Noncleft Side Research Articles

Functional stability analyses of maxillofacial skeleton bearing cleft deformities

The symmetrically stable craniofacial bony structure supports the complex functions and delicate contour of the face. Congenital craniofacial deformities are often accompanied by bony defects and have been repetitively correlated with compromised dento-maxillary stability, but neither the extent nor the pattern of cleft-related maxillary instability has been explored in detail. Furthermore, it is largely unknown if the bony defect and related instability are correlated with secondary maxillary deformity common among patients with orofacial clefts. With the aid of finite element modeling, we studied the detailed relationship between cleft-related bony defect and maxillary stability under occlusal loading. Craniofacial models were generated based on cone-beam computed tomography data and loaded with mimicked bite forces along the axial axis of each tooth. Our data showed that all cleft models exhibited more asymmetrical deformations under mastication compared with the normal. Models with palatal cleft demonstrated greater asymmetry, greater dental arch contraction, and less maxillary protrusion compared to models with alveolar cleft only. For unilateral cleft models, alveolus on non-cleft side tended to be more protruded and lifted than the cleft side. For bilateral cleft models, the most prominent feature was the seriously contracted alveolar arch and curved and pitched premaxillae. These findings indicated cleft type-specific pattern of maxillary instability, which were largely in accordance with dentoalveolar morphological features among patients. Collectively, our study elucidated the detailed relationship between cleft bony defect and the pattern of maxillary instability, and suggested a prototype for studying the abnormal maxillary and dental arch growth among patients with craniofacial deformities.

Odontological analysis of Polish children with unilateral cleft lip and palate

Tooth size, being the effect of interaction of genetic and prenatal factors, could be of importance in interpreting the multifactor causes of cleft lip/palate. Publications indicating decreased tooth parameters, no dental differences, or larger dimensions of teeth in cleft lip/palate patients. Researchers report mostly mesiodistal (MD) measurements of maxillary (affected) teeth. There is a lack of data for buccolingual (BL) diameters. Both MD and BL parameters have influence on the planning and performance of orthodontic treatment. The aim of this paper was to assess differences in mesiodistal and buccolingual tooth dimensions in Polish children with unilateral cleft lip and palate (UCLP) in comparison to patients without oral clefts. A total of 1883 permanent teeth, 1182 teeth of UCLP patients and 701 teeth of healthy participants were analyzed. Tooth diameters were performed using an orthodontic cast of dentition with a digital odontometer. The greatest anomalies were found in both maxillary canines and consisted of their reduced mesiodistal dimension and increased buccolingual dimension, resulting in a pathologically high crown shape index (BL/MD). Conclusion can be drawn that unilateral cleft lip and palate is a condition that causes morphological disturbances of varying severity in most mandibular and maxillary teeth both on the cleft and non-cleft sides.

Effect of Preoperative inhibition of Orbicularis Oris Muscle action On Philtrum length in primary Cleft Lip Repair

Hypothesis: Botulinum toxin injection before cleft lip repair will inhibit the Orbicularis Oris muscle action and decrease the tension applied on the wound edges during healing leading to improved esthetic outcome.Methods: Thirty two patients, under 6 months of age, with complete unilateral cleft lip, were enrolled in this double-blind, randomized, placebo-controlled prospective study. Patients were randomly divided into two equal groups; in the BTX group, botulinum toxin type A (BTX-A) was injected while in the Placebo group normal saline was injected in 4 points in the subjacent orbicularis oris muscle on both edges of the cleft, one week before the primary lip repair. At six-month follow up patients were assessed, in blinded fashion, for length of philtrum ridge both in cleft and non-cleft sides as well as for scar width. Collected data were tabulated and statistically analyzed.Results: Thirty patients completed the study. After 6 months, difference in philtrum length between cleft and non-cleft sides in the BTX group was significantly less than the placebo group (P=0.001). The scar width in the BTX group was also statistically significantly less than the Placebo group (P =0.001). Conclusions: Inhibition of orbicularis oris muscle during wound healing by BTX injection, before primary repair of unilateral cleft lip, safely and effectively reduced the difference in philtrum length between cleft and non-cleft sides and it also reduced the width of the scar.

