• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Korean Journal of Cleft Lip And Palate
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• v.8 no.2
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• pp.63-70
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• 2005

Patients with cleft lip and palate usually show up maxillary hypoplasia. In these cases, a large amount of maxillary advancement is often needed to correct the severe deformity, but local soft-tissue scars around the maxilla restrict maxillary advancement and increase the relapse rate. Maxillary distraction osteogenesis is an effective method for facial and occlusal improvement in these patients. By gradually lengthening both the bones and the soft tissues, distracted midface can greatly increase postoperative stability and decrease the relapse rate. However, the maxillary extraoral appliances of the early days used were esthetically unappealing as well as difficult for the patient to manage. Recently, more inconspicuous intraoral distraction appliances have been developed and used with success. We acquired favorable result in two patients(bilateral 1 patient and unilateral 1 patient) with severe maxillary hypoplasia secondary to complete cleft lip and palate were treated with midface distraction using internal distractor (Zurich Pediatric Maxillary Distractor, KLS Martin, Tuttlingen, Germany). So, we report our experience with literatures.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.3-12
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• 2018

Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

• The korean journal of orthodontics
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• v.43 no.3
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• pp.113-119
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• 2013

Objective: To compare three-dimensionally the midfacial hard- and soft-tissue asymmetries between the affected and the unaffected sides and determine the relationship between the hard tissue and the overlying soft tissue in patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) by cone-beam computed tomography (CBCT) analysis. Methods: The maxillofacial regions of 26 adults (18 men, 8 women) with nonsyndromic UCLP were scanned by CBCT and reconstructed by three-dimensional dental imaging. The frontal-view midfacial analysis was based on a $3{\times}3$ grid of vertical and horizontal lines and their intersecting points. Two additional points were used for assessing the dentoalveolar area. Linear and surface measurements from three reference planes (Basion-perpendicular, midsagittal reference, and Frankfurt horizontal planes) to the intersecting points were used to evaluate the anteroposterior, transverse, and vertical asymmetries as well as convexity or concavity. Results: Anteroposteriorly, the soft tissue in the nasolabial and dentoalveolar regions was significantly thicker and positioned more anteriorly on the affected side than on the unaffected side (p < 0.05). The hard tissue in the dentoalveolar region was significantly retruded on the affected side compared with the unaffected side (p < 0.05). The other midfacial regions showed no significant differences. Conclusions: With the exception of the nasolabial and dentoalveolar regions, no distinctive midfacial hard- and soft-tissue asymmetries exist between the affected and the unaffected sides in patients with nonsyndromic UCLP.

• Korean Journal of Cleft Lip And Palate
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• v.2 no.1_2
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• pp.5-14
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• 1999

The aim of treatment of cleft lip and palate is to correct the cleft and associated problems surgically and thus hide the anomaly so that patients can lead normal lives. This correction involves surgically producing a face that does not attract attention, a vocal apparatus that permits intelligible speech, and a dentition that allows optimal function and esthetics. In neonatal periods, gross distortion of tissues surrounding the cleft requires considerable effort and time due to post operative functional defect and scarring and induces milk feeding problem, malocclusion of deciduous or permanent dentition, congenital missing teeth, skeletal dysplasia. The occurrence of a cleft deformity is a source of considerable shock to the parents of an afflicted baby, and the most appropriate approach is very important things. Thus we tried to analysis of dental arch, shape and size of deformity in cleft patients. The results were obtained as follows. 1. When the cast measurements of UCLP subjects at first visit it was found that the mean length was 9.29mm at the alveolar cleft width, also that was 11.7mm at the anterior width and 14mm at the posterior cleft width. 2. Comparison of UCLP group at first visit and just lip surgery, it was found that the older group showed a insignificant reduction in the width of the cleft in the alveolar, canine, and tuberosity regions. 3. The maxillary casts of the UCLP group at 6 months differ Significantly from those of the at 3 months in both length and width. but there was no statistical difference except anterior ridge length of nonclefted site. 4. Comparison at 6 months and 18 months, there was a greater change in length of the alveolar cleft width, intercanine width, and anterior cleft width. Maxillary arch became wider at both the canine region and intertuberosity region. also posterior anteroposterior length was increased but anterior AP length was decreased from 8.1mm to 7.7mm. There was meaningful increase at intertuberosity length; however, a significant reduction in width t-t'

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.591-598
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• 2000

This study was designed to analysis the airway which affects to breathing, speech and facial growth pattern in unilateral cleft lip and palate patients. Upper airway and the position of hyoid bone pattern were analyzed on the lateral cephalometric radiographs of the 78 subjects of complete unilateral cleft lip and palate group and each group was divided two sub-groups by circumpubertal growth peak and gender. These data were statistically analyzed to examine the difference between pre-circumpubertal growth peak group and post-circumpubertal growth peak one, and between male and female group. The results of this study were as follows: 1. After circumpubertal growth peak stage, the position of hyoid bone was lower than before in both male and female group. 2. After circumpubertal growth peak stage, the measurement were increased in CV3ia-APH, PNS-ad which related to the volume of pharyngeal space. This was due to the decrease of adenoid and anteroiferior growth of mandible and affected to breathing and speech after circumpubertal growth peak. 3. During circumpubertal growth peak stage, all measurements increased more in male than female group, which due to the different amount of growth in different gender. 4. The position of hyoid bone was lower in male than female group in all age group. 5. After circumpubertal growth peak stage, CV3ia-APH increased more in male. This was due to the more growth in madible of male which resulted in the activation of digastric muscle.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.2
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• pp.133-139
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• 2012

This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.

