Unilateral Cleft Lip-Approach and Technique (original) (raw)
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Primary treatment of lip and nasal deformity in unilateral cleft lip or cleft lip and palate
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery
Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais Introduction: Cleft lip and palate, the most frequent congenital craniofacial deformity, mainly affects the upper lip, nose, and palate. One possible treatment is single-stage lip repair with primary rhinoplasty. Here we assessed the correlations among cleft severity, surgical age, and aesthetic results. Methods: A total of 26 patients with unilateral cleft lip or cleft lip and palate aged 3-12 months underwent surgical lip repair associated with the Göteborg/McComb rhinoplasty technique. Steps before and after surgery were separately evaluated by five plastic surgeons using pictures and the data were analyzed. Results: The average patient age at surgery was 6.5 ± 3.15 months, and only seven patients (26.9%) underwent surgery at 3 months of age as recommended by the protocol. Cleft severity and results quality were associated, whereas surgical age and aesthetic results were not correlated. Results in all cases were considered optimal or satisfactory. Conclusions: The lip repair technique, which presents good reproducibility and aesthetic results and can be used with other primary treatment techniques for the nose, should be adopted by treatment centers managing cleft lip and palate. Cleft severity is an important factor in results quality; the greater the severity, the worse the results. In the present study, surgical age was not correlated with results quality.
Unilateral cleft lip and nasal repair: techniques and principles
Iranian journal of pediatrics, 2011
The Mashhad University of Medical Sciences and the Sheikh Hospital in Mashhad sponsored a Cleft Lip and Palate Workshop 30 April - 1 May 2009. During the Workshop, 6 surgical cases were performed and televised live to the audience attending the conference. Two of those cases were unilateral cleft lip repairs. The surgical technique used to repair these patients by the primary author (JGM) is a hybrid technique. It has evolved over the last decade as a result of prior surgical literature as well as first hand observation of various surgical colleagues. The following manuscript describes the surgical technique used at the Cleft Workshop in a step-wise or atlas-like fashion. The technique portion of the paper describes the repair of the unilateral cleft lip and nasal deformity in roughly the order the first author typically performs the procedure. More importantly, the final section of the paper details the principles that form the foundation for the techniques described.
Functional and aesthetic correction of secondary unilateral cleft lip nasal deformities
Indian Journal of Plastic Surgery, 2009
The treatment of patients with unilateral cleft lip has undergone signiÞ cant development during the last decades. With better understanding of the anatomy of the unilateral cleft lip and nasal deformities, primary correction of the nasal deformity at the time of lip repair, critical evaluation of short and long-term results following various treatment protocols, and constant striving for perfection in both aesthetics and function, we have been able to design improved treatment strategies and more accurate surgical techniques so as to achieve overall superior and long-lasting results. In this review article, we present our protocols and experience for functional and aesthetic correction of secondary unilateral cleft lip nasal deformities and a retrospective review of 219 consecutive patients treated at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities. The protocols used in the treatment of 219 consecutive patients at our Craniofacial Centre for correction of secondary unilateral cleft lip nasal deformities were reviewed. In addition, analysis of the most recent 51 consecutive patients who underwent complete clinical and functional evaluation with rhinomanometry followed by correction of the cleft lip nasal deformity was performed. A variety of time-honoured techniques of rhinoplasty were applied in the correction of the residual deformities to achieve symmetry, aesthetic balance, and functional correction of the nose. Follow-up ranged from 5-11 years. Analysis of the data revealed that 39 patients (76.47%) had signiÞ cant functional and aesthetic improvement; seven patients (13.07%) had signiÞ cant aesthetic improvement but a modest functional improvement; and Þ ve patients (9.8%) required additional surgery to improve their appearance and had no functional improvement. Further analysis demonstrated that Þ ve out of seven patients in the second group had pharyngeal ß aps in place that were primarily responsible for the airway obstruction. No attempt was made to revise the ports of these ß aps because the speech was excellent. The surgical plan is based on the information gained from our extensive clinical evaluation and is tailored to the patient's speciÞ c functional and aesthetic needs.
A new method for the correction of secondary unilateral cleft lip nose
European Journal of Plastic Surgery, 1994
In 1982, Dibbell described a procedure to correct this distortion by rotating and advancing the nostril medially and superiorly. We used this method in our department for several years, but as Dibbell himself experienced, we didn't always obtain satisfactory results. Like many authors, I agree that the best approach for proper correction of the secondary unilateral cleft lip nose deformity is the external approach using transcolumellar incisions, because the lower lateral cartilage exposure is inadequate with Dibbell's method. I added the transcolumellar incision similar to Bardach's to solve this problem. In this paper, this combination technique will be presented and contrasted with Dibbell's and Bardach's techniques.