Analysis of preoperative measurements in unilateral cleft lip patients toward the outcome of secondary cleft deformities

Introduction: The purpose of this study is to determine whether the severity of the initial cleft deformity has any effect on the postoperative result of primary lip and palate repair in terms of the presence or severity of secondary deformity. The anthropometric measurements of the cleft side will be measured against the noncleft side as control. Materials and Methods: This was a cross-sectional, noninterventional study conducted for 12 months from March 2017 to March 2018. All children aged 5–12 years old with unilateral cleft lip deformity who underwent cleft lip repair from the year 2005 to 2013 were included in the study with a total of 42 patients. Both preoperative and postoperative lip and nose, anthropometric measurements were taken with a ruler and caliper. Difference between cleft and noncleft sides for philtrum lateral height (PLH), lip height (LH), nostril floor width (NF), and nostril height (NH) were taken to represent asymmetry or the severity of deformity and categorized into a grading system representing initial severity (IS) and postoperative asymmetry (PA). Relationship between the IS and PA were analyzed. Results: All four indices were lesser for the postoperative measurements showing an improved outcome after surgery. There was a significant difference between the IS and PA for PLH (P < 0.001) and NF (P = 0.007), thereby inferring that IS grade is not symmetrical from PA for both indices measured. However, there was no statistically significant difference between the IS and PA for LH (P = 0.055) and NH (P = 0.410). Therefore, the IS and the PA for these two indices are symmetrical. A majority of patients are within the similar grade for both IS and PA for LH; 15 patients for IS and PA Grade 1 and 11 patients for IS and PA Grade 2 (n = 26). As for NH, there were 13 patients with IS and PA Grade 1 and eight patients with IS and PA Grade 2 (n = 21). Conclusion: This study determines a coherent connection between the preoperative and postoperative LH and NH asymmetry. Thus, the postoperative lip and nose height asymmetry was worse in more severe clefts compared to those with a less severe initial cleft deformity.

Pilot Study of Visual and Quantitative Image Analysis of Facial Surface Asymmetry in Unilateral Complete Cleft Lip and Palate.

To visualize and quantitatively analyze facial surface asymmetry following primary cleft lip repair in patients with unilateral cleft lip and palate (UCLP) and to compare this with noncleft controls. Retrospective comparative study. Twenty-two patients with complete UCLP who underwent primary lip repair from 2009 to 2013 were enrolled in this study. The preserved 3-dimensional (3D) data of 23 healthy Japanese participants with the same age were used as controls. All patients had received primary labioplasty in accordance with Cronin triangular flap method with orbicular oris muscle reconstruction. Shadow and zebra images established from moiré images, which were reconstructed from 3D facial data using stereophotogrammetry, were bisected and reversed by the symmetry axes (the middle line of the face). The discrepancies of the gravity and density between cleft and noncleft sides in 2 regions of interest, facial and lip areas, were then calculated and compared with those of healthy participants. In the UCLP group, the mean discrepancies of gravity on shadow and zebra images were 1.76 ± 0.70 and 2.63 ± 1.72 pixels, respectively, in the facial area and 1.31 ± 0.36 and 3.83 ± 2.08 pixels, respectively, in the lip area. There was a significant difference in the mean discrepancies of gravity and density on zebra images in the lip area between the UCLP and control groups. Our image analysis of digital facial surface asymmetry in patients with UCLP provides visual and quantitative information, and it may contribute to improvements in muscle reconstruction on cleft lip repair.

Impact of nasalis muscle repair in unilateral cleft lip patients

BackgroundAlthough the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry. Patients and methodsA controlled prospective randomized study was conducted on 45 cases of unilateral complete pre-alveolar cleft. Patients were divided into two groups; Group 1 (repair of the Orbicularis muscle only), Group 2 was further divided into 2 subgroups: Subgroup A (repair of the orbicularis oris muscle and dissection and repair the origin of the nasalis muscle). Subgroup B (repair of the orbicularis oris muscle and dissection of both origin and abnormal insertion of the nasalis and repair of the origin). Evaluation was conducted both subjectively and objectively through cleft lip evaluation profile and nostril angles measurement. ResultsGroup 2B patients showed significantly better shape and symmetry of nasal tip, size and symmetry of nostrils and size, form and lateral displacement of the ala. Objective evaluation showed that group 2B had the closest results to the non-cleft side, with statistically significant difference, when compared to other groups. ConclusionDissection and repair of both origin and insertion of nasalis muscle produced a nasal width, columellar height, and nasal tip projection close to the normal population of the same age.

