Complete Unilateral Cleft Lip Patients Research Articles

Mixed Dentition Period Follow-up of Primary Unilateral Cleft Nose Deformity Repair.

Recently, there has been an increased acceptance of the primary cleft rhinoplasty providing acceptable outcomes. Nose reconstruction, and specifically cleft nose deformity, should be addressed based on this philosophy. The purpose of this study was to evaluate surgical outcomes during the mixed dentition period after primary surgery to address unilateral cleft lip nose deformity based on the proposed technique. This is a retrospective cohort study. Thirty-two primary complete unilateral cleft lip patients were operated on by a single surgeon using the V-Y-Z cleft rhinoplasty. This method combines a composite V-Y advancement flap with lateral Z-plasty. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements performed under general anesthesia during primary cleft palatoplasty and alveolar bone graft. The outcomes were evaluated through anthropometric measurements of the repaired nose during the mixed dentition period of follow-up, and no type of presurgical management was performed for any of the patients. Total nasal symmetry has been observed in 34.37% of patients at 7 years or more and 40.62% at 1-year follow-up. Nonstatistically significant differences were observed during follow-up, and major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 9.37% of patients. The proposed primary cleft rhinoplasty is a good approach to improve nasal appearance in patients with complete unilateral cleft lip and palate.

Primary correction of the nasal deformity on patients with unilateral cleft lip

Introduction. Orofacial clefts, is a group of conditions that includes cleft lip, cleft palate, and both together. Symmetry of the face can be obtained with primary nose reconstruction. The goal: Analysis of patients with unilateral complete cleft lip patients treated with or without a primary nasal correction at the time of cleft lip repair were compared to evaluate the relevance of early surgical correction of the nose Material and method. The 5 unilateral cleft subjects were operated on in 2022 by a technique of primary cleft nose correction (PCR), and 5 were operated without primary nose reconstruction (NNC). The anteroposterior and inferior facial appearances of each of the cases have been evaluated. A computer-based method of measuring nasal asymmetry was used to objectively analyze the results and compare them between children with and without primary nasal reconstruction. Measuring was done before and after the surgery and include qualitative and quantitative measurements. Results: The results support the observation that nasal shape become symmetric in children that support primary nasal reconstruction and asymmetric in children without primary nasal reconstruction. Conclusion: Primary nose reconstruction result in better cosmetic outcomes.

Curved-line cleft lip repair in unilateral complete cleft lip patients: Comparative analysis of lip dimensions after cheiloplasty

This study aimed to restore upper lip symmetry and minimize tissue sacrifice using a curved line design and wire technique and analyze the postoperative outcomes. In this retrospective study, medical records of patients with complete unilateral cleft lip who underwent unilateral cheiloplasty between August 2017 and February 2019 were reviewed. The postoperative clinical photos were analyzed to determine vertical, diagonal philtral heights and the horizontal lengths of the upper lip. The average of the cleft side to non-cleft side length ratios were compared between the curved line group and conventional group. At 3, 6, and 12 months, the average vertical length ratios were significantly greater in the curved line group than in the conventional group (0.927–0.823, p = 0.007; 0.940 to 0.885, p = 0.037; and 0.947 to 0.883, p = 0.040, respectively), but the average horizontal length ratios were not significantly different between the two groups. Within the limitations of the study it seems that curved line cheiloplasty aids in preventing short lip deformity development at regular term without significantly sacrificing the horizontal length and, therefore, should be adopted whenever appropriate.

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients: Erratum.

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients: Erratum.

Modified Rotational Advancement Technique for Primary Unilateral Complete Cleft Lip Repair.

Importance: Leveling Cupid's bow while maintaining lip height and width in unilateral complete cleft lip patients with improved nose outcomes is a significant challenge for surgeons. Objective: This study aimed to measure the symmetry of the nasal and labial anthropometric points after using this modified cleft lip repair technique. Design, Setting, and Participants: In this retrospective study, 72 consecutive nonsyndromic unilateral complete cleft lip patients underwent a modified rotational advancement technique. Photos of at least 1 year follow-up period were collected. Main Outcomes and Measures: The nose measurements included columella length, nostril height and width, ala width, nostril inclination, columella angle, and ala bases angle. The lip measurements included lip height and width, vermillion height; midline-philtrum angle, and angles of Cupid's bow peaks. Descriptive quantitative analysis of the lip and nose measurements, intraclass correlation coefficient, and ANOVA tests were conducted. Results: Well-aligned Cupid's bows with symmetrical lip height and width were obtained with satisfactory aesthetic nasal outcomes. Conclusions: The present technique had leveled the Cupid's bow while preserving the lip height and width, with resultant satisfactory nasal outcomes.