Otolaryngologic Clinics of North America, 1999
Cleft lip nasal deformity has been considered by most surgeons to be a difficult problem to correct. The great multitude of rhinoplasty techniques developed since the 1920s serves as a testament to the difficult nature of the secondary cleft rhinoplasty. All of the techniques address some aspects of the deformity. Completely correcting all of the deficiencies of some cleft lip noses, however, remains an elusive goal. Certainly, each patient presents a unique challenge that may be addressed best with some techniques and not others. To understand what a cleft rhinoplasty technique accomplishes, the secondary deformity of the cleft lip nose must be understood. It must be distinguished from the nasal deformity of the unrepaired cleft of the lip mainly by the position of the alar base. In the repaired lip, the alar base displacement can be largely corrected in some individuals. The unilateral cleft lip nasal deformities result from tissue deficiency of the cleft lip, a deficiency in the maxilla, or abnormal muscular pull on the nasal structures. The "typical" secondary deformity consists of the following: 1. The dome on the cleft side is retrodisplaced. 2. The columella on the cleft side is foreshortened. 3. The medial crus slumps laterally.
Treatment of Complete Bilateral Cleft Lip-Nasal Deformity
Seminars in Plastic Surgery, 2005
The modern technique of presurgical orthopedics and nasoalveolar molding produces a better skeletal foundation and nasal shape for the repair of the bilateral cleft lip-nasal deformity. The general principles are as follows: (1) preserve the presurgical columellar length; (2) keep the width of the central lip segment narrow without compromising the blood supply; (3) advance the columella prolabium complex superiorly to allow reconstruction of the orbicularis oris muscle behind the prolabium; (4) release the alar cartilage attachment from the pyriform rim and provide additional coverage of this soft tissue deficiency with the use of inferior turbinate flaps; (5) release and reposition the lower lateral cartilage; (6) adequately dissect above the maxillary periosteum; (7) reconstruct the nasal floor by local mucosal flaps; (8) reconstruct the prolabial buccal sulcus with tissue from the prolabium; (9) reconstruct the orbicularis muscle sphincter and attach it to the anterior nasal spine; (10) reconstruct a new Cupid's bow, central vermilion, and lip tubercle with tissue from the lateral lips; (11) balance the height of both lateral lips without any incision around the ala; and (12) maintain the presurgical nasolabial angle. The residual nasal deformity remains a problem that needs further improvement. The long-term result in Chang Gung Craniofacial Center suggests overcorrection of columella height before, during, and after lip repair.
Secondary Unilateral Cleft Lip Nasal Deformity: Functional and Esthetic Reconstruction
Journal of Craniofacial Surgery, 2003
Secondary correction of residual unilateral cleft lip nasal deformities is necessary in a number of patients for functional and cosmetic purposes. Myriads of techniques and modifications have been reported. Most of these publications, however, deal with the correction of the esthetic aspects of the deformity, and little attention has been given to the functional problems associated with the deformity and to the functional outcome of these procedures. A comprehensive protocol of care for correction of residual nasal deformities describing our preoperative anatomical and physiological evaluation, our surgical techniques, and postoperative outcome is presented here. The first 30 consecutive patients managed with this protocol were evaluated clinically and physiologically with rhinomanometry. Significant functional improvement was identified in 73.3% of our patients. It is recommended that airway obstruction be evaluated and addressed in all patients with residual cleft nasal deformities. Component rhinomanometry provides objective information about airway obstruction, and postoperative testing and comparison with preoperative data provide for an objective evaluation of results and assist the surgeon to evaluate the outcome of all procedures critically and to modify or improve them appropriately.
The Cleft Palate-Craniofacial Journal, 2006
To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair. Method: The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force generated during suction and swallowing. A conventional intraoral plate is built with a nasal extension added to the labial vestibular flange. The nasal extension was modified and consists of three components. The palatal plate is left loose in the mouth to generate a discontinuous but controlled impact directed to the affected nasal structures during suction and swallowing. The principle aim of the DPNR technique in unilateral cases is to improve the deformation of nasal structures by straightening the columella, elevating the nasal tip, and remodeling the depressed cleft side alar cartilages. In bilateral cases, the aims are to elongate the columella and to obtain nasal tip projection. Conclusions: The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate. KEY WORDS: cleft nasal deformity, dynamic presurgical nasoalveolar remodeling, presurgical infant orthopedics, unilateral and bilateral cleft lip and palate Most surgeons agree that primary correction of the nasal deformity is important. Dissatisfaction with the long-term results, obtained with any of the available surgical techniques, stimulated us to modify conventional surgical strategies. To improve the chances for better nasal outcomes after cleft lip surgery, during the past 18 years, an intraoral plate with a nasal extension has been used to reshape and improve the primary nasal deformity in patients with unilateral and bilateral cleft lip and palate (Dogliotti et al., 1991). The original tech
Tip Rhinoplasty in Cleft Lip Nasal Deformity
2015
It is important to identify the aim of the rhinoplasty in cleft lip nasal deformities as to restore the nasal symmetry, improvement of the nasolabial and naso-facial relationship with minimal evidence of surgical intervention as well as the functional objectives as patent air way, proper position of the maxilla and achievement of normal speech [2]. Rhinoplasty in cleft lip nasal deformities could be performed either primary or secondary after repair of the cleft lip. Primary correction has been reappraised in the last two decades having particular advantages as more symmetrical nose and better appearance in the early life. Even when rhinoplaty is re-required after nasal growth is complete, the deformity is less severe and more amenable final results [3].