• 대한구순구개열학회지
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• 제7권1호
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• pp.1-16
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• 2004

본 연구에서는 구순접합술의 효과를 알아보기 위하여, 일측성 완전구순열을 가진 5명의 환아에서 Millard의 high haU-underminded adhesion과 Seibert 의 lip adhesion을 이용한 구순접합술후 Millard 변법을 이용한구순성형술을 시행하였다. 구순접합술은 상악치조분절 간의 관계를 개선해 주고 구순성형술을 쉽게해주며 최종적인 구순성형술 후 더욱 좋은 결과를 나타냈다. High kalf-underminded adhesion과 Seibert의 lip adhesion은 둘 다 넓은 구순열을 하는데 유용한 방법이며, 특히 Seibert의 lip ahesion은 강한 접합력을 얻을 수 있고 변위된 비중격의 개선 효과가 있으며 보다 심미적인 상순의 연속성을 얻게 해 주었다. 이상의 결과에서 넓은 완전구순열 환아에서 구순성형술에 앞서 구순접합술을 시행하면 상악치조분절 간의 관계를 개선시키고 구순성형술 후 최종적인 결과를 향상시킴을 알 수 있다.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.547-551
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• 2011

Purpose: Pierre Robin sequence is a congenital malformation in which micrognathia causes glossoptosis and airway obstruction. If conservative treatment fails, surgical procedures such as tongue-lip adhesion can be performed. However, this procedure remains a subject of debate, with favorable results being countered by reports of complications. To overcome the above limitations, we revised the traditional method of tongue-lip adhesion using an alveolar protector. Methods: Between 1992 and 2011, a total of eight patients were identified with Pierre Robin sequence and were treated with tongue-lip adhesion. Two of these eight tongue-lip adhesion procedures were performed with an alveolar protector. The operative technique for tongue-lip adhesion was similar to that described in other published reports. The alveolar protector was inserted between the ventral surface of the tip of the tongue and the lower labial sulcus. Results: Tongue-lip adhesion failed in two patients because of wound dehiscence. The primary surgical success rate was 66.7%. In the two tongue-lip adhesion procedures performed with the alveolar protector, we observed no postoperative complications. Conclusion: Resistance to traction of the tongue can be encountered with nonunionized symphysis menti, causing loosening of the traction suture through the symphysis menti. This can lead to backward positioning of tongue, resulting in dehiscence of tongue lip adhesion. The alveolar protector is a good adjunct to tongue-lip adhesion because this method avoids postoperative loosening of the traction suture and wound dehiscence. It is a simple and effective auxiliary method that yields functional improvement.

• Archives of Plastic Surgery
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• 제49권4호
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• pp.510-516
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• 2022

Background Surgical correction of bilateral cleft lip deformities remains one of the most challenging areas in facial plastic surgery. Many surgical techniques and conservative devices have been offered for the early management of bilateral cleft lip in infants. The purpose of this study was to evaluate the effect of lip adhesion on the lip and nose of patients with bilateral cleft lip. Methods A retrospective review of 13 patients with bilateral cleft lip was performed and compared with age-matched noncleft children. Patients underwent lip adhesion at a mean age of 2.8 months, and cheiloplasty at 6.6 months of age using a modification the Mulliken method. Secondary rhinoplasty was performed at the age of 6 in 13 patients. The surgical results were analyzed using photographic records obtained at the age of 1 and 7 years. Twelve length measurements and one angle measurement were obtained. Results All measurements were not statistically different from those of the noncleft age-matched control group at the age of 1. At 7 years of age, upper lip height and vermilion mucosal height were shorter (p < 0.05) than in the control group. Nasal tip protrusion and the nasolabial angle were greater (p < 0.05) than in the control group. Conclusion Lip adhesion followed by secondary rhinoplasty resulted in an acceptable lip and nasal appearance. Although nasoalveolar molding is now widely used, lip adhesion can be an appropriate alternative if an orthodontist is not available due to geographical or economic constraints.

• 대한구순구개열학회지
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• 제3권2호
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• pp.67-73
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• 2000

The purpose of this survey was to obtain an overall view of the status of cleft lip and palate management in Oral and Maxillofacial Surgery(OMFS) in Korea. Korea Cleft lip and Palate Association conducted mailed survey which was composed of 29 questions conceming pre-operative and post-operative management in CLP surgery and completed by 58 training hospital. Of 58 questionnaires sent, 23 were returned(response rate of 40%). Authors compared this results with those of other similar surneys, which reveal much difference between OMFS and Plastic Surgery(PS) in CLP treatment. In OMFS, many surgeons were in favor of presugical orthopaedics than lip adhesion to manage protruded premaxilla. It reflects interdisciplinary team approach between OMFS and orthodontic department reduces the need of lip adhesion through presurgical orthopaedics. Timing of palatal surgery was later than that of PS, which reflects concern for an impediment of maxillaty growth. To our knowledge, this survey may be the first on organization and management for cleft patient in OMFS in Korea.

