• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.19 no.2
• /
• pp.135-142
• /
• 1997

Despite the current accomplishments with the repair of cleft lips, the surgical management of the nasal deformity remains a functional and aesthetic dilemma for patients, their families, and reconstructive surgeons. Recent improvements in the understanding and technical execution of te primary cleft lip repair have significantly reduced secondary sequelae and the consequent need for secondary surgical correction. But, secondary surgical corrections are necessary according to numerous factors. Such factors include the secondary surgical corrections are necessary according to numerous factors. Such factors include the severity of the initial deformity, the surgical plan, precision of execution of the primary repair, and success of the postoperative management. We preformed the secondary correction of cleft lip and palate in 11 patients via various methods. In conclusion, primary repair of cleft lip and palate patients is the most important to prevent the secondary deformities, and most of cleft lip and palate with secondary deformities must be treated with combined cheiloplasty and rhinoplasty.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.4
• /
• pp.401-406
• /
• 1999

Secondary deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may vary in severity, depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic technique. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. Residual lip deformities after primary repair may be esthetic or functional and include scars, skin shortage or excess(vertical and transverse), orbicularis oris muscle malposition or diastasis. The key to accurate repair of secondary cleft lip deformities is a precise diagnosis. This requires observation of the patient in animation and repose. The quality of the scar is not the only factor determining the overall appearance of the lip. Observing the patient in the animated position is critical to assess muscular function. Factors that require precise analysis include lip length, the appearance of the Cupid's bow and philtrum, and nasal symmetry. Only after this detailed analysis can a decision be made as to wether a major or minor deformity exists. We report successful cases using various techniques for the secondary lip deformities.

• Archives of Plastic Surgery
• /
• v.32 no.3
• /
• pp.287-292
• /
• 2005

The definitive correction of secondary lip nasal deformities is a great challenge for plastic surgeons. To rectify the secondary lip nasal deformities, various procedures and its modifications have been reported in many centers. However, no universal agreement exist to correct the various components of secondary nasal deformities. The secondary nasal deformity of the unilateral cleft lip has its own characteristic abnormalities including the retroplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, short columella, depressed alar base and so forth. Among these components of secondary nasal deformity, maxillary hypoplasia, especially in the area of piriform aperture, and alveolar bone defect can make the alar base depressed, which in turn, leads to wide and flat nasal profile, obtuse nasolabial angle coupled with subnormal nasal tip projection in aspect of aesthetic consideration. Moreover, the maxillary hypoplasia contributes to reduced size of the nasal airway in combination with other component of external nasal deformity and therefore the nasal obstruction may be developed functionally. Therefore, the current authors have performed corrective rhinoplasty with the augmentation of alar base with various methods which include rearrangement of soft tissue, vertical scar tissue flap and use of allogenic or autologous materials in 42 patients between 1998 and 2003. The symmetric alar base could be achieved, which provides the more accurate evaluation and more appropriate management of the various component of any coexisting secondary nasal deformity. In conclusion, the augmentation of alar base, as a single procedure, is a basic and essential to correct the secondary lip nasal deformities.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.2
• /
• pp.198-204
• /
• 1999

The treatment of cleft lip and palate patients requires multidisciplinary coorperation, and the involved clinicians rely on the completeness and accuracy of the patient's medical records in developing comprehensive treatment plans. There are so many classifications in cleft lip and palate but each classification has advantages and disadvantages. Furthermore there are few classification or assessment in secondary cleft lip and palate deformities. A modification of Kenahan's Y classification in primary cleft lip and palate and new classification in secondary cleft lip and palate deformities are proposed as a simple and reproducible method. These reproducible classification may be used to facilitate not only storing and analyzing of medical informations in computer but also the planning of secondary repairs

• Archives of Craniofacial Surgery
• /
• v.12 no.2
• /
• pp.75-80
• /
• 2011

Deformities related with cleft lip are not only limited to the cleft site but also extended to all around the nasolabial region. Facial development is composed of several complex processes as the formation, migration, coalescence and interaction of separate fields. When there is a cleft event, it means there are general problems of those processes. As a result facial elements should have displacement, deformation and functional hypotrophy. These also affect the mucocutaneous structures, which result in the typical deformities of cleft lip. Traditional surgical methods are not sufficient of the correction of functional impairments in the cleft lip. Accordingly, there are relatively high possibilities of occurring secondary deformities. The Delaire's method focuses on repair of functional impairment of the cleft. Consequently, it can maintain the initial good surgical result and avoid the unnecessary incision scar. And this method can minimize secondary nasal deformities which can reduce the risk of additional nasal correction. Therefore authors introduce this advantageous the Delaire technique cheliolplasty which it can be widely used for the cleft lip correction in Korea.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.17 no.2
• /
• pp.153-158
• /
• 1995

