Lip Revision Research Articles

Abstract: Comparison of Efficiency of Z Plasty and Diamond Shape Excision for Correction of Secondary Deformities in Unilateral Cleft Lip Patients

INTRODUCTION: Many different methods have been described for the revision of cleft lip scars in patients with unilateral cleft lip. The aim of this study is to compare Z plasty and diamond shape excision that commonly used techniques to correct secondary lip deformities. METHODS: 10 patients and 8 patients were operated diamond shape excision and Z plasty respectively in 2013–2016. Patients photos after lip revision were studied with facial symmetry program and by having the symmetry of the non-cleft side; a normal lip appearance without cleft was obtained. In the late period after surgery, VAS (visual analogue scale) was performed to determine the satisfaction rates of operation. When looking at the scale, patients were given 10 points for their photographs without cleft lip and the pre-revision photographs are considered 0 point. By the surgeon, the non-clefted lips and post-revision lips were overlaid in the 2015 version of Adobe Reader Photoshop CC program, and the asymmetry of the vermillion and the filtral colon distances were determined. The surgical outcome was evaluated by the surgeon. The result is excellent if there is a difference less than 0.5 mm, good result if difference between 0.5 and 1 mm, bad result is if the difference is more than 1 mm. Whether there is a statistically difference in patient and surgeon satisfaction between the two surgical techniques was evaluated by using the PearsonÂ’s squared test in the scale data in the SPSS 15 analysis. RESULTS: There was no statistical significance between the patients and surgeon satisfaction rates and two surgical procedures. CONCLUSION: Z plasty and diamond shape excision are the most commonly used methods for correcting the secondary cleft lip deformity. These methods, which have no difference in terms of surgeon and patient satisfaction, can be used according to shape of the deformity.

A novel technique using a subcutaneously pedicled islanded prolabial flap for the secondary correction of bilateral cleft lip and nasal deformity.

Context:The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle.Aims:We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity.Settings and Design:This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty.Subjects and Methods:The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31–40 = excellent, 21–30 = good, 11–20 = fair and 0–10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure.Results:The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high.Conclusions:This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.

Current and Emerging Treatments for Postsurgical Cleft Lip Scarring: Effectiveness and Mechanisms

Cleft lip with or without cleft palate is the most common congenital malformation of the head and the third-most common birth defect. Surgical repair of the lip is the only treatment and is usually performed during the first year of life. Hypertrophic scar (HTS) formation is a frequent postoperative complication that impairs soft tissue form, function, or movement. Multiple lip revision operations are often required throughout childhood, attempting to optimize aesthetics and function. The mechanisms guiding HTS formation are multifactorial and complex. HTS is the result of dysregulated wound healing, where excessive collagen and extracellular matrix proteins are deposited within the wound area, resulting in persistent inflammation and resultant fibrosis. Many studies support the contribution of dysregulated, exaggerated inflammation in scar formation. Fibrosis and scarring result from chronic inflammation that interrupts tissue remodeling in normal wound healing. Failure of active resolution of inflammation pathways has been implicated. The management of HTS has been challenging for clinicians, since current therapies are minimally effective. Emerging evidence that specialized proresolving mediators of inflammation accelerate wound healing by preventing chronic inflammation and allowing natural uninterrupted tissue remodeling suggests new therapeutic opportunities in the prevention and management of HTS.

Incidence of Le Fort Surgery in a Mature Cohort of Patients With Cleft Lip and Palate.

