Individuals with cleft lip and palate often require orthognathic surgery to estabilish facial harmony and optimal occlusal function because cleft induced secondary deformities of maxilla and mandible have been taken for the worse as growing up. During operation many problems as like residual oronasal fistula, bony defects, soft tissue-scarring from previous surgery, and the congenital absence of the maxillary lateral incisor teeth with cleft-dental gap are encountered and interfere the operation. In this retrospective study 16 patients who were performed orthognathic surgery from the January. 1991 to the March 1997, could remind the clinically important problems of the orthognathic surgery and suggest more easy, safety, and accurate methods to solve these problems. The preperative and postoperative cephalometric skeletal and soft tissue data were compared and many problems which could encounter during operation were checked and reviewed many historical experiments and newly suggested articles, so some results can be suggested as like: 1. The sum of maxillary advancement(mean 5.14mm) and mandibular retrusion(mean 6.71mm) is about 11.85mm. Two-jaw surgery is recommended because the scar of upper lip and palate limit the maxillary advancement. 2. Upper lip tightness interfere the soft tissue movement after bone segment mobilization, release of tightness improve the soft tissue profile. 3. Soft tissue profile is most important in orthognathic surgery.4. Soft tissue response to orthognathic surgery is not different in secondary cleft deformities and simple malocclusion patient but amount of soft tissue response is not constant in many experimental study. 5. Camouflage mandibular surgery is benefit in some maxillary deformity patient.
Cicatrix ; Cleft Lip ; Congenital Abnormalities* ; Fistula ; Humans ; Incisor ; Lip ; Malocclusion ; Mandible ; Maxilla ; Orthognathic Surgery* ; Palate ; Retrospective Studies ; Tooth

Previous anatomic concepts in cleft lip nose deformity have following characteristics: 1. Obtuse angle between medial and lateral crus in affected alar cartilage; and 2, Cleft side alar cartilage is hypoplastic. The purpose of this study was to review the anatomy of alar cartilage in cleft lip nose deformity and to find out the effects of removal of intercartilagenous soft tissue on the effects of removal of intercartilagenous soft tissue on relocation of alar cartilage. There were 97 cleft lip nose corrections from Oct. 1996 to March When the affected alar cartilage was dissected, redundant intercartilagenous fibro-fatty tissue was found. After removing this redundant soft tissue, we found that the cleft side alar cartilage was better adjusted to the normal position. In addition, the plicavestibularis was more improved. Alar cartilage suture fixation was subsequently performed. Alar cartilage suture fixation was subsequently performed. After this procedure, we found that subsequently performed. After this procedure, we found that the affected side of alar cartilage was more normally positioned than before. The summary of the author's view on affected alar cartilage is as follows: 1. An acute angle between the medial and lateral crus was noted in affected alar cartilage; 2. Redundant intercartilagenous fibro-fatty tissue was present in cleft lip nose deformity;3.The terminal portion of the lateral crus of alar cartilage makes a plica vestibularis in the cleft side; 4. The position of the medial crus of alar cartilage was lower in the cleft side with the lateral crus was lower and cephalic in the cleft side; 5. The cleft side of alar cartilage is not hypoplastic.
Cartilage* ; Cleft Lip* ; Congenital Abnormalities* ; Nose* ; Sutures

No abstract available.
Crystallins* ; Wounds and Injuries*

No abstract available.
Alopecia* ; Scalp* ; Tissue Expansion*

The microform cleft lip is the mildest expression of cleft lip and nose deformity, but it has no specific definition, classification, and few methods have been reported for its correction. It is characterized by deformity of the nostril, skin striae of the upper lip, notching of peaked Cupid's bow, deformity of the vermilion, and anomaly of the upper lateral incisior and alveolar ridge on the affected region. Sixty-three microform cleft lip patients were operated on between Dec. 1993 and Sep. 1998 in our department(29 males and 34 females). The age of the patients ranged from 5 months to 30 years(Mean 9 years). We classified and treated the microform cleft lip as follows: Class I: Cleft lip nose with very slight lip deformity Class II: Minimal lip deformity without vermilion notching Class III: Mild lip deformity with slight vermilion notching. The goals in the correction of a microform cleft lip are to obtain an esthetically pleasing upper lip and nose, and to reestablish muscle continuity for improved function. To attain these goals, we used the above classification and satisfactory results were obtained by treating the microform cleft according to the classification.
Alveolar Process ; Classification* ; Cleft Lip* ; Congenital Abnormalities ; Humans ; Lip ; Male ; Microfilming* ; Nose ; Skin

