Secondary Cleft Lip Deformity Research Articles

Evaluation the effect of fat grafting in the correction of secondary cleft lip deformities

Evaluation the effect of fat grafting in the correction of secondary cleft lip deformities

Use of De-Epithalialized Flap for Elevating the Alar Base in Patients With Cleft Lip.

Alar base asymmetry is a common problem in cleft lip patients. Caused by a lack of bone support and soft tissue deficiency, it is one of the problems that must be corrected during cleft lip repair. While it is encountered during primary lip repair, it can also be seen as a secondary cleft lip nasal deformity after repair. This study aimed to provide alar base symmetry with a de-epithelialized muscle-skin flap during the primary cleft lip repair of incomplete cleft lip patients and secondary cleft lip deformity repair. In incomplete cleft lip patients, the tissue under the incomplete part is de-epithelialized and elevated as a superiorly based flap. The flap is rotated and sutured under the alar base for the elevation. In secondary patients, scar tissue to be removed is de-epithelialized and elevated as a superiorly based flap. It is turned over and sutured under the alar base for augmentation. The effect of the surgery is monitored during the follow-up period. There were no complications related to the flap, and no volume loss was observed. Using a de-epithelialized musculocutaneous flap, the augmentation of the alar base and nasal sill can be achieved without additional incisions in patients undergoing primary incomplete cleft lip repair and in patients undergoing secondary cleft lip deformity repair. We think it is an effective and safe method, improving the esthetic outcomes of cleft lip patients.

Abbe Flap for Secondary Cleft Lip Deformity.

The objective of cleft lip surgery is to restore the structure and function of the upper lip. Despite initial repair, some patients develop secondary cleft lip deformity encompassing a shortened philtrum, reduced vermillion height, with excessive tooth visibility. The Abbe flap is a well-described approach for the management of this deformity. The following case describes a 33-year-old female with a history of bilateral cleft lip and palate who presented with secondary cleft lip deformity. She was successfully treated with an Abbe lip-switch flap. Anthropometric measurements supported improved facial aesthetics similar to those in the supplemental literature review. This case also illustrates how oral mucosa from the resected, scarred philtrum can be used to repair nasolabial fistulae.

Repair of a secondary cleft lip deformity with the Abbé flap in a pediatric patient

Repair of a secondary cleft lip deformity with the Abbé flap in a pediatric patient

Force Balance Reconstruction of the Orbicularis Oris in Secondary Unilateral Cleft Lip Deformity.

Secondary unilateral cleft lip deformities are commonly observed in patients with cleft lip and traditional surgical methods can't completely tackle this problem. The purpose of this study was to evaluate the outcomes of a novel surgical technique using force balance reconstruction of the orbicularis oris. 53 patients with secondary unilateral cleft lip deformity were included in this study, in which the orbicularis oris muscle was reconstructed symmetrically to achieve optimal force balance. Photometric 2d indexes were employed to evaluate the outcome of 27 patients, and 3d indexes for the remaining 26 patients. Aesthetic evaluation and parent-patient satisfaction surveys were also recorded. Significant differences were found in the following: (1) LH (the lip height), LW (the lip width), D1(the vertical distance from the white roll to the vermilion bottom at the christa philtra points) and D2(the vertical distance from the christa philtra points to the facial midline) when comparing preoperative and postoperative 2D images; (2) LH, LW, D1 and D2 when comparing preoperative and follow-up 2D images; (3) RMS (root mean of square) when comparing preoperative and postoperative 3D images. Aesthetic evaluation in the follow-up period was a mean of 4.29, while parent-patient satisfaction of the overall appearance was a mean of 4.41. The results suggest this new muscle reconstruction technique can significantly improve the surgical outcome of secondary unilateral cleft lip deformities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

Modifications to the WHISTLE Flap Procedure for Correction of Secondary Cleft Lip Deformities.

The whistle deformity, a deficiency of tissue in the central upper lip, is a consequential outcome of primary cleft lip repair. Among multiple described reconstructive options, the wide-hinged island swing transposition labial enhancement (WHISTLE) flap procedure by Grewal et al has been shown to be a reliable technique that restores the continuity of the orbicularis oris muscle and creates a more natural appearing tubercle and central lip element. This article aims to refine the WHISTLE flap procedure with the addition of tailored mucomuscular flaps and an upper lip-lengthening mucosal Z-plasty. A total of 11 patients with a whistle deformity were examined. All underwent the WHISTLE flap procedure with tailored mucomuscular flaps and a mucosal Z-plasty. The patients were followed for a period of from 6 to 51.5 months. Pre- and postoperative photographs were used for objective outcome comparison. From 2018 to 2023, a total of 11 patients with a whistle deformity were included in the final cohort, comprised four bilateral and seven unilateral cleft lips. Ten cases (90.1%) resulted in satisfactory postoperative cosmetic appearance and did not require further interventions. A single patient with a significant preoperative discrepancy between the upper and lower lip volumes had a postoperative residual deformity. None of the patients demonstrated any functional deficits associated with the procedure. The WHISTLE flap procedure with the proposed individual tailoring of the mucomuscular flap and Z-plasty for mucosal scar lengthening has excellent cosmetic outcomes and can be considered as the primary treatment modality in most patients with a whistle deformity.