Seventy-one nonsyndromic patients with cleft lip and/or palate were followed until age 23 years, and data regarding original diagnosis, surgical procedures, and dates were collected. Within our patient cohort, 12 patients (16.9%) underwent orthognathic surgery. Binary logistic regressions, Fisher exact tests, and Mann-Whitney U tests were used to determine whether timing of primary palate repair and primary lip repair contributed significantly to subsequent orthognathic surgery. In our cohort, the association of early lip repair with later orthognathic surgery trended toward significance (P = 0.080). Timing of primary palate repair was not significantly associated with later orthognathic surgery (P= 0.291). When correcting for sex, race, diagnosis, location of care, incidence of lip adhesions, and incidence of lip revisions, patient age at primary lip procedure was a significant predictor of later orthognathic surgery (P = 0.041). Inconsistent with prior research, age at primary palate repair in our cohort was not correlated with incidence of orthognathic surgery. Delayed primary lip repair was associated with a significant decrease in the rate of subsequent orthognathic surgery.

Bilateral cleft lip revision: techniques and results

Bilateral cleft lip deformities can be difficult to correct and it is universally agreed that a large number of cases will require further revisions after the primary repair. The need for secondary repair and the type of secondary deformities is determined by the following:1.Type and severity of the initial cleft.2.The principles applied in the primary repair of these deformities. This presentation will look at the effect of different principles applied during the primary repair and how to manage the secondary deformities resulting from use of different principles of repair. The principles of repair will be considered under the following heads:1.Presurgical orthopaedics2.Lip adhesion procedures3.Staging of bilateral lip repair4.The utilisation of the prolabial tissues5.Muscle approximation6.Reconstruction of the central vermilion7.Sulcal release incision8.Management of the nasal deformities.

Structural Fat Grafting to Improve Reconstructive Outcomes in Secondary Cleft Lip Deformity.

To describe the technique and results of structural fat grafting in cleft lip revision, including patient satisfaction and aesthetic outcome. Retrospective case series. Multidisciplinary cleft care center. All patients who underwent structural fat grafting between June 2006 and September 2012 for cleft lip revision, with appropriate photographic follow-up included. Twenty-two cases were reviewed; 18 had sufficient data to be included. Patients underwent structural fat grafting for cleft lip revision, most commonly injecting fat under deficient philtral columns, the nostril base, and upper lip. Blinded observers rated outcomes using the Asher-McDade nasolabial appearance rating scale. Patients completed questionnaires assessing their satisfaction. A paired Student's t-test was used to test outcomes for significance (alpha = 0.05). Patients were an average of 16 years old (range: 6-43); average length of follow up was 11.7 months. Overall symmetry and aesthetics were improved based on the nasal form (P = 0.006) and vermillion border (P = 0.04) when rated using the Asher-McDade scale. No complications were recorded. Patients were significantly happier with their appearance after fat grafting (P < 0.001) and were uniformly positive when questioned about the ease of the surgery and rate of recovery. Structural fat grafting is a safe and effective way to improve symmetry and enhance facial proportions in patients with cleft lip. Given the high degree of patient satisfaction, few complications, and durable results, fat grafting offers many advantages in cleft lip revision.

National Estimates of and Risk Factors for Inpatient Revision Surgeries for Orofacial Clefts.

To provide national estimates of the number and cost of primary and revision cleft lip and palate surgeries in the U.S. and to determine patient and hospital characteristics associated with disproportionate use of revision surgery. Retrospective cross-sectional study using data obtained from the 2003, 2006, and 2009 Kids' Inpatient Database. Inpatient. Children with CL, CP, or CLP undergoing inpatient cleft lip and/or palate surgery. Inpatient cleft lip and/or palate surgery. Orofacial cleft surgery estimates, estimates of primary versus revision surgeries, and estimated inflation-adjusted hospitalization costs. In 2009, there were a total of 2824 and 5431 hospitalizations for cleft lip and palate surgeries, respectively. Revision surgery accounted for 24.2% of cleft lip surgeries and 36.8% of cleft palate surgeries. Children with CLP (OR 1.87, 95% CI: 1.48-2.38), a syndromic diagnosis (OR 1.47, 95% CI: 1.16-1.87), or private insurance (OR 1.71, 95% CI: 1.41-2.09) were more likely to undergo cleft lip revision surgery. Similar risk factors were found for children undergoing cleft palate revision. Mean cost per hospitalization ranged from $7564 to $8393 in 2009, depending on surgery type, and did not change significantly (in 2009 U.S. $) between 2003 and 2009. Interventions to reduce revision surgery by improving results of primary surgery should be targeted in the population of identified high-risk (e.g., syndromic) patients. In addition, the association of health insurance status with revision surgery highlights the need to understand and address the impact of economic disparities on cleft care delivery.

