• 대한전기학회:학술대회논문집
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• 대한전기학회 2004년도 학술대회 논문집 정보 및 제어부문
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• pp.3-5
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• 2004

Cleft lip is one of the most common congenital deformities in craniofacial region. Despite the many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome is based on the subjective observation because of lack of the objective evaluation system. Therefore, a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nose deformity is critical to improve the management of the cleft patients including the decision of optimal age of operation and surgical technique as veil as evaluation of the outcome. In this study, a new method was proposed to evaluate the nasal deformity using nostril angle, distance, and area of patient images. The images were also evaluated by three expert plastic surgeons, and put into scale of 5 percentile. Measurement results were compared between the each category and the surgeon's evaluation, and coefficients of each category were statistically tested. As a result, The normalized overlap area of right and left nostrils and distance ratio between two centers of nostrils showed high coefficient with evaluations of plastic surgeons.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.427-432
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• 2010

Purpose: The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. Methods: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist. Results: The philtral ridge eminence scored $2.79{\pm}0.54$ and $1.40{\pm}0.53$ at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored $1.44{\pm}0.53$ and $2.27{\pm}0.66$ at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be $3.78{\pm}2.14$ mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant (p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker (p=0.815) using Spearman's rank correlation. Conclusion: Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.190-197
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• 2012

Background : This article presents long-term outcomes after correcting secondary bilateral cleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combination with a composite graft in order to elongate the short columella. Methods : A total of forty-six patients underwent surgery between September 1996 and December 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-U incision and V-Y plasty were used in 24 patients. A composite graft from the helical root was combined with a bilateral reverse-U incision in the 22 patients who possessed a severely shortened columella. The follow-up period ranged between 2 and 10 years. Results : A total of 32 patients out of 46 were evaluated postoperatively. The average columella length was significantly improved from an average of 3.7 mm preoperatively to 8.5 mm postoperatively. The average ratio of the columella height to the alar base width was 0.18 preoperatively and 0.29 postoperatively. The postoperative basal and lateral views revealed a better shape of the nostrils and columella. The elongated columella, combined with a composite graft, presented good maintenance of the corrected position with no growth disturbance. A composite graft showed color mismatching in several patients. Twenty-six patients demonstrated no alar-columella web deformity and satisfactory symmetry of the nostrils. Four patients experienced a drooping and overhanging of the corrected alar-columella web. Conclusions : A bilateral reverse-U incision with V-Y plasty or in combination with a composite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

• 대한구순구개열학회지
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• 제4권2호
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• pp.9-18
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• 2001

구순구개열은 악안면 영역의 선천기형 중 발생빈도가 가장 높으며 출생시부터 성장완료 시기까지 일관된 치료계획에 의한 종합적 진료체계가 필수적이다. 구순구개열의 개선을 위한 구개부 및 입숭? 조기 봉합 후의 반흔조직의 형성은 치열궁 협착 뿐 아니라 상악골 열성장에 의한 중안모의 함몰을 야기하며 이러한 상악골의 열성장 경향은 연령이 증가할수록 점진적으로 증가하는 성향을 보인다. 따라서, 성장잠재력을 이용한 조기의 악정형치료는 구순구개열 환자에서 반드시 필요하며, 적절한 치료 결과를 얻어내기 위하여 환자의 전후방 골격 형태 뿐 아니라, 성장 방향에 대한 고려가 필요하다. 그러나 혼합치열기의 악정형치료는 좋은 결과를 얻었다 하더라도 높은 재발 성향 및 잔여성장에 의한 악골관계의 변화가 예상되므로 장기간의 보정이 필수적이며 성장에 대한 지속적 평가가 이루어져야 할 것이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권4호
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• pp.287-294
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• 2006

The secondary correction of cleft lip nasal deformity (CLND) presents difficult surgical problems. Characteristically, nostrils are asymmetric. The present study was aimed to examine and compare the effect of Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base for augmentation of the nostril with or without lengthening the columella in CLND. The subjects were 28 patients with unilateral cleft lip, who had secondary nostril correction. The nostril correction methods were Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base. Facial photographs were taken before and 20 days after the operation. By using Adobe photoshop, the columella length 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. The degree of improvement of the columella length using Straith's alar web Z-plasty was 70.20%. And then Millard's alar web Z-plasty was 55.01%, alar web excision was 39.93%, and lateral V-Y advancement of the alar base was 16.38% in order. The degree of improvement of the nostril size using lateral V-Y advancement of the alar base was 55.26%. And then alar web excision was 52.72%, Millard's alar web Z-plasty was 34.86%, and Straith's alar web Z-plasty was 16.06% in order. Straith's alar web Z-plasty and Millard's alar web Z-plasty resulted in elongation of the columella, equalization of asymmetrical nostril, and enlargement of small nostrils. Alar web excision enlarged nostrils and restored symmetry. Lateral VY advancement of the alar base increased nostril width and enlarged nostrils. These results indicate that the correction of nostrils improve the shape and the symmetry of the nostrils in CLND.

• 대한구순구개열학회지
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• 제2권1_2호
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• pp.29-41
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• 1999

구순구개열은 악안면의 선천기형중 발생빈도가 가장 높은 것으로 알려져 있으며,출생시부터 성장이 완료되는 시기까지 일관된 치료계획에 의한 종합적인 진료체계가 필수적이다. 구순구개열이 존재할 경우 구개부의 조기 봉합후의 반흔조직 형성으로 인한 치열궁의 협착 또는 중안모의 함몰 경향과 함께 상악 측절치의 선천적 결손 또는 기형치, 전치의 회전과 경사 등이 수반되므로 교정치료에 의한 기능적, 심미적인 치열의 회복이 필요하게 된다. 구순구개열 환자의 교정치료에 있어서 상악치열의 정상적인 배열과 구치부 반대교합의 치료를 위해 상악골 확대가 종종 필요하며, 이를 위하여 Hyrax appliance, Quad-helix 및 Fan-type expansion screw, Jointed fan type expander 등 다양한 장치가 활용될 수 있다. 심하지 않은 구순구개열 환자의 교정치료에서 상악골 확대를 위한 장치의 선택은 환자의 치열궁 형태, 연령, 구치부와 전치부의 치열궁 폭경 등 다양한 요인이 고려되어야 하며, 치료 후 악궁형태의 보정에 특별한 주의를 기울여야 할 것이다.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.511-517
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• 2019

Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.