• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.55.1-55.7
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• 2019

Background: Transverse facial clefts are Tessier's number 7 facial cleft among numbers 1-15 in Tessier's classification of craniofacial malformations, which varies from a simple widening oral commissure to a complete fissure extending towards the external ear. Case presentation: In a patient with a transverse facial cleft, to functionally arrange the orbicularis oris muscle and form the oral commissure naturally, we performed a surgical procedure including orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. Conclusion: We achieved good results functionally and esthetically by orbicularis oris muscle reconstruction and cheiloplasty with Z-plasty. The surgical modality of our anatomical repair and 3 months follow-up results are presented.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.11-15
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• 2013

Background: In cleft lip patients, the necessity of a thorough preoperative analysis of facial deformities before reconstruction is unquestioned. The surgical plan of cleft lip patient is based on the information gained from our preoperative anthropometric evaluation. A variety of commercially available three-dimensional (3D) surface imaging systems are currently introduced to us in plastic surgery for these use. However, few studies have been published on the soft tissue morphology of unrepaired cleft infants described by these 3D surface imaging systems. Methods: The purpose of this study is to determine the accuracy of facial anthropometric measurements obtained through digital 3D photogrammetry and to compare with direct anthropometry for measurement in unilateral cleft lip patients. We compared our patients with three measurements of dimension made on both sides: heminasal width, labial height, and transverse lip length. Results: The preoperative measurements were not significantly different in both side of labial height and left side of heminasal width. Statistically significant differences were found on both side of transverse lip length and right side of heminasal width. Although the half of preoperative measurements were significantly different, trends of results showed average results were comparable. Conclusion: This is the first study in Korea to simultaneously compare digital 3D photogrammetry with traditional direct anthropometry in unilateral cleft lip patients. We desire this study could contribute the methodological choice of the many researchers for proper surgical planning in cleft lip reconstruction field.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.1
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• pp.11-22
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• 2005

There ate anteroposterior$\cdot$vertical maxillary underdevelopment, transverse maxillary deficiency and wide cleft alveolus$\cdot$oroanual fistula among cleft lip ant palate related maxillary deformities. For treatment of these deformities, ones have used conventional treatment methods, there were often unsatisfactory results to patients and operators both. Since llizarov introduced effective technique of bone lengthening and augmentation for a variety of limb defotmities, application of distraction osteogenesis on maxillofacial area has been used to solve those disadvantages of conventional methods. Authors introduced following three cases about use of distraction osteogenesis. The first case is the application of RED(rigid external distraction) II system for the treatment of the anteroposterior$\cdot$vertical maxillary hypoplasia after several times of surgery and end of development in bilateral cleft lip and palate patient. The second case is the application of the USPD(unilateral segmental palatal distraction) for the resolution of the unilateral posterior crossbite and transverse dental arch asymmetry after alveolorraphy in growing unilateral cleft lip and palate patient. The third case is the application of transport distraction osteogenesis far closure of the wide clef alveolus and oroantral fistula in growing bilateral cleft lip and palate patient. There were satisfactory results in these cases. Particularly, in comparison with the decreases of relapse rates, the reduction of the hospitalization time and post-operative discomfort owing to minimal surgical intervention.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.390-396
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• 2022

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

• The Journal of the Korean dental association
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• v.51 no.6
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• pp.322-329
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• 2013

Among the occlusal discrepancies, maxillary transverse deficiency is quite common in several reasons. The reasons are comprised of maxillary hypoplasia, thumb sucking habits, non-syndromic palatal synostosis and syndromal patients including cleft patients. Orthodontic treatment is used routinely to correct a deficiency in young patients while it has limitations for a skeletally mature patient. Surgical treatments help provide effective maxillary expansion to correct a deficiency in adults. Surgical methods can be categorized to segmental Le Fort I osteotomy and surgically assisted rapid maxillary expansion(SARME). Both methods seem successful but each method would have its own indication. We give a review on transverse maxillary deficiency and two surgical methods.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.143-147
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• 2011

