• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.41-44
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• 2010

Purpose: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. Methods: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. Results: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. Conclusion: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.61-66
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• 2006

The purpose of this study is to introduce the method of palate repair that combines minimal hard palate dissection and radical retropositiong of levator musculature, which was presented by Sommerlad. As this method presents, additional use of the operating microscope enables atraumatic and radical dissection, and it might provide more improved speech function to the patients. A total of 17 patients with cleft palate underwent Sommerlad's method from December 2003 to August 2004. The mean follow-up period was 4.5 months. The use of a microscope provided high quality variable magnification and good illumination at the operating field. Repair was carried out through incisions at the margins of cleft with mucoperiosteal flap elevation. Muscles were rearranged and repaired properly. It was unable to evaluate the improvement of speech because the patients were too young to learn meaningful speech. Average operating time including anesthetic induction time, V-tube insertion and recovery from anesthesia was 2 hours 45 minutes which was not quite different from conventional method's operating time. Oronasal fistula developed in 2 patients of them. One of them was healed spontaneously. As meticulous and radical muscle dissection was possible with Sommerlad's method, we could minimize the trauma to the muscular and neurovascluar structure. In addition, we expect better faculty of speech as a result of this method although longer follow-up time was unavailable.

• Archives of Plastic Surgery
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• v.44 no.3
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• pp.210-216
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• 2017

Background In treating minor-form or microform cleft lip, obtaining an optimal result is a challenge because of the visible scarring caused by traditional surgery. We present a refined method using muscle overlapping with a minimal skin incision in patients younger than 3 years, a group characterized by thin muscle. Methods The surgical technique involves restoration of the notched vermillion using Z-plasty, formation of the philtral column using overlapping of an orbicularis oris muscle flap through an intraoral incision, and correction of the cleft lip nasal deformity using a reverse-U incision and V-Y plasty. A single radiologist evaluated ultrasonographic images of the upper lip. Results Sixty patients were treated between September 2008 and June 2014. The age at the time of operation ranged from 6 to 36 months (mean, 26 months). The follow-up period ranged from 8 to 38 months (mean, 20 months) in minor-form cases and from 14 to 64 months (mean, 37 months) in microform cases. A notched cupid's bow was corrected in 10 minor-form cases and 50 microform cases. Ultrasonographic images were obtained from 3 patients with minor-form cleft lip and 9 patients with microform cleft lip 12 months after surgery. The average muscle thickness was 4.5 mm on the affected side and 4.1 mm on the unaffected side. Conclusions The advantages of the proposed procedure include the creation of an anatomically natural philtrum with minimal scarring. This method also preserves the continuity and function of the muscle and provides sufficient augmentation of the philtral column and nostril sill.