A wide variety of deformities can occur following repair of the cleft lip. Especially, cleft lip nasal deformities offer the severe psychologic, esthetic, and functional impairment. We must restore the deformities of alar cartilge, nasal tip, septum, columella, or pyriform aperture. The authors reconstructed the cleft lip nasal deformities using with the alar cartilage rearrangement, postauricular cartilage graft, and/or columellar lengthening. The 3 case reports are presented.

• Archives of Craniofacial Surgery
• /
• v.11 no.2
• /
• pp.77-84
• /
• 2010

Purpose: The nasal bones are the most common fracture sites of the facial bones, and a careful reduction may still result in secondary deformities, such as saddle nose, deviated nose, hump nose etc, requiring secondary cosmetic rhinoplasty. Therefore, this study examined the clinical characteristics of nasal bone fractures to propose guidelines for patient selection and surgical procedures to achieve more satisfactory results and to prevent secondary deformities with simultaneous augmentation rhinoplasty and bony reduction. Methods: The study was based on 26 out of 149 nasal bone fracture patients who underwent simultaneous augmentation rhinoplasty with bony reduction between May 2008 and April 2009. Retrospective analysis was performed according to the clinical data, surgical techniques and postoperative results. Results: Of the 26 patients, there were 15 males and 11 females. The incidence according to the Stranc's classification revealed that 62% of patients were injured by a frontal impact and 38% by a lateral impact. Frontal impact plane I (50%) was the most frequent type. At the follow up, 18 (81.2%) out of 22 patients were satisfied with their postoperative outcome, and the remaining 4 patients were fair. No one was dissatisfied. However, 5 cases in 3 patients (23%) had some complications; minimal implant deviation in 2 cases, minor irregularity on the nasal dorsum in 2 cases and palpable implant movement under palpation in 1 case. None of these cases required surgical correction. Conclusion: With the proper guidance, simultaneous augmentation rhinoplasty with bony reduction can prevent secondary deformities and satisfy the cosmetic outcomes.

• Archives of Craniofacial Surgery
• /
• v.12 no.2
• /
• pp.102-106
• /
• 2011

Purpose: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. Methods: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. Results: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. Conclusion: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.

• Archives of Plastic Surgery
• /
• v.33 no.2
• /
• pp.135-143
• /
• 2006

The characteristics of the cleft lip nasal deformity is defined in this article in three planes. The alar flaring is explained in X axis, the lower positioning of the alar free margin is imagined in Y axis and the short hemicolumella is in Z axis. Most cleft surgeons have focused on the malposition of the lateral crus of alar cartilage while the author defined it in X and Y axises and tried to correct that deformity of short hemicolumella in Z axis. For the last 13 years the author applied that method in 818 cases of secondary cleft lip nose deformity. Through the columellar splitting incision extended to free margin of the alar not beyond the nasal dorsum, the skin and soft tissue of the webbing deformed the nasal tip was excised in crescent fashion. The dissected short hemicolumella including the medial crus was thus elevated and advanced into the space of the deformed nasal tip after the crescent excision. This procedure should be followed by the correction of the deformities in X and Y axis. The medial crus elevation is more effective and critical way to have the constant and nice outcome than the lateral crus reposition in secondary cleft lip nasal deformity

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.16 no.1
• /
• pp.21-27
• /
• 1994

There are many residual nasal deformities following midface injury. The treatment of primary nasal deformities is delayed frequently due to several factors. And then, we usually perform the secondary nasal reconstruction. Autogenous bone is the material of choice for major nasal augmentation. It can be contoured appropriately and securely immobilized. It is rapidly incorporated as living tissue by the recipient bed. We used with iliac bone, contochondral graft and ear cartilage for secondary nasal augmentation and obtained the relatively fair results.