• Archives of Plastic Surgery
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• 제43권3호
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• pp.248-253
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• 2016

Background Financial, clinical, and psychological considerations have made same-day surgery an attractive option for a variety of procedures. This article aimed to analyse the postoperative results of same-day primary unilateral cleft nasolabial repair. Methods This study was performed from 2011 to 2014. Unilateral cleft lip patients fulfilling the inclusion criteria were preoperatively classified as mild, moderate, and severe. All patients underwent same-day surgery and were discharged after satisfying the appropriate clinical criteria, receiving thorough counselling, and the establishment of a means of communication by phone. Postoperative outcomes were assessed and stratified according to preoperative severity and the type of repair. Results A total of 423 primary unilateral cleft lip patients were included. Fisher's anatomical subunit approximation technique was the most common procedure, followed by Noordhoff's technique. The postoperative outcome was good in 89.8% of cases, fair in 9.9% of cases, and poor in 0.2% of cases. The complication rate was 1.18% (n=5), and no instances of mortality were observed. The average hospital stay was 7.5 hours, leading to a cost reduction of 19% in comparison with patients who stayed overnight for observation. Conclusions Mild unilateral cleft lip was the most common deformity for which Fisher's anatomical subunit approximation technique was performed in most of the cases, with satisfactory postoperative outcomes. Refinements in the cleft rhinoplasty techniques over the course of the study improved the results regarding cleft nasal symmetry. Single-day primary unilateral cleft cheiloplasty was found to be a cost-effective procedure that did not pose an additional risk of complications.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.748-752
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• 2007

Purpose: The goal of palatoplasty is focused on two points. One is to close the palatal defect completely, and the other to create a velopharyngeal system for normal speech. While established methods such as pushback palatoplasty or double opposing Z palatoplasty are used in wide cleft palate repair, sequelae such as maxillary hypoplasia or oronasal fistula may result. Therefore, when palatoplasty with buccinator myomucosal flap is used in the case of wide cleft palates, maxillary hypoplasia and oronasal fistula is reduced and optimal results are obtained. Methods: From October 2005 to December 2006, four children with wide complete cleft palate underwent unilateral buccinator myomucosal flap and intravelar veloplaty. Mean age at cleft repair was 15 months, and mean cleft size was 2.15 cm. The patients underwent intravelar veloplasty and palatoplasty was done using unilateral buccinator myomucosal flap. Results: The patients, after mean 10 months of follow-up observation, showed no signs of oronasal fistula resulting from flap tension. The shape and color similar to normal oral mucosa was obtained, and velopharyngeal function was acquired. Conclusion: When intravelar veloplasty and palatoplasty with unilateral buccinator myomucosal flap is done on wide cleft palates, postoperative speech function is optimal, velopharyngeal incompetence is effectively corrected, and sequelae resulting from pushback palatoplasty and double opposing Z-plasty, such as maxillary hypoplasia and oronasal fistula, is reduced.

• Archives of Plastic Surgery
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• 제38권6호
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• pp.740-746
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• 2011

Purpose: In the treatment of the unilateral cleft lip nasal deformities, the correction of the low-nostril height and short-columella are very difficult problems. We report the treatment outcomes of web uni-limb Z-plasty used for correction of unilateral cleft lip nasal deformities by using photographic analysis. Methods: A total of 36 patients with unilateral cleft lip nasal deformities were enrolled in this study, who underwent web uni-limb Z-plasty and were followed up for at least 6 months. First, a triangular flap was made on the medial side of alar-columella web. The nostril apex of cleft side was corrected to a higher point compared to noncleft side by 2 mm. The flap was transposed into the defect of the vestibule. To reduce the bulging of the flap, horizontal cinching sutures were added. Postoperative outcomes were evaluated by using photographic analysis. 2 indices and 1 angle were measured on their photographs taken before and after the surgery. Symmetry was also evaluated by means of the noncleft side to cleft side index. For anthropologic assessment, observers described postoperative outcomes, using Ordinary Scale Method. Results: The postoperative values obtained in photographic analysis improved compared to preoperative ones. More improving anthropologic assessment was shown in post-than pre-operative. Conclusion: Although, further long term follow up is needed, we found this technique to be an effective procedure to the symmetry of nostril apex level and the lengthening of columella in the unilateral cleft lip nasal deformities.

• 대한구순구개열학회지
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• 제8권1호
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• pp.31-37
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• 2005

In alveolar deformity of cleft patient, the flap design is very important to make the functional and esthetic outcome. Especially in bilateral cleft alveolus with wide defect, deficiency of covering tissue is a greatest problem. Wound dehiscence may develop oronasal fistula of palatal and labial region and loss of the bone graft. We report 2 cases with bilateral cleft alveolus. In both case, bilateral buccal mucosal flap was used for closure of bilateral cleft alveolus with wide defect. The one was operated with iliac bone graft according to secondary grafting method, the other was closed without bone grafting. The patient was 3 years old. So, secondary alveolar bone graft will be required some years later for the establishment of bony continuity and esthetic advantage. In both cases, we found the entire soft tissue closure without the lack of covering flap. In these case, the closure of alveolus defect was accomplished successfully by the use of bilateral buccal mucosal flap. There was no complication, secondary fistula. The most important thing is the tension-free closure of the bilateral buccal mucosal flap. So, we report these cases with literatures.