Abstract: Decreasing Burden of Care for Patients with Cleft Lip and Palate

PURPOSE: In most treatment protocols, patients with unilateral complete cleft lip and palate (UCCLP) will have a minimum of 3 operations prior to adolescence- lip repair, palate repair, and alveolar bone grafting. Every additional surgery and orthopedic intervention (such as NAM) increases the burden of care. The purpose of this study is to examine the outcome of number of secondary surgeries of patients with UCCLP treated by a single surgeon using a standard protocol without presurgical orthopedics. METHODS: In an IRB approved study, all patients with UCCLP treated from infancy to at least age 6 in the period of 1996–2010 by a single surgeon were identified. 48 consecutive patients were identified and retrospective chart review was done. All patients had lip repair with primary nasal repair at about 10 weeks of age. No presurgical orthopedics lip adhesion, or soft tissue taping was done. Patients underwent palate repair at 9–12 months of age, and alveolar bone grafting at an average of 8 years. Surgical revisions were offered when medically indicated. The incidence of secondary surgeries was determined and compared to published Americleft data using the Pearson Chi Squared test. RESULTS: 22 of 48 patients underwent a secondary procedure, including lip revision (16), PPF(1), Fistulorrhaphy(7) and secondary rhinoplasty (5). Of the patients undergoing lip revision, 12 of 16 had the procedure done at the time of another surgical procedure, most commonly a minor revision during the palate repair or the Alveolar bone graft (8/12). Of the patients undergoing secondary rhinoplasty, 2 of the 5 had the surgery done while undergoing an additional operation. Overall, 83% of patients had only 3 surgical sessions (lip repair, palate repair, and alveolar bone graft) prior to adolescence. Results compared favorably with centers reported by Sitzman in the Americleft study of burden of care, with significantly lower incidences of lip revision compared to sites A and D, and lower incidences of secondary rhinoplasty compared to sites A, D, and E.1,2 CONCLUSIONS: A protocol without using naso-alveolar molding can result in 83% of patients requiring only 3 operative sessions with good acceptance of appearance by the family. Burden of care can be minimized for these patients. All protocols for cleft care should be considered for their burden of care. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Sitzman TJ, Allori AC, Thorburn G. Measuring outcomes in cleft lip and palate treatment. Clin Plastic Surg. 2014;41:311–319. 2. Sitzman TJ, Mara CA, Long RE Jr., et al. The Americleft project: Burden of care from secondary surgery. Plast Reconstr Surg Glob Open. 2015; 3:422; doi: 10.1097/GOX.00000000000415.x

The Burden of Care for Children With Unilateral Cleft Lip: A Systematic Review of Revision Surgery.

To identify the average rate of revision surgery following cleft lip repair. PubMed, CINAHL, and SCOPUS were searched from database inception through March 2013 using the search terms cleft lip and surgery. Two investigators independently screened all abstracts and determined eligibility from review of full manuscripts using prespecified inclusion and exclusion criteria. Strengths and limitation of the studies were assessed, followed by qualitative synthesis. The I(2) test of homogeneity was performed to determine if meta-analysis was appropriate. The search identified 3034 articles. Of those, 45 met the inclusion criteria. Studies were primarily case series and retrospective cohort studies, with only one randomized controlled trial. One-third of studies (n = 15) did not describe how the study sample was selected. Follow-up duration was not reported in one-fourth of studies (n = 11). Nasolabial aesthetics were reported in 44% of studies (n = 20). The incidence of revision surgery ranged from 0% to 100%. Meta-analysis was precluded because of study heterogeneity (I(2) = 97%). The average incidence of cleft lip revision surgery cannot be estimated from the published literature, due to significant heterogeneity among existing reports and limited study quality. To provide valid information about the burden of care for unilateral cleft lip, a population-based or multicenter longitudinal cohort study is necessary; this study should measure the number of surgical procedures and the patient's aesthetic outcomes.

