• Korean Journal of Cleft Lip And Palate
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• v.7 no.1
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• pp.63-76
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• 2004

Cleft lip and palate(CLP) patients usually have midface deficiency and Class III malocclusion. Distraction osteogenesis (DO) has been used recently to correct the maxillary hypoplasia with stable and predictable result. Both external and internal devices that permit midface distraction are available, This case report describes intraoral DO for correction of the midface deficiency in a adult CLP patient with relapse following orthognathic surgery. The purpose of this report is to present advantages of the intraoral DO for the treatment of CLP, The relative and potential clinical indications, treatment planning, patient preparation, and possible vector control for DO are discussed.

• Journal of Chest Surgery
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• v.22 no.3
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• pp.448-455
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• 1989

Till June 1988, We experienced 3 cases of single atrium at Dept. of Thoracic k Cardiovascular Surgery of National Medical Center. Case 1 was 26 years old female, and had single atrium associated with partial cleft in mitral anterior leaflet and PAPVC. Atrial septation with Dacron patch and MVR [I-S, 31 mm] were done, followed by TAP, De Vega. Postoperative course was good, OPD follow-up for about 4 years with normal physical activity and ordinary working. Case 2 was 4 years old female with single atrium alone. Atrial septation with pericardial patch. Good postoperative course and OPD follow-up for about 2 years with appropriate physical growth. Case 3 was 22 years old female, single atrium with complete cleft in the anterior and posterior mitral leaflet, and septal tricuspid cleft were identified. Atrial septation with polystan bovine pericardial patch and repair of mitral anterior cleft. Postoperatively, residual regurgitation of mitral and tricuspid valve, but tolerable in some limitation of physical activity.

• Archives of Craniofacial Surgery
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• v.21 no.6
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• pp.372-375
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• 2020

Congenital midline cervical cleft is a rare congenital disease. The disease is often misdiagnosed as a branchial cleft deformity, thyroglossal duct cyst, or other skin diseases. It has the following characteristics: skin defect at the midline of the anterior neck, a skin tag at the upper end of the lesion, and a blind sinus tract at the caudal aspect with or without mucoid discharge. Treatment is usually for aesthetic purposes; therefore, early surgical en bloc resection with Z-plasty or W-plasty is recommended to reduce recurrence and scar formation.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.406-415
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• 2010

Purpose: The secondary correction of cleft lip nasal deformity still presents a difficult surgical problems. The present study was aimed to investigate the usefulness of Bardach's technique for secondary correction of cleft lip nasal deformity. Materials and Methods: The subjects were eight patients with unilateral and bilateral cleft lip nasal deformity, who had secondary correction by using Bardach's rhinoplasty technique. Age range was from 2 to 21 years and mean age was 10.6 years. There were 3 boys and 5 girls. Six patients had bilateral and two patients had unilateral cleft lip. Facial photographs were taken before and twenty days after the operation. By using Adobe photoshop, the columella height and the nostril width were measured from the facial frontal photograph and Worm's eye view. The degree of improvement was calculated and statistically analyzed. Results: The degree of improvement of the columella length and the nostril width after Bardach's technique was $70.39{\pm}50.14%$ and $-22.93{\pm}0.15%$ respectively. Bardach's technique resulted in projecting the nasal tip, lengthening the columella, medially advancing the alar bases, restructuring the lower lateral cartilages, and changing orientation of the nostrils from horizontal to oblique. The profile view shows projection of the nasal tip, lengthening of the columella, and the change in the nasolabial angle. The scars remained at the philtrum were matter little in compared with improvement of the nasal appearance. Conclusion: These results indicate that Bardach's technique is an useful surgical technique for secondary correction of cleft lip nasal deformity.

• Korean Journal of Cleft Lip And Palate
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• v.6 no.1
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• pp.27-34
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• 2003

Patients with maxillary hypoplasia secondary to cleft lip and palate present numerous challenging problems for the oral and maxillofacial surgeon, These patients present with maxillary hypoplasia in multiclimensions, and often have thin or structually weak bone. This deformity has been traditionally corrected by Le Fort I osteotomy and acute skeletal advancement with wide surgical exposure. The long-term results of cleft patients with maxillary deficiency treated with this traditional approach has been sometimes disappointing, and an increased relapse tendency has been reported, Distraction osteogenesis for these cleft patients offers successful results while potentially minimizing the risk of relapse. Advancing the maxilla via distraction forces requires only a minor surgical procedure that maintains vascularity and neurosensory integrity. Moreover, the response of the facial soft tissues during maxillary distraction has proven to be more favorable than with a conventional LeFort I osteotomy. The purpose of this report is to present the use of maxillary distraction osteogenesis by rigid external distraction (RED) system for the treatment of patient with maxillary deficiency secondary to cleft lip and palate.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.15-18
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• 2011