• 대한구순구개열학회지
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• 제9권2호
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• pp.79-84
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• 2006

Cleft palate is one of the most devastating congenital facial deformities frequently accompanied by cleft lip. In many cases, it causes phonetic and swallowing difficulties although surgical interventionwas applied. Among the surgical methods, Veau-Wardill-Kilner pushback palatoplasty (V-Y reposition) is widely used in the most cleft palate cases. It is designed to lengthen the palate posteriorly, hence to overcome the speech and swallowing problems, but broad postoperative palatal scar might interfere the normal maxillary growth. If the velar muscles were not reoriented, it could result in incomplete speech recovery. In this case report, the modified two-flap palatoplasty with minimal pushback was successfully applied to a 21 month-old girl who has had incomplete cleft palate extended to the posterior third of hard palate. The speech evaluation was confirmed as functional reconstruction of cleft palate was achieved.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.181-185
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• 2007

Purpose: Cleft lip and/or palate is the most common congenital facial anomaly whose incidence is about 1 in 500~1000 live births. As this anomaly may be associated with the serious chromosomal anomalies or the multiple organ abnormalities resulting in the fetal loss or perinatal maternal morbidity and mortality, careful prenatal counseling with early and accurate detection is important. Although conventional prenatal ultrasound(US) examination in midterm pregnancy has been applied for screening of cleft lip, there are definite limitations in the diagnosis of accompanying cleft palate or alveolar cleft. We applied high-resolution 3D US along the serial axial, coronal and sagittal plane so that we could diagnose the cleft palate and/or alveolar cleft in fetuses with cleft lip. Methods: From May 2005 to September 2005, 20 fetuses with cleft lip were examined with prenatal 3D US. Average maternal age was 28.8 years old(24-35 years old), and average gestational age was 24.8 weeks(17.6 to 34.2 weeks). Consecutive axial, coronal and sagittal multislice view were obtained via prenatal 3D US examination and diagnosis of cleft palate and/or alveolar cleft in cleft lip fetuses was followed. Results: With noninvasive and safe prenatal 3D US examination, 17 of 20 cleft lip fetuses were demonstrated to have cleft palate and/or alveolar cleft. Prenatal counseling according to the result was made. Conclusion: Existing prenatal US examination is suitable for screening the cleft lip fetuses but has limitation in identifying the related existence of cleft palate and/ or alveolar cleft. Authors verify the presence of cleft palate and/or alveolar cleft acquiring the successive multislice axial, coronal, and sagittal view with prenatal 3D US examination. Therefore, prenatal 3D US examination could be regarded as a noninvasive and secure screening modality in fetuses with cleft lip for confirming whether cleft palate and/or alveolar cleft is accompanied.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 1997년도 종합학술대회
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• pp.31-31
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• 1997

• 대한두개안면성형외과학회지
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• 제24권3호
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• pp.111-116
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• 2023

Background: In Indonesia, the prevalence of cleft lip and palate increased from 0.08% to 0.12% between 2013 and 2018. Children with cleft deformities typically undergo staged surgery. However, the coronavirus disease 2019 (COVID-19) pandemic has had negative impacts on the healthcare sector, including the suspension of elective procedures; this has raised concerns about the safety of performing surgery and the functional consequences of delaying treatment, the latter of which is associated with poor prognosis. The purpose of this study was to report the characteristics of clefts treated by the Bandung Cleft Lip and Palate Center team during the pandemic period. Methods: This brief comparative study based on a chart review was conducted at the Bandung Cleft Lip and Palate Center. We statistically evaluated data from all patients treated between September 2018 and August 2021. Frequency analysis was performed to analyze the average number of each procedure by age before and during the COVID-19 pandemic. Results: Data from 18-month periods before (n= 460) and during (n= 423) the pandemic were compared. Cheiloplasty procedures were examined (pre-pandemic, n= 230; pandemic, n= 248); before the pandemic, 86.1% were performed according to the treatment protocol (patient < 1 year old), and this proportion non-significantly dropped to 80.6% during the pandemic (p= 0.904). Palatoplasty procedures were also compared (pre-pandemic, n= 160; pandemic, n= 139); the treatment protocol (patient 0.5-2 years old) was followed for 65.5% of procedures before the pandemic and 75.5% during the pandemic (p= 0.509). Additionally, 70 (mean age, 7.94 years) revision and other procedures were performed before the pandemic and 36 (mean age, 8.52 years) during the pandemic. Conclusion: The cleft procedures performed at the Bandung Cleft Lip and Palate Center did not significantly change during the COVID-19 pandemic.

• 대한구순구개열학회지
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• 제4권2호
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• pp.69-78
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• 2001

Alveolar cleft exists in 75% of cleft patients, In alveolar cleft patients, alar base is widening, palatal fistular formation, maxillary growth disturbance & tooth loss of adjacent area is raised, Alveolar bone grafting, especially iliac bone grafting, is a general treatment method. As operation timing, bone grafting is classified with primary, early secondary, secondary, & late secondary, Here we report cleft width, marginal bone height, bone resorption rate, grafted shape & bone densities after secondary iliac bone grafting was done in the Dept. of oral and maxillofacial surgery of chonbuk national university hospital. We compared cleft width to bone resorption rate and grafted shape. Also, alveolar bone densities of grafted and contralateral site was compared with Emago 3 package? (Oral Diagonostic System, The Netherlands), The data obtained were analyzed using Spearman's rho coefficients and sign test with SPSS for window, The results were obtained as follows. 1. As alveolar cleft width is increase, bone resorption rate is, too. This relation showed significant difference(P<.01). 2, In proximal & distal area, alvolar cleft width and bone graft contour after bone grafting had a reverse proportional difference. It was not significant difference(P>.05). 3. After 3 month, in bone density results by using Emago 3 package? with periapical standard view, occlusal view & panoramic view, differences between grafted bone and alveolar bone of contralateral site didn't show a significant difference(P>.05). Thus, differences of bone densities in the alveolar bones didn't exist.

• 대한구순구개열학회:학술대회논문집
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• 대한구순구개열학회 1998년도 종합학술대회
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• pp.29-29
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• 1998