Old traditional classification of cleft lip is unilateral or bilateral, and incomplete or complete type, individually. But from the clinical study in India, more accurate new classification was possible as below; submucous cleft, incomplete cleft invo ...
Old traditional classification of cleft lip is unilateral or bilateral, and incomplete or complete type, individually. But from the clinical study in India, more accurate new classification was possible as below; submucous cleft, incomplete cleft involving vermillion but not extending beyond white roll, incomplete cleft extending beyond white roll but not involving the nose, incomplete cleft extending beyond white roll involving the nose, complete cleft without simonart's band, complete cleft with simonart's band, complete cleft without complete collapse of nasal dome and ala, complete type with complete collapse of nasal ala and dome, complete cleft without difference in level of alveolar ridges, complete cleft with difference in level of alveolar ridges, and so on.
We tried to find several muscular insertion sites of the compressor nasi muscle, and the nasal and nasolabial bundles of the deep orbicularis oris muscle. We dissected the anterior nasal spine and septum together, and repositioned the deviated anterior nasal septum to the midline by anchoring cinch suture with related muscles. During this corrective septorhinoplasty procedure, we found that most of the above muscles insert not to the anterior nasal spine alone, but to the perichondrium and anterior nasal septum directly. Instead of insertion to the anterior nasal spine, most nasal and deep bundles of the orbicularis muscles in unilateral complete cleft lip patients insert to the perichondrium and anterior nasal septum. And so, real insertion sites of distorted perioral and nasal muscles in complete cleft lip surgery was reviewed and confirmd from our these experiences.
Among several main approaches to the unilateral cleft lip operations, early correction of nasal deformity has been considered as important object to the most reconstructive surgeons. In the unilateral cleft lip, the base of the septum is usually deviated toward the noncleft side and dorsal portion toward the cleft side, so we tried to correct common problems of septal deviation using anchoring cinch suture in the primary cheiloplasty procedure. During the primary cheiloplasty procedure, nasal septum was relieved from its attachments and could be positioned at the center of nose by detaching the buckled septum from anterior nasal spine and surrounding muco-perichondrium. Nasal floor was created from the nasalis muscle, perichondrim, anterior nasal septum, perichondrium and nasalis muscle in opposite side with a non-resorbable suture material. In the immediate postoperative outlook of nose, no deviated nose and good nostril symmetry with firmed support to both alar base and nasal sill was observed. During 6-months follow-up of more than 120 patients, no deviated midline growth can make the symmetrical facial growth of the patient. And so, deviated septal cartilage repositioning in the primary cleft lip surgery can be considered as the most effective procedure.
Congenital fusion of the maxillary alveolar and mandible is a very rare disease. Most of cases are occurred either as a single mucosal band called a synechiae or as a complete bony fusion called a synostosis. We experienced a case of isolated congenital alveolar synechiae in a 16-month-old baby girl, and details of the operative and anesthetic management of isolated congenital alveolar synechiae are studied with literature review.
In the treatment of Tessier No. 7 facial cleft, Pfeifer wavy incison has also valuable advantages such as functional incision, a good length maintenance, easy mobilization and exposure of the beneath soft tissues, minimal scar, and so on. In this visiting research period, we reviewed total 6 cases of Tessier No. 7 facial cleft ranging from mild to severe form, despite of several disadvantages such as tension in closure, and needs of multiple modifications, our immediate outcomes by using Pfeifer wavy incison were satisfactory to both surgeons and patient's parents.