Purpose: The anterior iliac crest is a common source for autologous cancellous bone graft. For patients who have previously received cancellous bone grafts from bilateral anterior iliac crests, there may be concerns of whether a sufficient quantity of autologous cancellous bone remains for additional grafts without harvesting it from other sites, such as the posterior iliac crest. Methods: We experienced 3 cases of reharvesting in 2 patients. The diagnosis of the first patient was bilateral facial cleft number 3. This patient received bilateral side cleft alveoloplasty with corticocancellous bone graft from the both anterior iliac crest respectively by a previous surgeon. This patient then needed reharvesting of the anterior iliac crest cancellous bone to correct an ongoing skeletal problem for the bilateral cleft. The other patient had bilateral incomplete cleft of the primary palate. This patient received left side cleft alveoloplasty with cancellous bone graft from the right anterior iliac crest. Before the patient could receive the alveoloplasty on the other side, a radial head osteotomy and cancellous bone graft was performed by orthopedic surgeons who then used the remaining left iliac crest in order to treat a pulled elbow. For the completion of the right side cleft alveoplasty, the anterior iliac crest cancellous bone needed to be reharvested. Prior to the reharvesting, a preoperative computed tomography scan of the pelvis was obtained to assess the maturity of the donor site regeneration. The grafts were then taken from site where a greater amount of regeneration was evident. Results: Long term follow ups showed that the grafts were successfully taken. This sufficient volume was obtainable 14 months after the first harvest. Conclusion: Satisfactory results were achieved after the reharvesting of iliac cancellous bone. Thus, it appears that the reharvesting of the iliac bone is a possible alternative to multiple site grafting, use of allograft or bone substitute materials.

• Korean Journal of Cleft Lip And Palate
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• v.9 no.2
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• pp.63-70
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• 2006

Patients with cleft lip and palate usually present midfacial depression and anterior cross-bite. This dentofacial deformity has been believed due to the undergrowth of maxilla and/or the collapse of premaxilla. But, in the case that the collapsed premaxilla exists only, the reconstruction of the premaxilla has to be required for the correction of that deformity. These cases show the surgical treatment of midfacial depression and anterior cross-bite in the cleft lip and palate. After the careful diagnosis for the collapse of premaxilla, the reconstruction using distraction osteogenesis was done successfully. As a result, the anterior overbite / overjet, and facial esthetics were improved remarkably, and the occlusion was also recovered to normal state. In conclusion, the premaxillary reconstruction by distraction osteogenesis in cleft lip and palate patients is a good treatment method based on the pathophysiology.

• Journal of Korean Dental Science
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• v.6 no.1
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• pp.13-21
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• 2013

Purpose: To report the successful results of using chin bone graft and autogenous tooth bone graft material (AutoBT) in alveolar cleft patients. Materials and Methods: Five patients with alveolar cleft defects underwent alveolar bone grafting. Three patients were treated using chin bone graft, and the other two patients underwent AutoBT graft. After implant site development using chin bone graft in the fi rst three cases, endosseous implant restorations were placed. In case #4 and 5, AutoBT graft material was placed to guide the normal eruption of partially impacted maxillary right canine and to the upper docking site after distraction osteogenesis. Result: Successful implant restorations with closure of the oronasal fistula were achieved in alveolar cleft defect reconstruction using either chin bone graft (Case #1, 2, 3) or AutoBT graft material (Case #4, 5). Case #4 showed enlarged follicle of the right maxillary canine, indicating a normal eruption guide pattern. Conclusion: Both chin bone graft and AutoBT graft showed favorable outcomes in reconstructing alveolar cleft defects. Autogenous tooth bone graft opens up the possibility of avoiding harvesting autogenous bone graft with complications and morbidities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.4
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• pp.353-360
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• 2009

The principles for repair of bilateral cleft lip and nasal deformity are 1) symmetry, 2) primary muscular continuity, 3) proper philtral size and shape, 4) formation of the median tubercle and vermilion-cutaneous ridge from lateral labial elements, and 5) primary positioning of the alar cartilages to construct the nasal tip and columella. The authors underscore the essential role of preoperative premaxillary positioning for the synchronous closure of the cleft lip and primary palate, and describe Mulliken's operative technique. We discuss three-dimensional adjustments based on predicted fourth-dimensional changes. In a consecutive series of 50 patients, no revisions were necessary for philtral size or columellar length. Preoperative premaxillary positioning and primary repair of bilateral cleft lip and nasal deformity may impair maxillary growth. Nevertheless, a symmetric nasolabial appearance, rather than emphasis on maxillary growth, is the priority for the child with bilateral cleft lip.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.470-476
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• 2012

Background The whistle deformity is one of the common sequelae of secondary cleft lip deformities. Santos reported using a crossed-denuded flap for primary cleft lip repair to prevent a vermilion notching. The authors modified this technique to correct the whistle deformity, calling their version the cross-muscle flap. Methods From May 2005 to January 2011, 14 secondary unilateral cleft lip patients were treated. All suffered from a whistle deformity, which is characterized by the deficiency of the central tubercle, notching in the upper lip, and bulging on the lateral segment. The mean age of the patients was 13.8 years and the mean follow-up period was 21.8 weeks. After elevation from the lateral vermilion and medial tubercle, two muscle flaps were crossed and turned over. The authors measured the three vertical heights and compared the two height ratios before and after surgery for evaluation of the postoperative results. Results None of the patients had any notable complications and the whistle deformity was corrected in all cases. The vertical height ratios at the midline on the upper lip and the affected Cupid's bow point were increased (P<0.05). The motion of the upper lip was acceptable. Conclusions A cross muscle flap is simple and it leaves a minimal scar on the lip. We were able to reconstruct the whistle deformity in secondary unilateral cleft lip patients with a single state procedure using a cross-muscle flap.