A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities.

Secondary cleft lip (CL) deformities are commonly encountered in cleft management. Various attempts have been made to create a classification system that can comprehensively encapsulate residual CL deformities after primary repair. The aim of this study is to reinforce valid classification systems and to introduce a new classification subtype (Type V Revision). A longitudinal retrospective analysis was done in 35 outreach programs in 4 countries (Ecuador, Lebanon, Peru, and El Salvador) between 2015 and 2023. Two hundred sixty-nine patients, between the ages of 9 months and 45 years, with residual CL deformities after primary lip repair, were classified into one of the 5 classification types. Patients with syndromes were excluded from the study. Patients received one of 5 revision types depending on their initial preoperative evaluation and intraoperative analysis of anatomic involvement. The mean age at surgery was 12.86 years. Twenty-five patients received type I revision, 29 patients received type II revision, 81 patients received type III revision, 106 patients received type IV revision, and 28 patients received type V revision. As the surgical complexity advanced from type I to V, there was a gradual increase in the average surgical time. The Congruence between preoperative and postoperative revision types was substantial. Residual CL defects cause a significant burden on both the patient and cleft care provider. This classification system, with the newly introduced type V revision, enhances and eases the categorization and management of secondary CL deformities.

Children's Visual Perception of Facial Scarring and Cleft Lip Deformity Using Eye Tracking Data.

The purpose of this study is to determine children's perception of secondary cleft lip deformity (SCLD) using objective eye tracking technology and subjective responses on a survey to understand pediatric perceptions of facial scarring. Cross-sectional study of participants aged 5-17 years old. Participants viewed images of children's faces with an eye tracking device. Sixteen images were displayed, 12 with unilateral SCLD and four with no facial scarring. Eye tracking data were obtained. Gaze samples were analyzed for areas of interest (AOIs). Immediately after viewing each image, participants answered two survey questions relating to facial asymmetry attitude toward the child pictured. For analysis, participants were divided into age groups. A total of 259 participants were enrolled (42.5% female). Mean age was 10.5 years and 78% identified as White. In all age groups, total fixation time was greater for SCLD compared to control images. Early elementary age children spent significantly less time assessing the nose AOI compared to other groups, and also spent the least total fixation time and had the lowest visit count on all AOIs. Subjective survey questions showed similar trends with elementary age not noticing facial asymmetry compared to older age groups. This study demonstrates the successful use of eye tracking technology in children as young as 5 years old. This study suggests that SCLD is perceived as less noticeable in elementary age children and becomes more noticeable to older groups. Understanding peer perception on SCLD from this study may impact decision on revision surgery for SCLD. IV Laryngoscope, 134:2726-2733, 2024.

Exploring Self-Perception and Peer-Perception in Adolescents With Secondary Cleft Lip Deformities Using Eye-Tracking

Background: Patients with cleft lip often have a secondary cleft-lip deformity (SCLD), resulting from the initial repair procedure for their congenital cleft. Patients with SCLD often undergo multiple surgeries to achieve symmetry of the lip and nose. However, little is known about how patients perceive their deformity, and if those deformities are noticeable to their peers. The purpose of this study is to use eye-tracking to evaluate how patients with cleft lip repair look at themselves and evaluate how this perception changes when the same photo is perceived by 2 different cohorts: patients who have undergone cleft-lip surgeries and control subjects who have no craniofacial pathology. Methods: Participants were divided into 4 cohorts: adolescents with SCLD viewing images of themselves (Cohort 1), adolescents with SCLD viewing images of peers with SCLD (Cohort 2), adolescents without SCLD viewing images of peers with SCLD (Cohort 3), and healthy adolescents without SCLD viewing images of themselves (Cohort 4). Surveys were conducted after the eye-tracking portion to determine correlations between objective gaze data and subjective opinions. Results: Total fixation duration was highest in the eye region for all 3 cohorts, followed by the upper lip region. Cohort 2 fixated the longest on all areas of pathology, while Cohort 1 fixated the least on all areas of pathology. Cohort 4 spent significantly more time looking at the nose bridge compared to Cohort 1. Conclusions: The results provide insight into how adolescents with SCLD are perceived by themselves and others and can help to better understand the complexities of the roles different areas of pathology play in self-perception.