Purpose: A Tessier classification number 7 cleft is an uncommon malformation that results from a failure of mesenchymal fusion within the maxillary and mandibular prominences of the 1st pharyngeal arch. Many operative techniques of the number 7 cleft repair have been proposed to restore function and improve aesthetics. Fifteen patients underwent repair of a number 7 cleft over 13 years by a modification of the surgical Technique, and an appraisal of the operative outcome is reported herein. Methods: A retrospective review was conducted involving 15 patients with number 7 clefts who underwent surgery from 1996 to 2009. The changes in surgical technique included skin closure, attachment of the orbicularis oris muscle, and position of the repaired commissure; the changes were analysed with a review of the medical records and the outcomes of surgery were analysed via photographs. Specifically, the technique of skin closure was changed from the a Z-plasty to a linear closure, the orbicularis oris muscle overlapped attachment was replaced by a side-to-side approximation with horizontal mattress sutures, and the position of the repaired commissure was changed from 1 mm laterally to 1 mm medially in reference to the non-cleft side. Results: A Z-plasty caused additional cutaneous scarring, an overlapped attachment of the orbicularis oris muscle caused a thick oral commissure, and the repaired commissure migrated to the lateral side, so a 1 mm, laterally-positioned commissure caused asymmetry. The altered procedure included a linear skin closure, a side-to-side orbicularis oris muscle approximation, and a 1 mm, medially-positioned commissure, which together resulted in a good outcome. Conclusion: The altered procedure for repair of a number 7 cleft as described herein, yields a short scar, no functional problems with the orbicularis oris muscle, a thin oral commissure, and symmetry of the repaired commissure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.207-215
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• 2008

Patients who have repaired cleft lip and palate generally undergo restriction of maxillary growth. Concave facial profile is often exhibited with relatively normalized mandible. Horizontal and sagittal deficiency of the maxilla could cause anterior and posterior crossbites. In growing patients, ortho-dontic and orthopedic treatment is acceptable with maxillary expansion and protraction. However, surgical approach has to be accompanied with orthodontic treatment in skeletally matured patients. We used SARPE and BSSRO to expand the constricted maxilla and retract the mandible in a patient who had cleft palate repaired in infancy. Through SARPE, orthodontic treatment and BSSRO, we sufficiently expanded the maxillla and improved facial profile.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.197-200
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• 2008

Purpose: A congenital lacrimal sac fistula is unusual and consists of a dimple opening below the medial canthal tendon that leads to the lacrimal sac. This anlage ducts occur when the lacrimal anlage cells proliferate and canalize rather than involute. And, the anomaly is usually not associated with any systemic abnormalities. Also congenital cleft of the earlobes is rarely seen among congenital ear anomalies. Therefore, we report rare case with symptomatic bilateral lacrimal fistula with the ear cleft. Methods: A 4-year-old boy was admitted with aggravated chronic maxillary sinusitis, recurrent chronic dacryocystitis, and epiphora. He had two minor anomalies including bilateral lacrimal fistula originated in lacrimal tear sac and unilateral transverse ear cleft. The patient had been operated with fistulectomy and perioperative antibiotics. A small vertical ellipse is made around the opening with sharp dissection. The tract is excised using the probe as the guide. Another probe is placed through the lower canaliculus to prevent the damage. A suture ligature of 6-0 Maxon is placed around the deepest point of the tract, which is then excised. Additional sutures are placed in the tissues to form a tight closure to prevent reestablishment of the fistula. The skin is closed with 6-0 Black Silk. Results: The patient recovered well without any complications such as infection, epiphora, and obstruction of lacrimal sac. Conclusion: Our case illustrates bilateral lacrimal anlage ducts in a patient with unilateral congenital ear cleft. We recommend careful evaluation of lacrimal system in these patients, especially bilateral case and other congenital anomalies. Finally, we recommend excision of the ducts when epiphora, infection, or chronic skin irritation occur.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.31-36
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• 2010

Purpose: The primary goal of palatoplasty is to enable normal speech with harmonious growth of face. Some children who had palatoplasty display typical findings of transverse maxillary deficiency requiring orthodontic widening of the maxilla. Levi (2009) described a cleft palate repair coupled with pedicled buccal fat pad flaps to cover bone exposed areas of the hard palate. Hence we report clinical experiences of cleft palate repair using pedicled buccal fat pad flap. Methods: Four Veau class II and a Veau class I cleft palate patients underwent palatoplasty with buccal fat pad flap by single surgeon from April 2009 to August 2009. Two patients received 2-flap palatoplasty and three patients 1-flap palatoplasty, respectively. After the cleft palate repair, sharp mosquito scissors was placed in the superior buccal sulcus just lateral to the maxillary tuberosity and inserted directly through the mucosa resulting in buccal fat pad extrusion. The elevated flap was moved to cover mucoperiosteal defect in hard palatal area. Results: Five patients underwent primary palatoplasty using buccal fat pad flap. Flap harvest and inset took on average 9 minutes per flap. Mucosal epithelization took 18 days on average. No patients had complications related to the buccal fat pad flap. Conclusion: Buccal fat pad pedicled flap has significant potential to function as an added vascularized tissue layer in cleft palate repair and we can expect better growth of maxilla with this method although longer duration of follow-up was unavailable.

• 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.