Three-dimensional analyses of nasolabial forms and upper lip surface symmetry after primary lip repair in patients with complete unilateral cleft lip and palate

PurposeTo analyze three-dimensional (3D) nasolabial forms and upper lip surface symmetry after primary lip repair in children with unilateral cleft lip and palate (UCLP). MethodsSubjects were 22 Japanese children with complete UCLP who underwent primary lip repair and were followed-up for 4–6 years. The 3D coordinates of facial landmarks and the angle and radius of the approximate nasal alar circle were calculated. Upper lip surface symmetry was analyzed using histogram intersection. ResultsThe nasal tip and columella base were slightly dislocated to the cleft side, and the midpoint of Cupid's bow shifted to the non-cleft side. The nasal alar and the top of Cupid's bow were reconstructed at the same height, while the approximate nasal alar circle was smaller on the cleft side. The mean value of similarity for upper lip surface symmetry was 0.82; a subject with a higher value had more symmetrical contour lines in the visualized surface image. ConclusionsPostoperative nasolabial forms were almost restored to symmetrical levels, while retaining a small nasal alar. Histogram intersection is applicable as a method for the quantitative evaluation of upper lip surface symmetry in UCLP.

Analysis of Intramaxillary and Mid-Face Skeletal Asymmetry in a Three-Dimensional Model With Complete Unilateral Cleft Lip and Palate

Cleft lip and palate is the commonest congenital craniofacial anomaly and also affects the facial bones. In a unilateral cleft lip and palate (UCLP), there is asymmetry in the mid-face and also within the maxilla between the cleft and non-cleft sides. The aim of this study is to develop a 3-dimensional model of an UCLP skull from a patient's cone-beam computed tomography and measure the asymmetry. The model is constructed with manual segmentation of all regions using MIMICS v14.0 and measurements were done by 3-matic software. Measurements in the mid-face and maxilla were carried out in all planes of interest. Asymmetry was present not only in the maxilla but extends to the orbital, zygomatic, and frontal bones. Through this methodology and model, asymmetric variations <0.5 mm could be assessed precisely thus having potential applications in treatment planning of craniofacial deformities.

Permanent canine eruption into the alveolar cleft region after secondary alveolar bone grafting: Are there prediction factors for impaction?

The aims of this study were to investigate the eruption pattern of maxillary permanent canines in the alveolar cleft area after secondary alveolar bone grafting and to assess the risk indicators for canine impaction. The sample consisted of 75 patients with unilateral cleft lip and palate who underwent secondary alveolar bone grafting with rhBMP-2 with a mean age of 9.8years of age at 1 center. A split-mouth study design was used, with the noncleft hemiarch comprising the control group. Panoramic radiographs taken before, immediately after, and 1year after secondary alveolar bone grafting were used to assess the following parameters in both cleft side (CS) and noncleft side: canine mesiodistal angulation, canine height relative to the occlusal plane, canine mesial displacement, and superimposition with the neighboring maxillary incisors. The frequency of associated dental anomalies was compared between patients with and without CS canine impaction. Data were evaluated using analysis of variance, t tests, Fisher tests, and multiple logistic regression analysis (P<0.05). On the CS, maxillary canines were usually more mesially angulated and more distant from the occlusal plane compared with the noncleft side. The prevalences of canine impaction on the CS and noncleft side were 24% and 1.3%, respectively. Maxillary impacted canines on the CS demonstrated increased mesiodistal angulation and height at all time points. No association between CS canine impaction and mesial displacement (sectors) was found. An increased prevalence of lateral incisor agenesis on the CS was observed in the subgroup with canine impaction. Increased mesial angulation and lateral incisor agenesis on the CS are early risk indicators for maxillary canine impaction in patients with unilateral cleft lip and palate.

Reconstruction of the oral commissure in patients with unilateral transverse facial cleft

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013–2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.

Permanent maxillary central incisor and first molar rotations in the mixed dentition in repaired complete unilateral cleft lip and palate and their relationship with absence of teeth in their vicinity.

To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity. Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity. Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment. Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.

Evaluation of Nasal Airway Volume of Operated Unilateral Cleft Lip and Palate Patients Compared With Skeletal Class III Individuals

Cleft lip and palate (CLP) patients have various problems with nasal anatomy beyond just oronasal separation. The alar base, concha, and septum are over impressed in these individuals. Additionally, skeletal class III deformity is seen. These conditions may limit nasal function. In our study, 15 unilateral patients with CLP older than 15 years (10 females, 5 males; mean age: 19.13) who had received surgery were included as the study group, and 15 participants with noncleft skeletal class III deformities were included as the control group (10 females, 5 males; mean age: 19.20). The individuals' nasal airway volumes (total/cleft side/noncleft side/control/ nasal passages) were examined and compared statistically. The results showed that the study group had significantly higher values in terms of total airway volume ( P < .05). Additionally, there were significant differences between the cleft side and noncleft side volumes, between the cleft side volumes and the volumes of the control group participants, and between the noncleft side volumes and the volumes of the control group participants ( P < .05). There was no difference between the groups in terms of nasopharyngeal ( P = .39) and nasal passage volumes ( P = .73). The results show there are some problems regarding nasal airway volume in patients with CLP, even when lip, palate, and alveolar cleft operations have been performed. The aim of this study was to evaluate differentiation of nasal airway volumes between unilateral patients with CLP and individuals with noncleft skeletal class III serving as the control group.