Number of Surgical Procedures for Patients With Cleft lip and Palate From Birth to 21 Years Old at a Single Children's Hospital

Pediatric patients with cleft lip and palate undergo numerous surgeries throughout their childhood and early adulthood to correct the aesthetic and functional stigmata of their diagnoses. This study identifies patient and clinical factors that contribute to the number of surgeries and anesthesia events children undergo for their cleft repair. Retrospective chart review was performed using the genetic and dysmorphology database at Rady Children's Hospital San Diego. All patients with cleft lip or cleft palate diagnosis who underwent surgery at Rady Children's Hospital San Diego between 1988 and 2014 were included. A sample size of 71 patients was analyzed. Poisson regression was used to determine if there is a relationship between each variable of interest and the number of procedures. For our sample of 71 patients, the average number of surgical procedures was 8.6 (SD, 4.4). The average number of anesthesia events was 6.7 (SD, 3.3). Across and within diagnosis, race and sex were not statistically significant factors in patients' number of surgeries. Patients with bilateral cleft lip and palate (BCLP) and unilateral cleft lip and palate had, on average, 10 and 9.4 procedures, respectively. This is in contrast to patients with unilateral cleft lip and isolated cleft palate who had, on average, 5.3 and 5.9 procedures, respectively. This difference was significant (P value = 0.01). Patients were also compared based on continuity of care. Patients who had their cleft surgeries by multiple plastic surgeons affiliated with our children's hospital had significantly more surgeries (P = 0.01). A surgical outlier subset of 17 patients (24%) was identified who had more than 10 surgeries. These patients also had, on average, 11.3 (unilateral cleft lip and palate) and 11.8 (bilateral cleft lip and palate) anesthesia events; this is in contrast to the nonoutliers who had, on average, 4.1 to 8 anesthesia events. This retrospective review identifies patient and clinical factors that contributed to the number of surgeries and anesthesia events that children with a cleft underwent from birth to adulthood at a single children's hospital. We found that "heralding" events, such as palatal fistula and multiple nasal or lip revisions, can put children at risk for an increasing--and perhaps deleterious--number of surgery and anesthesia events.

Orthodontic management of excessive incisor display of an adult bilateral cleft lip and palate patient

This report entails successful orthodontic treatment of a case of postsurgical malocclusion, short upper lip, and excessive incisor display in an adult patient with bilateral cleft lip and palate. The patient underwent cleft lip repair at an early age of 2 years followed by palatoplasty at the age of 6 years and alveoloplasty at an age of 26 years. He reported with irregular teeth, inability to close lips, excessive visibility of upper incisors associated with short upper lip and difficulty in speech. He was treated with maxillary arch expansion, arch alignment, and intrusion of the incisors followed by prosthetic replacement of the missing right and left lateral incisors. Subsequently, he underwent nose and lip revision surgery at the age of 32 years. The orthodontic procedures and prosthetic rehabilitation have resulted in a near normal dental occlusion with significant improvement in esthetics and psychosocial benefits to the individual. These benefits were further enhanced by nose and lip revision surgery.

Primary Abbe Flap for Median Cleft Lip Deformity: New Trends on an Old Concept.

