Correction of middle facial depression deformity of unilateral cleft lip and palate with expanded polytetrafluoroethylene filling
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Objective To study the feasibility and the effect of expanded polytetrafluoroethylene (e-PTFE) filling to correct the middle facial deformity of unilateral cleft lip and palate. Methods Fifteen unilateral cleft lip and palate patients with serious middle facial deformity and nasal deformation,who could not afford the treatment of orthodontics and orthognathic surgery, were retrospectively reviewed from Jun 2002 to Jun 2005. All the patients underwent surgical procedures which included correction of secondary cleft lip deformity, e-PTFE filling to augment the middle facial depression and alar cartilage suspending of the cleft side. The following-up period was from 6 months to 2 years and the photographs of facial state were taken and compared preoperatively and postoperatively. Results After surgery, the middle facial depression was augmented and the nasal base was put up, the nose became quite symmetrical and the face looked much improved and natural. Conclusion E-PTFE filling was a simple and effective method to augment the middle facial depression of unilateral cleft lip and palate who could not afford the systemic treatment to correct the dento-maxillofacial deformities.Keywords:
Facial symmetry
Depression
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Clinically, patients with operated unilateral cleft lip and palate always present with a concave profile, depressed midface, maxillary hypoplasia, narrow upper dental arch, and class III malocclusion. In this clinical report, the authors describe the successful orthodontic treatment of a patient with unilateral cleft lip and palate. A boy, 7 years 11 months of age, with a history of unilateral cleft lip and cleft palate presented with a Class I malocclusion on Skeletal Class III base. A satisfactory occlusion and a favorable lateral profile were achieved after maxillary protraction (face mask) combined with fixed appliance treatment, including alveolar bone grafting surgery. An acceptable occlusion and facial proportion were maintained after a 3-year retention period. These results suggest orthodontic treatment with growth interference is an effective option for a patient with cleft lip and palate.
Bone grafting
Maxillary hypoplasia
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To develop a new method to correct secondary nasanl deformities of cleft lip and palate.Establishing the balance of maxilla on both sides, followed by varied procedures to correct anormaly of osseous-cartilagious framework of nose, and taking some of nasal-labial muscle to restore the continuity and balance of anterior facial expressive muscles.78 cases were treated by this way and the result was satisfying.Imbalance of maxilla and anterior facial expressive muscle and anormaly of nasal framework should be repaired for correcting the nasal deformity of cleft lip and palate effectively.
Facial muscles
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Objective:To introduce the second repair methods and outcomes of the patients with the secondary deformities after primary repair of the bilateral cleft lip or / and bilateral cleft lip and cleft palate.Methods:Fifty patients with the secondary deeformities may adopt Noordhoff's method of the bilateral cleft lip repair;The patients who have severe nasal and labial deformities and tight upper lip may use advancement of the prolabium into the columella for lengthening,combined with an Abbe flap for upper lip reconstruction when a deficient upper lip is unable to yield donor tissue.Results:Thirty patients of 50 cases have had an obvious Cupid's bow,Cupid's bow peak and the median tubercle, and have recovered the normal nasal configuration, the nostril size, the nostril sill, proper length of the columella and the height and width of the upper lip.Other 11 patients had an improvement for the secondary nasal and labial deformities.Conclusion:The three operative techniques may be used for repairing secondary nasal and labial deformities of the patient with the bilateral cleft lip and bilateral cleft lip and cleft palate after the primary repair of the bilateral cleft lip or/and bilateral cleft lip and cleft palate.
Columella
Nostril
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Objective To explore a comprehensive treatment in repairing secondary unilateral cleft lip nasal deformity. Methods According to the different levels of deformity,we took different treatments and correct all kinds of the factors that cause the nose deformity. Results The repairing operation were performed in 60 cases from 2005 to 2010,the short nasal columella,flat tips and collapsed nasal ala were elevated. The view of noses was improved apparently. The outcome was satisfactory. Conclusion With the comprehensive plan and individual surgerical procedure,secondary unilateral cleft lip nasal deformity were corrected satisfactorily.PTFE is an optimal plastic material,which is compatible perfectly with circumferential tissues.The outcome of filling is excellent.