Novel classification system for adult Asian secondary bilateral cleft lip with nasal deformity that guides surgical strategy

BackgroundBilateral cleft lip is a congenital defect often accompanied by secondary lip and nose deformity. The current classification system for secondary cleft lip deformity of has limitations in guiding surgical planning. In this article, we report a method for secondary bilateral cleft lip classification that can guide surgery based on the pathological anatomy of the columellar and upper lip. MethodsPhotographs of patients were retrospectively classified into four types based on the ratio of columellar height to alar base width (CH/AW) and upper lip protrusion to lower lip (UP), as follows type I: with CH/AW ≥ 0.2 and UP ≥ 0; type II: with CH/AW ≥ 0.2 and UP < 0; type III: with CH/AW < 0.2 and UP ≥ 0; type IV: with CH/AW < 0.2 and UP < 0. Surgical treatments and the change of nasal profile were documented. ResultsA total of 105 patients from January 2008 to December 2018 were included in this study. The nasal profile was significantly improved in types III and IV patients with postoperative CH/AW values close to normal. The upper lip was distinctively retruded in type II and IV patients before treatment, and the postoperative view revealed improved upper lip protrusion with UP values close to normal. Ninety-eight patients reported satisfactory outcomes after treatment. ConclusionsThe new classification method described provides key information regarding the deformity of different types of secondary bilateral cleft lip patients and provides clear guidance for surgical planning based on the anatomical defect of each type.

Establishment of a Three-Dimensional Finite Element Model and Mechanical Analysis of the Upper Lip Flap With Secondary Cleft Lip Deformity.

Cleft lip secondary deformity is a common oral and maxillofacial deformity, usually accompanied by the upper lip and nasal cleft. The main treatment method for cleft lip secondary deformity is surgical repair. Among them, upper lip flap repair is a common method; the principle is to transplant the healthy tissue to the lesion site to achieve the purpose of repair. However, during the surgical process, each key point's stress distribution and strain conditions are quite different. Therefore, special attention should be paid to the mechanical properties of each key point during the repair operation to ensure the surgical effect. This paper aims to establish a 3-dimensional finite element model and perform finite element analysis to simulate the mechanical properties and key point displacement of the upper lip flap repair operation for cleft lip secondary deformity to improve the operation's success rate and safety.

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity.

Although surgical techniques have developed, the incidence of secondary cleft lip deformities after the primary repair is still high. Asymmetry of Cupid's bow and philtrum is a common presentation and a technical challenge to reconstruct the upper lip. The authors introduce a technique to use the free grafts of the full-thickness scalp for the correction of scars and tissue deficiency in secondary unilateral cleft lip deformity. Thirty-seven patients with a prominent scar, tight upper lip, deformed Cupid's bow and philtrum, and irregular vermillion border were included in this study. The specific points of interest were assessed before and after surgery by independent examiners with both subjective and objective methods. All surgeries were successfully completed, and the assessment results were satisfactory. The rating scores of philtrum improvement was 1.6±0.4, the POSAS result of patient scales was 13.48±3.21, and the observer scale result was 11.98±3.88. The asymmetry of Cupid's bow was corrected ( P =0.004), the central tubercle of vermilion was more natural ( P =0.001), and the irregular vermillion border was improved ( P =0.015). The results presented significant differences before and after surgery. This method could be an optional treatment for repairing scars and tissue deficiency in secondary unilateral cleft lip deformity.

Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip.

Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients ( n = 13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for three-dimensional morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. Three-dimensional morphometric analysis revealed a significant (all P < 0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference ( P > 0.05) between cleft and noncleft sides. The postoperative three-dimensional projection of the philtral ridges was significantly ( P < 0.001) larger in cleft (1.01 ± 0.43 mm) than in noncleft sides (0.51 ± 0.42 mm). The average philtrum volume change was 1.01 ± 0.68 cm 3 , with an average percentage fat graft retention of 43.36% ± 11.35%. The panel assessment revealed significant ( P < 0.001) postoperative scar enhancement for the qualitative rating scale, with mean preoperative and postoperative scores of 6.69 ± 0.93 and 7.88 ± 1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. Therapeutic, IV.

Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity.

Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/- palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.

Longitudinal Morphological Changes in the Mucosal Free Margin After Unilateral Cleft Lip Repair.

Weakness of the mucosal free margin is common in secondary cleft lip deformities. However, the incidence is rarely reported after a long-term follow-up. We evaluated the evolution of patient mucosal free margin after primary repair and until the end of growth. Blinded retrospective study (photography and chart reviews). Tertiary care hospital; private practice. Forty-eight patients with unilateral cleft lip with or without cleft palate who underwent primary nasolabial repair between 1996 and 2004 were followed up until their end of growth marked at 18 and 16 years of age for male and female patients, respectively. Primary nasolabial repair using a straight-line closure without a triangular flap on the vermilion was performed; if needed, a revision surgery was performed at 5 years of age (85%). The contour of the mucosal free margin was classified into nodular, smooth, and recessed types at 1, 5, and 10 years and at the end of growth. At 1 year of age, the nodular type was more common (58%). However, the recessed type was more common (75%) at the end of growth. The mucosal free margin continued to change after 10 years of age. At the end of growth, half of the patients with incomplete cleft experienced center weakness, and the others had cleft-side weaknesses. Patients with incomplete clefts showed favorable results at early ages. However, two-thirds of the patients with complete and incomplete clefts showed focal weakness at the end of growth.