The authors present our experience using primary Abbe flaps for median cleft lip. The records of 9 patients who underwent primary Abbe flaps were reviewed for indications, operative details, and complications. Flap design is discussed, including the "W" method to facilitate columellar reconstruction. Maxillomandibular fixation was not used. From 2004 to 2015, 9 patients with median cleft lip received primary Abbe flaps. Mean age was 10.2 ± 6.2 months. Lobar holoprosencephaly was confirmed by imaging in 5 of the 9 patients. Operative time averaged 70 ± 22 minutes. Flap division was performed at a mean of 3.6 ± 0.9 weeks. Patients were followed for a mean of 45 ± 49 months. No flaps were lost to vascular compromise and no dehiscences or infections were noted after initial repair. Five patients required prolonged intubation ranging from 4 to 7 days and 3 required transition to gastric feedings postoperatively. One patient with holoprosencephaly expired for reasons independent of surgery. Four patients have undergone 5 lip revisions to date. Patients with holoprosencephaly-spectrum disorder and median cleft lip have more favorable prognoses today. The Abbe flap may be safely and advantageously used for the primary repair of median cleft lip with extreme prolabial tissue deficiency.

Epidemiology and clinical profile of cleft lip and palate patients, in a tertiary institute in Punjab, India: A preliminary study

Objective: The purpose of this study was to report the epidemiological profile and surgeries done on patients with cleft lip and palate from August 2007 to December 2014. Materials and Methods: A retrospective study was done to evaluate the patients operated for either cleft lip (with or without alveolus), cleft palate or secondary correction. The age of operative intervention, sex distribution, type of cleft, laterality, type of surgery, and duration of stay were reported. Results: A total of 411 cleft patients were seen during this period (August 2007-December 2014). Among this 36 (8.7%) patients had an incomplete cleft lip, 57 (13.9%) had a complete cleft lip, and 29 (7%) had cleft lip with alveolus. Isolated cleft palate was seen in 104 (25%) patients and cleft lip and palate were seen in 185 (45%) patients. Eighty percentage patients were aware of the surgeries for cleft lip and palate by various hospital communications. The mean age of patients operated for cleft lip was 5.3 months and Randall Tennison modified repair was done in 88% of these patients. The mean age of patients undergoing palatoplasty was 1.6 years and the most common surgery done was pushback palatoplasty with intervelar veloplasty (73.6%). Seventy-six patients underwent a secondary correction, out of which 30 patients got lip revision and 26 got fistula repair. A total of 15 patients had other associated anomalies. The average duration of stay in hospital for a cheiloplasty patient was 7 days, of palatoplasty was 8 days and of secondary surgery was 5 days. Conclusion: This study indicates that cleft lip and palate are most common types of cleft predominantly on the left side and males being more. Newspapers, various medical institutions, and media are useful measures to spread public awareness about early surgery, follow-up, secondary corrective surgeries, speech and dental therapy. Early diagnosis and appropriate timings of these surgeries produce satisfactory results with minimal morbidity.

Cleft Rhinoplasty- Columellar lengthening prolabial reconstruction with Abbe flap.

Introduction:A single center's experience of correction of cleft lip/palate associated rhinoplasty using Abbe flap is relatively rare in literature. The outcome and perception of the Abbe flap for cleft rhinoplasty at patient, surgeons, and patient's caregiver level have not been found in literature. This manuscript aims to address this lacuna through the use of rhinoplasty outcomes evaluation questionnaire (ROEQ).Materials and Methods:A retrospective analysis of preoperative satisfaction and prospective analysis of postoperative satisfaction of patients who underwent cleft rhinoplasty were carried out using ROEQ. This was used twice measuring the pre- and post-operative periods.Results:Twenty-one cases of bilateral cleft lip and palate who had earlier undergone (0.5–3 years back) cleft rhinoplasty and lip revision with Abbe's flap formed the study group. The mean age of the 21 subjects was 22.87 ± 4.23 years. There were 13 males and 8 females forming the study group. The mean presurgical ROEQ score was 19.8 ± 11.2, while the postsurgical score was 78.5 ± 21.2. This difference was statistically significant (P = 0.001). The difference in score between the time period was 58.7%.Discussion:From the ROEQ and other qualitative parameters, it is possible to demonstrate the impact of Abbe flap for cleft rhinoplasty and its impact on the quality of life of patients. Most of the patients and caregivers believed that this approach achieved a good or excellent postoperative result. The biological and operators factors behind such a success are discussed in light of previously published literature.