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients.

Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and non-cleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 ± 0.15, and the lateral lip height ratio was 0.91 ± 0.09 (P < 0.001). No significant differences were observed in lip width and vermilion height between the cleft and non-cleft sides of the upper lip of 6-year-olds; the alar base width ratio was 1.22 ± 0.16, medial lip height ratio was 1.11 ± 0.11, and lateral lip height ratio was 0.89 ± 0.09 (P < 0.05). There were no significant differences in the alar projection and nasal dome height on the cleft side of the nose; the nostril height and width ratios were 0.82 ± 0.11 and 1.31 ± 0.21 (P < 0.001), respectively. These consecutively performed lip adhesions for patients with wide unilateral complete cleft lip resulted in excellent long-term results. Therefore, lip adhesion for wide unilateral complete cleft lip is a reasonable alternative to presurgical molding.

Revisiting straight-line repair in unilateral complete cleft lip: a comparison with rotation-advancement repair

Rotation-advancement repair (RAR) has been the most widely used technique for unilateral cleft lip repair. We recently used a straight-line repair with medial orbicularis muscle lengthening (SLR-ml) technique, based on the hypothesis that it could minimize the postoperative scar appearance without causing s short-lip deformity when muscle reorientation is performed correctly. A retrospective cohort study was conducted on unilateral complete cleft lip patients who underwent cheiloplasty between 2009 and 2017. Two cheiloplasty techniques were compared: RAR and SLR-ml. Outcomes were evaluated by assessing follow-up photographs using three methods: (1) glance impression on a five-point scale, (2) Manchester Scar Scale, and (3) indirect anthropometry. Seventy-one patients were analysed: 41 in the RAR group (28 male, 13 female) and 30 in the SLR-ml group (15 male, 15 female). The glance impression (P=0.506) and Manchester Scar Scale (P=0.347) scores did not differ between the groups. According to the symmetry ratio (cleft side value/non-cleft side value), vertical lip height (P=0.804), horizontal lip length (P=0.881), and Cupid’s bow width (P=0.122) did not differ significantly between the groups. The preoperative lip height discrepancy was not correlated with the postoperative vertical lip height. The SLR-ml method can be regarded as a successful tool for symmetric repair of unilateral cleft lip.

Quantitative Evaluation of Nasolabial Alterations following Nasoalveolar Molding (NAM) Therapy in Patients with Unilateral Cleft Lip.

The clinical benefit of nasoalveolar molding (NAM) is actively debated between cleft centers without clear consensus. Nasolabial measurements were performed on pediatric patients with unilateral clefts of the lip, with or without cleft palate, at an academic cleft/craniofacial center prior to and following NAM therapy between June 2015 and August 2016. The parameters of interest were: columella height and width, cleft nostril height and width, and lip width. Measurements were performed using photographs taken alongside a reference object. The image output was then scaled to the size of the reference object and the capture angle. Intraclass correlation coefficient was calculated to assess reliability of the photographic measurements. Descriptive statistics (mean, standard deviation [SD]) were calculated to characterize the pre- and post-NAM measurements. Student's t-tests were performed to compare the pre-NAM versus post-NAM measurements. The primary objective was to measure the effect of NAM on the nasal aesthetic units that are known to be anatomically aberrant in the cleft lip patient. Nine patients were included in this study. Average pre-NAM age was 2.5 weeks, and average post-NAM age was 13 weeks. Average columellar height increased from 3.70 mm (SD = 0.14) pre-NAM to 5.85 mm (SD = 1.96) post-NAM (p < 0.01); average columellar width increased from 4.71 mm (SD = 0.49) to 5.93 mm (SD = 0.71) (p < 0.01); average cleft nostril height increased from 3.54 mm (SD = 2.97) to 6.81 mm (SD = 2.98) (p = 0.01); and average cleft nostril width decreased from 15.46 mm (SD = 2.91) to 11.05 mm (SD = 1.01) (p = 0.01). Average lip width decreased from 34.61 mm (SD = 1.73) to 33.87 mm (SD = 3.67); however, this change was not statistically significant (p = 0.16). This study objectively quantifies positive changes in nasal aesthetics associated with NAM therapy, providing further evidence for its utility as a presurgical treatment modality for optimal aesthetic nasal results in the unilateral cleft lip patient. The major limitation of this study was a lack of control group, as our center universally treats complete unilateral cleft lip patients with NAM therapy. However, the authors strongly believe that the positive aesthetic nasal findings would persist if compared with a non-NAM control group.