Symmetrical Reconstruction of the Orbicularis Oris in Correction of Secondary Unilateral Cleft Lip Deformity.

Symmetrical Reconstruction of the Orbicularis Oris in Correction of Secondary Unilateral Cleft Lip Deformity.

Meta-analysis of secondary cleft lip deformities management

Meta-analysis of secondary cleft lip deformities management

Revisional Techniques for Secondary Cleft Lip Deformities.

Secondary deformities of repaired cleft lips are an unfortunate complication despite the meticulous approach of modern primary procedures. Most of these surgeries take place in the patient's early life and must be strategically planned to provide optimal cosmesis with minimal interventions. Depending on the level of severity, treatment of the secondary deformities ranges from noninvasive or minimally invasive techniques to complete revision cheiloplasty. Many novel topical, injectable, and laser therapies have allotted physicians more technical flexibility in treating superficial distortions. Nonetheless, surgical techniques such as diamond excision and adjacent tissue transfer remain popular and useful reconstructive modalities. Deformities involving the orbicularis oris must be completely taken down to allow full access to the muscle. Complete revision cheiloplasty requires recreation of the cleft defect and reconstruction similar to the primary repair. Due to the myriad of presentations of these secondary deformities, familiarity with the various treatments available is imperative for any cleft surgeon.

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity.

There is an increasing patient expectation for better esthetics, manifesting through anatomical harmony, projection, and volume of the upper lip relative to the lower lip, in patients with cleft deformity. The aim of this study is to investigate the outcome of vermilion augmentation using autologous dermofat graft (DFG) to enhance the lip using both quantitative and qualitative assessment. Patients with secondary cleft lip deformity who received the surgical treatment in our institution from 2015 to 2018 were recruited. Panel assessment was performed on standardized preoperative and postoperative digital photographs. A patient questionnaire was used for the reported outcome. Image processing and analyses were applied to measure the lip change. Statistical analyses were performed. A total of 91 patients were included. The mean age at operation was 22.7 years, and postoperative follow-up was 3.6 years. There were no complications in the study group. The panel assessment showed significant improvement (P < .00001) on upper lip vermilion in both frontal and lateral profile views. Ninety-five percent of patients reported improvement of the upper lip projection and volume. Quantitative image analysis showed an increase in the upper lip vermilion ratio in 97% of the cases in frontal views and improvement of the vermilion projection in 87% of the cases in the superimposed lateral views. The use of DFG is an effective and reproducible method for vermilion augmentation and aesthetic enhancement in patients presenting with upper lip insufficiency relative to the lower lip.

Synchronous correction in secondary cleft deformities: a prospective cohort study.

Patients with cleft lip and palate deformities undergo multiple surgical procedures from infancy till adolescence. We hypothesized that combining these surgical procedures might offer a better quality of life without compromising on surgical outcomes. A prospective cohort study was conducted at our center including all adult patients who reported to us for the correction of secondary cleft deformities. All patients with secondary deformities associated with cleft lip palate and alveolus were enrolled in the study. Patients with medical issues who are not fit for general anesthesia, Bilateral Cleft deformities, and patients with gross skeletal deformity warranting surgical correction by Le fort I distraction were excluded from the study. All the patients who were included in the study underwent simultaneous lip revision, rhinoplasty and cleft alveolar bone grafting. The outcome lip nose profile was assessed using standardized patient photographs with Ascher Mcdade Scale and Aesthetic outcome index by 2 blinded maxillofacial surgeons and the bone grafting was assessed using Berglands grading system. Twenty-eight patients were enrolled in the study, 10 patients were excluded based on the exclusion criteria. Thus 18 patients planned for synchronous correction of unilateral secondary cleft deformities were included in the study The Ascher Mcdade Score improved from 15 (13-16), to 4 (4-5) in the post op. All the patients were totally satisfied with the surgical outcome. The aesthetic index showed excellent outcomes in all the lip-nose procedures, except for one case which showed a good outcome. The Bergland Scale showed normal bone height in all cases of alveolar bone grafting, except for one case, which showed less than 3/4th fill of bone. No complications were associated with any of the procedures. Simultaneous correction of multiple secondary cleft lip deformities should be considered when feasible, to improve the psychological benefit and reduce financial burden on these patients. However, careful planning and execution of the techniques is essential to avoid complications associated with vascular compromise.