Use of combination of Millard and Pfeifer incision technique for treatment of unilateral complete cleft of lip: A report of two cases

Cleft lip and palate is one of the most common congenital deformities of the head and neck region. The prevalence of cleft lip and palate depends on racial, ethnic, geographic origin, and socioeconomic status. It is estimated that isolated cleft lip occurs in 20–30%, cleft lip along with palate occur in 35.50% and isolated palate in 30–45% of cases. It affects the psychological, social, and mental well-being. It is considered as a social stigma and has poor acceptance with a negative perception. These patients require a multidisciplinary approach and aged specific treatment plan. Early repair of cleft lip is advocated for making the child acceptable to the parents and relatives as well as to the society. It also helps in the feeding of the child. There are various techniques for repair of the complete unilateral cleft lip. Almost all techniques continue to leave behind some amount of dissatisfaction. Even today most of the surgeons like to use Millard's technique or its modifications. Here, we present two cases of a newly developed technique utilizing both Millard and Pfeifer incision. For assessment of the success of the technique, we evaluated the vermilion match, lip length, nasal symmetry, white roll match, and postoperative scar after 6 months of primary lip closure. At 6 th month follow-up, we found the overall result was average for both the cases. (minor deformities which can be corrected by lip revision procedure). As this technique is based on the principle of rotation and elongation, we found that this technique allowed tension free closure of the cleft lip even when both the patients had a wide cleft of the lip. This technique addresses the overall anatomy of cleft lip including nasal region. The incision marking is such that rhinoseptoplasty and alar cinch suturing can be done without making any new incision.

Cleft and Craniofacial Care During Military Pediatric Plastic Surgery Humanitarian Missions.

Military pediatric plastic surgery humanitarian missions in the Western Hemisphere have been initiated and developed since the early 1990 s using the Medical Readiness Education and Training Exercise (MEDRETE) concept. Despite its initial training mission status, the MEDRETE has developed into the most common and advanced low level medical mission platform currently in use. The objective of this study is to report cleft- and craniofacial-related patient outcomes after initiation and evolution of a standardized treatment protocol highlighting lessons learned which apply to civilian plastic surgery missions. A review of the MEDRETE database for pediatric plastic surgery/cleft and craniofacial missions to the Dominican Republic from 2005 to 2009 was performed. A multidisciplinary team including a craniofacial surgeon evaluated all patients with a cleft/craniofacial and/or pediatric plastic condition. A standardized mission time line included predeployment site survey and predeployment checklist, operational brief, and postdeployment after action report. Deployment data collection, remote patient follow-up, and coordination with larger land/amphibious military operations was used to increase patient follow-up data. Data collected included sex, age, diagnosis, date and type of procedure, surgical outcomes including speech scores, surgical morbidity, and mortality. Five hundred ninety-four patients with cleft/craniofacial abnormalities were screened by a multidisciplinary team including craniofacial surgeons over 4 years. Two hundred twenty-three patients underwent 330 surgical procedures (cleft lip, 53; cleft palate, 73; revision cleft lip/nose, 73; rhinoplasty, 15; speech surgery, 24; orthognathic/distraction, 21; general pediatric plastic surgery, 58; fistula repair, 12). Average follow-up was 30 months (range, 1-60). The complication rate was 6% (n = 13) (palate fistula, lip revision, dental/alveolar loss, revision speech surgery rate). The average pre-surgical (Pittsburgh Weighted Speech Score) speech score was 12 (range, 6-24). The average postsurgical speech score was 6 (range, 0-21). Average hospital stay was 3 days for cleft surgery. There were no major complications or mortality, 1 reoperation for bleeding or infection, and 12 patients required secondary operations for palatal fistula, unsatisfactory aesthetic result, malocclusion, or velopharygeal dysfunction. Military pediatric plastic surgery humanitarian missions can be executed with similar home institution results after the initiation and evolution of a standardized approach to humanitarian missions. The incorporation of a dedicated logistics support unit, a dedicated operational specialist (senior noncommissioned officer), a speech language pathologist, remote internet follow up, an liaison officer (host nation liaison physician participation), host nation surgical resident participation, and support from the embassy, Military Advisory Attachment Group, and United States Aid and International Development facilitated patient accurate patient evaluation and posttreatment follow-up. Movement of the mission site from a remote more austere environment to a centralized better equipped facility with host nation support to transport patients to the site facilitated improved patient safety and outcomes despite increasing the complexity of surgery performed.