Modified Fisher method for unilateral cleft lip-report of cases

BackgroundRehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisher introduced an innovative method, named “an anatomical subunit approximation technique” in unilateral cleft lip repair. According to this method, circumferential incision along the columella on cleft side of the medial flap is continued to the planned top of the Cupid’s bow in straight manner, which runs parallel to the unaffected philtral ridge. Usually, small inlet incision is needed to lengthen the medial flap. On lateral flap, small triangle just above the cutaneous roll is used to prevent unesthetic shortening of upper lip. This allows better continuity of the Cupid’s bow and ideal distribution of tension.Case presentationAs a modification to original method, orbicularis oris muscle overlapping suture is applied to make the elevated philtral ridge. Concomitant primary rhinoplasty also results in good esthetic outcome with symmetric nostrils and correction of alar web. As satisfactory results were obtained in three incomplete and one complete unilateral cleft lip patients, indicating Fisher’s method can be useful in cleft lip surgery with functional and esthetic outcome.ConclusionsClinically applied Fisher’s method in unilateral cleft lip patients proved the effectiveness in improving the esthetic results with good symmetry. This method also applied with primary rhinoplasty.

Facial Symmetry Index as a measure of Surgical Outcome in complete Unilateral Cleft Lip patients using 3D photographs

Facial Symmetry Index as a measure of Surgical Outcome in complete Unilateral Cleft Lip patients using 3D photographs

Three-dimensional analysis of alveolar changes of complete unilateral cleft lip patients after presurgical nasoalveolar molding treatment

This study analyzed the alveolar changes of complete unilateral cleft lip (UCCL) patients after pre-surgical nasoalveolar molding (PNAM) treatment using a three-dimensional method. Palate impressions of thirty UCCL patients who underwent PNAM treatment in the Affiliated Stomatology Hospital of Guangxi Medical University were taken pre- and post-PNAM. The plaster impressions were scanned using cone beam computed tomography (CBCT). The DICOM files were exported and 3D models reconstructed in Mimics 15.0. The following parameters were analyzed in SPSS 17.0: cleft alveolar gap width, alveolar arch end width, upper lip frenulum-median plane distance, alveolar shift distance, and length of alveolar section. After PNAM treatment, the cleft alveolar gap width and upper lip frenulum-median plane distance decreased significantly (P<0.05). No statistically significant change was observed in the alveolar arch end width (P>0.05). Alveolar shift distances for both sides increased significantly (P<0.05), and the shift distance of major alveolar sec-tion had a more significant increase than the minor alveolar section. The lengths of the alveolar section of both sides increased significantly (P<0.05) with the length of the major alveolar section increasing more significantly than the minor alveolar section. The impression-CBCT method supply accurate three-dimensional data of the alveolar process. The PNAM treatment can significantly correct alveolar deformity and improve appearance.

Effect of maxillary alveolar reconstruction on nasal symmetry of cleft lip and palate patients: A study comparing iliac crest bone graft and recombinant human bone morphogenetic protein-2

Recombinant human bone morphogenetic protein (rhBMP)-2 has been used in some craniofacial centers worldwide. However, its influence on nasal morphology is unknown. Thus, the objective of this investigation was to assess the effect of maxillary alveolar reconstruction on nasal position and symmetry in unilateral complete cleft lip patients who underwent traditional iliac crest bone grafting transferring versus reconstruction using rhBMP-2. Nineteen unilateral complete cleft lip patients were randomly divided into two groups. In group 1, patients underwent traditional iliac crest bone grafting transferring (n=11) and in group 2, patients underwent alveolar reconstruction using collagen matrix with lyophilized rhBMP-2 (n=8). Computerized tomography (CT) imaging was performed preoperatively and at 6 months postoperatively using a previously standardized protocol. Linear distances using anatomic landmarks were performed using tridimensional CT data reformatted by the OsiriX(®) software. Quantitative and qualitative measurements to assess intra- and inter-group nasal position modifications were performed. Intra-group pre- and postoperative comparisons showed significant differences (p<0.05) in two linear measurements of group 1, while group 2 did not present a difference (p>0.05). Group 2 presented significant postoperative enhancement (p<0.05) in the quantitative nasal symmetry in one measurement. Qualitative analysis showed postoperative nasal symmetry enhancement in 75% of the measurements of group 2 and 36% of group 1. There was no statistically significant difference in the inter-group comparisons. Our study demonstrated that both groups showed similar effect on nasal symmetry.