The maxillary lateral incisor in the rehabilitation of cleft lip and palate.

ObjectiveThis study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate.Material and MethodsThe study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study.ResultsThe results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS).ConclusionIn conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

Oronasal Transfixion Suture to Prevent Uplifted Nasal Floor Deformity in Cleft Lip and Palate Patients: A 5-Year Follow-Up.

In unilateral cleft lip and palate, the reconstructed nasal floor is sometimes uplifted regardless of the reconstructive method used. We used a 5-0 absorbable anchoring suture, the oronasal transfixion suture (ONT suture), to fasten the reconstructed nasal floor to the orbicularis oris muscle to prevent this deformity. This study was performed to evaluate the effects of the ONT suture. Blind retrospective study of photography and chart review. Shinshu University Hospital, tertiary care, Nagano, Japan. Private practice. Ninety-three consecutive patients with unilateral complete cleft lip and palate who had undergone primary nasolabial repair in our department and affiliated hospitals between 1999 and 2011 participated in this study. Finally, 45 patients were included. The ONT suture was put in place at the time of primary nasolabial repair. The height of the nasal floor was evaluated on submental view photographs at 5 years old. The ONT suture was applied in 21 patients. The height of the nasal floor on the cleft side was significantly closer to that on the noncleft side with the ONT suture than without the ONT suture ( P = .008). The ONT suture is effective to prevent uplifted nasal floor deformity on the cleft side// in unilateral complete cleft lip and palate at the time of primary nasolabial repair.

Evaluation of the Effectiveness of an Alar Transfixion Suture for the Correction of a Vestibular Web and Alar-Facial Groove: A Photogrammetric Analysis.

Alar transfixion sutures are commonly used for vestibular web correction. The purpose of this study was to evaluate the long-term results of the use of alar transfixion sutures in patients with a unilateral cleft lip nasal deformity using photogrammetric analysis. The study included 42 patients who were divided into child and adult groups. A total of 4 measurement items were evaluated from a basal view by photogrammetry using standardized clinical photographic techniques preoperatively, immediately postoperatively, 3 months postoperatively, and 6 months postoperatively. When the preoperative and last postoperative values were compared, no significant changes in any measurement items were noted in the adult group. In the child group, the proportional index (the ratio of the cleft side to the noncleft side) of the alar slope line inclination was significantly increased, but other measurement items showed no significant change. When the measurement items were compared between time points, no significant changes in any measurement items were noted in the adult group. In the child group, the proportional indexes of the alar length, the width between the subnasale and the alare, and the webbing degree were significantly decreased immediately postoperatively compared with the preoperative values. However, these significant changes were diminished at 3 months postoperatively. The proportional index of the alar slope line inclination was significantly increased at 3 months postoperatively compared with the preoperative value, but the significant change was diminished at 6 months postoperatively. The alar transfixion suture procedure is not effective for correcting a vestibular web and alar-facial groove.

Three-Dimensional Soft Tissue Nasal Changes After Nasoalveolar Molding and Primary Cheilorhinoplasty in Infants With Unilateral Cleft Lip and Palate.

To quantify 3-dimensional (3D) nasal changes in infants with unilateral cleft lip with or without cleft palate (UCL±P) treated by nasoalveolar molding (NAM) and cheilorhinoplasty and compare to noncleft controls. Retrospective case series of infants treated with NAM and primary cheilorhinoplasty between September, 2012 and July, 2016. Infants were included if they had digital stereophotogrammetric records at initial presentation (T1), completion of NAM (T2), and following primary cheilorhinoplasty (T3). Images were oriented in 3dMD Vultus software, and 16 nasolabial points identified. Twenty consecutively treated infants with UCL±P. Nasoalveolar molding and primary cheilorhinoplasty. Anthropometric measures of nasal symmetry and morphology were compared in the treatment group between time points using paired Student t tests. Postsurgical nasal morphology was compared to noncleft controls. Nasal tip protrusion increased, and at T3 was 2.64 mm greater than noncleft controls. Nasal base width decreased on the cleft side by 4.01 mm after NAM and by 6.73 mm after cheilorhinoplasty. Columellar length of the noncleft to cleft side decreased from 2:1 to 1:1 following NAM. Significant improvements in subnasale, columella, and nasal tip deviations from midsagittal plane were observed. Treatment improved symmetry of the alar morphology angle and the nasal base-columella angle between cleft and noncleft sides. Three-dimensional analysis of UCL±P patients demonstrated significant improvements in nasal projection, columella length, nasal symmetry, and nasal width. Compared to noncleft controls, nasal form was generally corrected, with overcorrection of nasal tip projection, columella angle, and outer nasal widths.