The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip

1) To determine the concordance among surgeons on subjective assessments of nasolabial esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in relation to cleft lip revision surgery. School of Dentistry at University of North Carolina, Chapel Hill. Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery. Retrospective observational study from a non-randomized clinical trial. Ratings of nasolabial esthetics performed by six surgeons using the Asher-McDade scale at baseline and 12-month follow-up. Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were better in the Revision group than in the Non-Revision group, although differences were small. The most prevalent change in the Revision Group was improvement in one or more units on the scale, while 'no change' was most prevalent in the Non-Revision group. Participants in the Revision group were more likely to receive a 'no' in relation to the need for lip or nose revision at the follow-up visit. There were mild esthetic improvements observed in relation to lip revision surgery, which should be interpreted with caution given the subjectivity of the rating method used.

The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip

The effects of lip revision surgery on nasolabial esthetics in patients with cleft lip

Influence of Objective Three-Dimensional Measures and Movement Images on Surgeon Treatment Planning for Lip Revision Surgery

Objective : To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons' treatment plans for lip revision surgery. Design : Prospective longitudinal study. Setting : The University of North Carolina School of Dentistry. Patients, Participants : A group of patients with repaired cleft lip and palate (n = 21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions : Lip revision. Main Outcome Measures : (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results : With the use of the video images plus objective three-dimensional measures, the operating surgeon changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions : For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients.

Effects of Lip Revision Surgery on Long-Term Orosensory Function in Patients with Cleft Lip/Palate

OBJECTIVE : To determine whether secondary lip revision surgery impacts sensitivity of the upper lip. DESIGN : A three-group, parallel, prospective, nonrandomized clinical trial. SETTING : University of North Carolina School of Dentistry. PATIENTS, PARTICIPANTS : Three groups: (1) patients with repaired cleft lip/palate who were scheduled for lip revision (revision; N = 20); (2) patients with repaired cleft lip/palate who did not receive a lip revision (non-revision; N = 13); and (3) non-cleft control subjects (non-cleft; N = 22). Interventions : Lip revision surgery. MAIN OUTCOME MEASURES : Measures of (1) two-point perception threshold (two-point), (2) warmth detection threshold (warm), and (3) cool detection threshold (cool) were obtained from two sites on the upper lip vermilion. The revision participants were tested approximately 1 week before surgery and then approximately 3 and 12 months after surgery. The non-revision and non-cleft participants were tested at similar times. RESULTS : There were no significant differences among the three groups at baseline for two-point, warm, or cool. The main effects of group, age, sex, and time were not statistically significant for the two-point or warm (p > .05). The mean differences between the 3- and 12-month follow-up visits and baseline for two-point and warm were small for all three groups. For cool, group was statistically significant (p = .04), the difference in the non-revision group between follow-up and baseline was 31% to 34% higher than in the non-cleft group (p = .01). CONCLUSIONS : Although at postsurgery revision participants exhibited threshold values comparable to presurgical values, the sensory differences observed among subgroups of participants with cleft lip are complex.