• Archives of Plastic Surgery
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• 제48권6호
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• pp.630-634
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• 2021

To date, there have been no reports of patients showing a Tessier number 7 cleft with unilateral complete cleft lip and palate. Furthermore, no studies have established the sequence, plan, or timing of surgical methods for treating patients presenting the above anomalies simultaneously. We report a case of a Tessier number 7 cleft with unilateral complete cleft lip and palate. Two months after birth, lip adhesion was performed on the unilateral complete cleft lip and total excision was performed on the skin tag. At 4 months of age, Tessier number 7 cleft was corrected. At 6 months of age, surgery involving two small triangular flaps was performed on the unilateral incomplete cleft lip after performing lip adhesion. At 13 months of age, two-flap palatoplasty with a vomer flap was performed on the complete cleft palate. At 6 years of age, open rhinoplasty was performed on the unilateral cleft lip nose deformity. At 9 years of age, bone grafting was performed for the alveolar cleft. At follow-up appointments up to 13 years of age, there were no major complications. Here, we present this patient, surgical procedures and timelines, and show our results demonstrating good postoperative outcomes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권1호
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• pp.47-50
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• 2016

Patients with Pierre Robin sequence exhibit varying degrees of airway obstruction and feeding difficulty. In some patients, airway obstruction may be profound, warranting surgical intervention to maintain a patent airway. The purpose of this article is to highlight the advantages of the tongue-lip adhesion procedure for the management of airway obstruction in such patients compared to the currently available options.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.31-34
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• 2015

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.349-353
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• 2008

Purpose: There are 3 well-known surgical procedures to treat Pierre Robin sequence: tongue-lip adhesion, distraction osteogenesis of mandible, and tracheostomy. The classical tongue-lip adhesion is an effective way to keep airway. The tongue, however, becomes quite non-mobile and appears dormant until the patient could control upper airway and the adhesion can be maintained for prolonged period. Most of all, this procedure does not provide the correction of the micrognathia. Distraction osteogenesis is a good technique to correct micrognathia and to prevent tracheostomies in patients with Pierre Robin sequence. But airway keeping procedure is needed during the distraction period. The purpose of this study is to determine the usefulness of temporary tongue-lip traction during the initial period of mandibular distraction in Pierre Robin sequence patients with severe airway problems requiring operative procedure. Methods: It was a prospective study of 2 Pierre Robin sequence patients aged between 4 months and 6 months requiring surgical procedure to correct recurrent and severe pulmonary complications. Two patients underwent distraction osteogenesis of mandible. During the operation, deep one tension suture was performed to tract the tongue and lip. When the patient gained control of upper airway at the initial period of distraction and micrognathia was corrected, the traction suture was removed. Results: All patients were followed up. No patients complained severe pulmonary complications and tracheostomy could be avoided. No patients had severe pulmonary complication. The pulmonary condition of patients was good. Conclusion: In severe Pierre Robin sequence case, temporary tongue-lip traction is a good assistant method in distraction osteogenesis because this method can avoid tracheostomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권5호
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• pp.323-329
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• 2003

본 연구는 편측성 완전 구순열에서 Millard 회전신전법 만으로 수복한 경우와 구순접합술 후에 Millard 회전신전법으로 수복한 경우의 술후 결과를 비교하고자 시행되었다. 20명의 편측성 완전 구순열 환자를 대상으로 7명에서는 Millard 회전신전법만으로 수복하였고, 13명에서는 구순접합술 후에 Millard 회전신전법으로 수복하였다. 술전 술후 사진을 토대로 구순부에서는 수직 길이, 반흔, 적순, 입술의 볼록함(lip pout), 큐피드궁의 다섯 항목에 대하여, 비부에서는 비익, 비주, 비공저, 비첨, 비중격의 다섯항목에 대하여 각 항목 당 $0{\sim}10$점씩 총 100점으로 평가하고 술후 결과를 분석하였다. 총평점은 구순접합술 후에 Millard 회전신전법으로 수복한 경우 $74.74{\pm}1.09$점으로 Millard의 회전신전법 만으로 수복한 경우 $66.50{\pm}1.14$점에 비해 유의하게 높았다. 반흔 비대는 Millard 회전 신전법 만으로 수복한 경우에 28.6%, 구순접합술 후에 Millard 회전신전법으로 수복한 경우에 23.1%의 발생율을 나타냈다. 구순길이의 객관적인 평가 결과, 구순접합술 후에 Millard 회전신전법으로 수복한 경우 평균 길이비는 $0.84{\pm}0.08$로 Millard 회전신전법만으로 수복한 경우의 $0.73{\pm}0.10$에 비해 길었으나 통계학적으로 유의한 차이는 없었다. 이상의 결과는 편측성 완전 구순열 수복 시 Millard 회전신전법에 의한 구순성형술에 앞서 구순접합술을 시행함으로써 더 좋은 결과를 얻을 수 있음을 시사한다.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 2003년도 종합학술대회
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• pp.34-34
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• 2003