• Korean Journal of Cleft Lip And Palate
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• v.7 no.2
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• pp.93-106
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• 2004

본 연구의 목적은 편측성 구순구개열 (UCLP) 환자에서 술전 비치조 정형장치 (presurgical nasoalveolar molding appliance, PNAM) 와 구순 봉합수술의 치조골 정형효과를 3차원 (3-D) 분석을 통하여 평가하는 것이다. 연구대상은 16명의 UCLP 환자 (평균 파열부거리: 10.46mm) 이며 PNAM 장치에 의한 치료와 rotation-advancement법에 의한 구순 봉합수술을 받았다 처음 내원시 (평균연령: $37.0{\pm}27.89$ 일), PNAM 치료를 받고 난 후이며 구순봉합수술 1달 전 (평균연령: $119.25{\pm}40.18$ 일), 구순봉합수술 2달 후 (평균연령: $190.81{\pm}42.78$ 일)에 상악의 인상을 채득하였다. 그 후 laser scanning machine (Orapix, Dimennex, Seoul, Korea) 과 3-D view software (3Dxer, Dimennex) 를 사용하여 3-D모형을 제작하였다. 선, 각도, 정중선변이, 거리, 면적 항목을 3-D 모형상에서 계측하고, 각 시기별의 차이를 비교하기 위하여 Wilcoxon signed rank test를 사용하여 분석하였다. PNAM치료 동안과 구순 봉합수술 후에도 치조골 후방부는 안정된 구조물이었다. PNAM치료에 의한 파열부 거리의 감소는 대분절 (greater segment) 의 내측 굴곡 (bending) 에 의하여 발생하였다. 대분절 (greater segment)의 전방 성장은 PNAM치료에 의하여 억제되었으나, 구순 봉합수술 후에 회복되었다. 구순 봉합수술 후에 대분절과 소분절 사이의 전방부 각도의 증가는 구순 반흔 (lip scar) 의 압력에 의한 치조골 정형 효과 때문으로 생각된다. 정중선변이는 PNAM치료에 의하여 개선되었다. PNAM치료 동안과 구순 봉합수술 후에 구개부 (palatal segment) 의 면적은 계속 증가하였다. 치조골 면적과 거리 항목의 증가는 후방부에서 크게 나타났다. 이러한 결과는 PNAM치료에 의한 치조골 정형효과는 주로 전방부에서 발생하며, 치조골의 성장은 구순 봉합수술 후에 후방부에서 주로 발생한다는 것을 의미한다.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.1
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• pp.140-149
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• 2007

Cleft lip and palate are congenital craniofacial malformation. Reconstruction of dental arch in patient with alveolo-palatal clefts is very important, because they have many problems in functions and esthetics. Malnutrition, poor oral hygiene, respiratory infections, speech malfunctions, maxillofacial deformity, and psychological problems may be occured without proper treatment during the long period of management of the cleft lip and palate. So the treatment should be managed with a multidisciplinary approach. Bone grafting is a consequential step in the dental rehabilitation of the cleft lip and palate patient A complete alveolar arch should be achieyed of the teeth to erupt in and to form a stable dentition. And the presence of the cleft complicate the orthodontic treatment. Therefore bone grafting in patients with cleft lip and palate is a widely adopted surgical procedure. Grafted bone stabilizes the alveolar process and allows the canine or incisor to move into the graft site. After the bone grafting, orthodontic closure of the maxillary arch has become a common practice for achieving dental reconstruction without any prosthodontic treatment. Various grafting materials have been used in alveolar clefts. Iliac bone is most widely fovoured, but tibia, rib, cranial bone, mandible have also been used. And according to its time of occurrence, the bone graft may be divided into primary, early secondary, secondary, late secondary. Bone grafting is called secondary when performed later, at the end of the mixed dentition. It is the most accepted procedure and has become part of treatment of protocol A secondary bone graft is performed preferably before the eruption of the permanent canine in order to provide adequate periodontal support for the eruption and preservation of the teeth adjacent to the cleft. In this report, we report here on a patient with unilateral cleft lip and palate, who underwent iliac bone graft. The cleft was fully obliterated by grafted bone in the region of the alveolar process. The presence of bone permitted physiologic tooth movement and the orthodontic movement of adjacent tooth into the former cleft area. Satisfactory arch alignment could be achieved in by subsequent orthodontic treatment.

• The korean journal of orthodontics
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• v.33 no.4 s.99
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• pp.235-245
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• 2003

The goal of the present study was to evaluate the effects of PNAM appliance and cheiloplasty on alveolar molding. Samples consisted of 16 unilateral cleft lip and palate infants (10 males and 6 female, mean age=37.0 days after birth, average alveolar cleft gap=10.46m), who were treated with PNAM appliances by one orthodontist and rotation- advancement cheiloplasty by one surgeon in Seoul National University Hospital. Average duration of alveolar molding treatment was 13.10 weeks and these patients were recalled at average 8.31 weeks after cheiloplasty. These patients' models were obtained at initial visit (T0, mean age : $37.0\pm27.89$ days after birth), after successful alveolar molding (T1, mean age : $119.25\pm40.18$ days after birth), and after cheilopasty (T2, mean age : $190.81\pm42.78$ days after birth). Seven linear and five angular variables were measured using 1 : 1 photometry and soft ware program(V-ceph. Cybermed. Seoul, Korea). Paired t-test was performed to investigate statistical significance at p<0.05 level. 1 The posterior parts of alveolar segments were the stable structures during alveolar molding treatment period and after cheiloplasty in infants. 2. The closure of cleft gap during alveolar molding was usually due to backward bending of the whole part of the greater segment. 3. Although forward growth of the greater segment was hindered by alveolar molding, it resumed after cheiloplasty. 4. Increase of anterior inter-segment angle after cheiloplasty was due to the molding effect of the lip scar pressure.