Symmetry in nasolabial area of UCCL patients one year after primary lip repair with modified Millard technique

The aim of this study was to assess the nasolabial symmetry of unilateral complete cleft lip patients repaired by West China modified Millard technique. Photographs of 31 unilateral complete cleft lip patients were taken before, immediately after, and 1 year after the surgery. Photogrammetric measurements were taken to evaluate nasolabial symmetry. Symmetry for the christa philtri point was attained immediately after the surgery and maintained in the 1-year follow-up. The cheilion point and the sub alare point, however, did not achieve symmetry until 1 year after surgery. The alar point, unfortunately, never achieved satisfactory symmetry in this study. The ratio of symmetry for none of the above-mentioned facial landmarks had linear correlations with the width of the fissure or other facial anthropometric measurements. Symmetry could be achieved in most of the nasolabial anthropometric landmarks after our modified Millard procedure.

Long-Term Comparison of Four Techniques for Obtaining Nasal Symmetry in Unilateral Complete Cleft Lip Patients: A Single Surgeonʼs Experience

This study was the result of a constant evaluation of surgical techniques and results to obtain excellence in primary cleft rhinoplasty. This was a retrospective study from 1992 to 2003 comparing the long-term outcomes of four techniques of nasal reconstruction. There were 76 patients divided into four groups: group I (n = 23 patients), primary rhinoplasty alone; group II (n = 16 patients), nasoalveolar molding alone; group III (n = 14 patients), nasoalveolar molding plus primary rhinoplasty; and group IV (n = 23 patients), nasoalveolar molding plus primary rhinoplasty plus overcorrection. The surgical results were analyzed using photographic records obtained at 5 years of age. A ratio of six measurements was obtained comparing the cleft and noncleft sides. A panel assessment was obtained to grade the appearance of the surgical results. All surgery was performed by the senior author (P.K.T.C.). The results are given for groups I to IV, respectively. The nostril height ratio was 0.73, 0.77, 0.81, and 0.95. The nostril width ratio was 1.23, 1.36, 1.23, and 1.21. The one-fourth medial part of nostril height ratio was 0.70, 0.87, 0.92, and 1.00. The nasal sill height ratio was 0.75, 1.02, 1.07, and 1.07. The nostril area ratio was 0.86, 0.89, 0.95, and 1.08. The nostril height-to-width ratio was 0.58, 0.58, 0.71, and 0.92. Finally, group IV had the best panel assessment. The results revealed that group IV had the best overall result. Overcorrection of 20 percent was necessary to maintain the nostril height. Further technical modifications are necessary to minimize widening of the nostril width.

An Anatomical Study of the Three-Dimensional Structure of the Nasal Septum in Patients with Alveolar Clefts and Alveolar-Palatal Clefts

The present study was performed to quantitatively analyze the three-dimensional morphology of the nasal septa of patients with alveolar and alveolopalatal clefts. Twenty-five unilateral complete cleft lip patients with alveolar clefts only (alveolar cleft group) and 35 unilateral complete cleft lip patients with alveolar and palatal clefts (alveolar and palatal cleft group) were included in the study. Although no patient in either group had undergone alveoloplasty, all patients had undergone palatoplasty. The degree of nasal septum deviation was studied for each patient at three different depths along the anteroposterior axis using three-dimensional computed tomographic data; the data were compared between the two groups to elucidate whether the difference in cleft type affects the morphologic patterns of the nasal septum. The nasal septa of the alveolar and palatal cleft group patients presented more uneven morphologic patterns than those of the alveolar cleft group patients. In the alveolar cleft group, the nasal septa did not present significantly different degrees of deviation at their anterior and posterior parts. In the alveolar and palatal cleft group, however, the posterior parts of the nasal septa presented greater deviation than the anterior parts. In the alveolar and palatal cleft group, furthermore, a significant correlation was observed between the severity of the cleft and the degree of the nasal septum deviation. The nasal septa present different three-dimensional morphologic patterns between the patients with alveolar clefts only and those with alveolopalatal clefts. This difference should be considered when performing surgical treatments for these patients.