalies and occurs more frequently in Asian people. Dental abnormalities in number, size, shape, and eruption of teeth are frequently associated with CLP. The purposes of this study were to investigate the effects of CLP on number, size, shape and eruption of teeth and to provide basic clinical data for diagnosis and treatment of the CLP patients. With the orthodontic and cleft charts, diagnostic models, orthopantomograms and intraoral x-ray films from 241 CLP patients who visited Dept. of Orthodontics, Seoul National University Dental Hospital, we evaluated the frequency of congenital missing teeth, supernumerary teeth, Impacted teeth, and microdontia. The results were as fellows ; 1. Frequency of congenital missing was relatively high up to $56.8\%$. Congenital missing occurred frequently in the maxillary lateral incisor and the maxillary second premolar. Among the CLP types, frequencies of congenital missing in cleft lip and Palate group and cleft lip and alveolus group were higher than those of cleft lip group and cleft palate group. And bilateral cleft showed higher frequencies than unilateral ones. 2. Supernumerary tooth was shown in $11.2\%$ of CLP patients. It occurred frequently in the area between the maxillary lateral Incisors and the maxillary canine. Among the CLP types, cleft lip group showed relatively most highest frequency. 3. Impaction was shown in $18.3\%$ of CLP patients. It occurred most frequently In the maxillary lateral incisor and the maxillary canine than other teeth. Among the CLP types, cleft lip group and cleft lip and palate group showed most highest frequencies. 4. Microdontia was shown in $15.8\%$ of CLP patients. It occurred the most frequently In the maxillary lateral incisors and maxillary canines. Among the CLP types, cleft lip and alveolus group and cleft lip and palate group showed relatively higher frequencies. There was no microdontia in cleft palate group.

• The korean journal of orthodontics
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• v.29 no.6 s.77
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• pp.649-661
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• 1999

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 the lateral segment was $8.09{\pm}5.03mm$ and average duration of alveolar molding treatment was $8.8{\pm}3.1$ weeks. 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 results before cheiloplasty.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.63-70
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• 2005

Patients with cleft lip and palate usually show up maxillary hypoplasia. In these cases, a large amount of maxillary advancement is often needed to correct the severe deformity, but local soft-tissue scars around the maxilla restrict maxillary advancement and increase the relapse rate. Maxillary distraction osteogenesis is an effective method for facial and occlusal improvement in these patients. By gradually lengthening both the bones and the soft tissues, distracted midface can greatly increase postoperative stability and decrease the relapse rate. However, the maxillary extraoral appliances of the early days used were esthetically unappealing as well as difficult for the patient to manage. Recently, more inconspicuous intraoral distraction appliances have been developed and used with success. We acquired favorable result in two patients(bilateral 1 patient and unilateral 1 patient) with severe maxillary hypoplasia secondary to complete cleft lip and palate were treated with midface distraction using internal distractor (Zurich Pediatric Maxillary Distractor, KLS Martin, Tuttlingen, Germany). So, we report our experience with literatures.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.400-406
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• 2017

Background The purpose of this study was to evaluate changes in nasal growth after the implementation of a preoperative nasal retainer in patients with bilateral incomplete cleft lip. Methods Twenty-six infants with bilateral incomplete cleft lip and cleft palate were included in the study. A preoperative nasal retainer was applied in 5 patients from the time of birth to 2.6-3.5 months before primary cheiloplasty. Twenty-one patients who were treated without a preoperative nasal retainer were placed in the control group. Standard frontal, basal, and lateral view photographs were taken 3 weeks before cheiloplasty, immediately after cheiloplasty, and at the 1- and 3-year postoperative follow-up visits. The columella and nasal growth ratio and nasolabial angle were indirectly measured using photographic anthropometry. Results The ratio of columella length to nasal tip protrusion significantly increased after the implementation of a preoperative nasal retainer compared to the control group for up to 3 years postoperatively (P<0.01 for all time points). The ratios of nasal width to facial width, nasal width to intercanthal distance, columellar width to nasal width, and the nasolabial angle, for the two groups were not significantly different at any time point. Conclusions Implementation of a preoperative nasal retainer provided significant advantages for achieving columellar elongation for up to 3 years postoperatively. It is a simple, reasonable option for correcting nostril shape, preventing deformities, and guiding development of facial structures.

• The Journal of the Korean dental association
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• v.11 no.2
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• pp.117-121
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• 1973

The authors had treated 45 cases of cleft lip and cleft palate patients including 30 male patients and 15 female patients. There were 41 cases of unilateral cleft lip patients and 4 cases of bilateral cleft lip patients, and 4 cases with together cleft lips and cleft palates among the total 45 cases were showed. We had accomplished that surgical plastic closures of cleft lips and cleft palates had been performed by using of Millara's, Hagedorn's, Meyer's, LeMesurier's and Veau's methods with Z-plasty.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Proceedings of The Korean Cleft Lip And Palate Association
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• 1998.06a
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• pp.31-31
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• 1998

• The korean journal of orthodontics
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• v.49 no.5
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• pp.286-298
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• 2019

Objective: The objectives of this study were to evaluate linear and volumetric alveolar changes induced by nasoalveolar molding (NAM) in infants with complete unilateral cleft lip and palate (UCLP) and compare the maxillary dimensions after NAM with the normal dimensions in infants without clefts. Methods: A total of 26 infants with UCLP treated by NAM (mean age before and after NAM: $14.20{\pm}8.09days$ and $118.16{\pm}10.06days$, respectively) comprised the treatment group, while 26 infants without clefts (mean age: $115.81{\pm}8.71days$) comprised the control group. Changes in the maxillary dimensions following NAM were measured on three-dimensional models using Mimics software, version 17.0. Results: During NAM, there was a decrease in the cleft widths, maxillary arch depths, and rotation of the greater segment. While the anterior alveolar arch width exhibited a significant decrease, the posterior arch width was mostly maintained. There were no changes in the anterior vertical deviations of the alveolar segments. The alveolar crest lengths, arch circumference, and bilateral posterior volumetric measures exhibited an increase. After NAM, the anterior arch width was comparable between the treatment and control groups, whereas the posterior arch width and anterior vertical deviations were greater in the treatment group than in the control group. The maxillary arch depths, alveolar crest lengths, and maxillary volumes were smaller in the NAM group than in the control group. Conclusions: During NAM in infants with UCLP, the cleft width and anteroposterior and transverse alveolar dimensions exhibited a decrease while the vertical dimensions were maintained. Compared with infants without clefts, those with UCLP treated by NAM exhibited sagittal and vertical alveolar growth deficiencies and tissue insufficiency.