Columella
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Cleft lip and palateⅢ°patients are generally associated with different degrees of nasal deformity, using simple methods difficult to achieve satisfactory results.Diverse characteristics of cleft lip nasal deformity is mainly caused by nasal cartilage dislocation.Since June 2006 to January 2009,with theSmile Trainactivities carried out in our hospital,our oral surgery successfully treated with 78 cases of secondary nasal deformity of cleft lip and palate patients with autologous rib cartilage transplantation.After careful and attentive care,patients get better to improve nasal shape.Now,the perioperative nursing are summarized as follows.
Perioperative nursing
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This article presents the results of total reconstruction of the 'end stage of cleft lip and palate deformity' in fourteen patients. The deformity consisted of varying degrees of 1. midface retrusion and/or mandibular protrusion; 2 malocclusion; 3. nasal deformity; 4. lip deformity; 5. palate or alveolar fistulas and 6. nasal speech. These deformities resulted in aesthetic and functional problems. By a comprehensive approach in one session--total reconstruction--functional and aesthetic improvement was achieved in all patients.
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To investigate the method for simultaneous correction of nasal deformity and unilateral cleft lip so as to decrease the secondary operation for the deformity.The Millard procedure (or Millard plus triangle flap insertion) was used to repair the unilateral cleft lip. Through the incisions, the greater alar and nasalis were repositioned to the normal anatomical positions. The deviated septum and columella were corrected by cutting the abnormal attachment of the orbicular muscle of mouth to the anterior nasal spine. The mattress sutures through the tip of the columella and ala nasi helped to recover the shape of the nostril.108 patients were treated with this method. They aged from one month to 19 years, included 30 with second degree cleft lip and 78 with third degree cleft lip. The follow-up for as long as 3 years showed satisfactory results.This technique can eliminate the severe cleft nasal deformity and elevate the displaced alar cartilage at the time of lip repair without interference with nasal growth. It is recommended for the treatment of unilateral cleft lip with severe nasal deformity.
Columella
Nostril
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Objective To explore the effects of unilateral cleft lip(UCL) cheiloplasty on nasal deformity.Method The operative methods and post-operative conditions of 186 cases of unilateral cleft lip cheiloplasty in our hospital from 2002 to 2006 were retrospectively analyzed.Results After unilateral cleft lip cheiloplasty,35 cases had nasal deformity,of them,12 cases were repaired by the Millard method,16 by the Tennison method and 7 by rotation advancement and the triangular flap method.Conclusion The appropriate operative method can simultaneously repair both unilateral cleft lip and nasal deformity.
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Unilateral cleft lip nasal deformity is a complex three-dimensional malformation,the time of correction has advanced to the infant and early childhood in late half century.Traditional preoperative orthodontic treatment and newly presurgical nasoalveolar molding create favorable conditions for the primary cleft lip nasal deformity correction.All kinds of blind or open incision,different areas of soft tissue dissection,variety of suspension technology and the use of nasal molding in post-operation continuously improve the effect of the correction.Good aesthetic effects and alleviative psychological barriers in children have been reported in many literatures.In order to study the development trends and guide the clinical treatment,this article reviews the theory and the common methods in the primary correction of the unilateral cleft lip nasal deformity.
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AIM To seek an ideal method for correction of the secondary unilateral cleft lip nasal deformity . METHODS A total of 32 patients with secondary unilateral cleft lip nose deformity were treated by columella lateral displacement to unaffected side and lateral crus dystopy freeing and the nasi ala cartilage sling. RESULTS 30 in 32 cases were satisfied with their good surgical results. Two had fair results. CONCLUSION To obtain good results, a secondary rhinoplasty of the unilateral cleft should be performed according to the pathologic deformity.
Columella
Sling (weapon)
Nasal cartilages
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