Computed Tomography-Assisted Auricular Cartilage Graft for Depression of the Alar Base in Secondary Unilateral Cleft Lip Repair: A Preliminary Report.

To evaluate the feasibility, effectiveness, and safety of computed tomography-assisted auricular cartilage grafting for treating alar base depression secondary to unilateral cleft lip. For patients with obvious depression of the alar base, the difference in heights of the alar base and the piriform margin between the cleft side and the noncleft side were measured with computed tomography. If both were >3.0 mm, the cartilage was harvested postauricularly and subdivided into 2 to 4 pieces. A multiple layer graft was inserted under the depressed alar base. The procedure was performed from 2006 to 2013, and the follow-up period was 3 to 15 months. Chinese patients with alar base depression secondary to unilateral cleft lip were selected. Suture and cartilage graft techniques. Differences in bilateral alar base heights and piriform apertures. There was no wound dehiscence, exposure of bone, or donor site morbidity. The difference in heights in the bilateral alar bases and piriform apertures decreased. There were no obvious scars in any of the cases. This technique has several advantages including ease of operation, minimal trauma, satisfactory outcomes, and useful references for operation provided by computed tomography. It is a superior alternative for reconstruction of secondary alar depression.

Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair

&#x0D; &#x0D; &#x0D; &#x0D; Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques.&#x0D; Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients.&#x0D; Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio.&#x0D; Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.&#x0D; &#x0D; &#x0D; &#x0D;

Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Since 2008, a septal anchoring suture has been used in unilateral cleft lip repair at Chang Gung Memorial Hospital in order to stabilize the lateral lip centrally. This study compared the symmetry of two groups of patients: those treated with and without an anchoring suture. Multiple standardized direct and photographic facial measurements were performed on the faces of all patients pre-cheiloplasty and at 5 years post-cheiloplasty. The degree of nasolabial symmetry was evaluated by comparing the ratios of measurements of the cleft vs. non-cleft sides. The ratio of change in these measurements was also compared postoperatively. The vertical lip length ratio approached 1 in the septal anchoring suture group, which differed significantly from the group without the suture (0.968 vs. 0.873, P<0.001). As expected, the horizontal lip length and central lip height ratios showed no statistically significant change. The ratio of change from pre- to postoperative also showed a significant improvement (P=0.028) in the vertical lip length of the group with the septal anchoring suture compared to the one without. The septal anchoring suture is a useful method to correct the tendency of the lip to shift to the cleft side.

Augmentation of the Median Tubercle with Dermis-Fat Graft in Children with Repaired Cleft Lip.

Deficiency of the median tubercle is a common residual deformity after repair of cleft lip. The purpose of this study was to analyze the change in labial contour after insertion of a dermis-fat graft. Patients with repaired cleft lip who underwent secondary dermis-fat grafting of the median tubercle between 2012 and 2015, along with preoperative and greater than or equal to 3-month postoperative three-dimensional photographs, were included. The photographs were registered to one another and measurements made before and after grafting using anthropometric landmarks. Outcome variables included the following: labial surface area, midline labial height (ls-sto), and lateral labial height (cphi-sto'). Twenty-five patients were included: 14 with unilateral and 11 with bilateral repaired cleft lip. Mean age at graft placement was 10.9 ± 3.2 years. Preoperative and postoperative three-dimensional images were taken at 13.6 ± 21.6 weeks before and 34.8 ± 25.1 weeks after the procedure, respectively. There were significant increases in labial surface area (11.5 percent; p = 0.019) and labial height (14.1 to 18.5 percent; p = 0.002) after grafting. Augmentation was greater in bilateral clefts (25.5 percent at midline and 16.8 percent laterally) compared with unilateral clefts (11.6 percent at midline and 12.5 percent on the grafted noncleft side). Intrarater and interrater reliability was excellent for all measurements. Dermis-fat grafting significantly increases contour of the median tubercle in patients with repaired cleft lip. Therapeutic, IV.