The philtral unit plays a key role in the appearance of the upper lip. And making the philtral column is extremely important in unilateral cleft lip repair for natural looking lip. Previously, we have been satisfied with the well matched white line & cupid bow, even though that is flat lip. But symmetrical upper lip and symmetrical philtral unit is necessitated So author analysed philtral column anatomy and cleft lip anatomy to make a symmetrical philtral unit, Ipsilateral orbicularis oris fiber attached to the philtral column, labial levator muscles including levator labii superioris and thickened dermis of philtral column area have the major role to make a philtral column. And in the cleft lip anatomy, deviation of septum and lateral muscle bulge were the obstacles to make a philtral cloumn in primary cleft lip repair. Author tried to make a philtral column in secondary cleft lip with several methods and concluded that it is not easy to get a satisfactory result. Based on upper trial and experience, author hypothesized two considerable points(prerequisites) in making a philtal column. 1) Relief of tension 2) Skin excess over the repaired muscle of the lip. To relieve tension, author used intraoral orthopedic appliance to narrow alveolar gap. The deviated septum was dislocated and fixed to the midline point and cinching was done. Supraperiosteal dissection near the pyriform apperture was also done. Above mentioned techniques are the solving way to fill the two prerequites. In the primary cleft lip repair, to get symmetrical philtral unit, author tried weakening of non-cleft side philtral column and formation of cleft side philtral column. To weaken the prominent philtral column, septum transfer to midline and cinching were performed. To prevent making nostril sill depression, the author performed lengthening technique of nasal lining flap of nostril sill area for reconstruction of the philtral column. lengthening of nostril sill area. Regarding lateral muscle bulge, spreading of muscle suturing are needed. Supraperiosteal dissection to release of insertion of labial elevator muscles and beveled incision of vertical incision has the effect of philtral column formation. We performed 462 cases of unilateral cleft lip repair from 1990 to 1999. In most cases, we did not get flat lip in the repaired cases and we could get good appearing of philtral unit. Author think primary repair is the optimal time and Millard technique and above mentioned methods are the method of choice to make a philtral column.
Cleft Lip* ; Depression ; Dermis ; Elevators and Escalators ; Lip ; Muscles ; Orthopedics ; Skin

In traditional concepts, the beautiful nose was defined as showing a round tip and having a good relationship with his or her own face. Esthetically, it is thought to be good that the ratio of nasal lobule to columella is 1 : 1.618. Comparing oriental and Caucasian nose, oriental nasal tip has more oily skin and more thin cartilages than that of Caucasians. In addition, in case of cleft patients, Orientals have a shortage of nasal skin. Therefore oriental nasal tip shows more tension following nasal tip-plasty. Until now, for tip-plasty, we have applied many surgical methods, such as lengthening of columella with V-Y advancement or composite graft from concha, advancement of retruded columella by septal cartilage graft, Converse's method, Millard's method and silicone implant or bone graft. Above mentioned methods have several advantages of own themselves, but also have several disadvantages such as donor site morbidity, scar formation and so on. Nowadays, we have used silicone and cartilage graft or Alloderm for augmentation rhinoplasty and tip-plasty because of their simplicity. But autogenous cartilage graft has some disadvantages such as absorption, distortion and possibility of donor site morbidity. We think that there's no specific rationale to insist to use autograft or allograft on the nasal tip while using the silicone, which is synthetic material, on the nasal dorsum. Medpor is such a rigid, elastic and microporous material that can be fixed firmly on its original site by allowing an in-growth of fibrovascular tissues into its own micropores. In addition, it is free from donor site morbidity and offers simpler operation procedure. From November 1999 to January 2001, authors performed augmentation rhinoplasty to 32 patients with I-shaped silicone implant through an alar rim incision. Thereafter on nasal tip portion of implant we performed Medpor onlay implant and on the columella, from its base to the nasal tip area, we performed Medpor strut implant as we wanted. As a result of mean 6 months follow-up, we can achieve a good nasal tip projection, lengthening of columella, natural columella appearance and improvement to obtuse nasolabial angle. No specific complications were reported except for 2 cases. One case showed slight hardness on nasal tip area. We think more follow-up period is needed for this situation. The other case showed minimal displacement of silicone implant. But it did not require any additional operations because the patient wanted no more operation. We think that tip-plasty using Medpor onlay and strut implant is effective and simple method which can be performed at out-patient department.
Absorption ; Allografts ; Autografts ; Cartilage ; Cicatrix ; Follow-Up Studies ; Hardness ; Humans ; Inlays* ; Nose ; Outpatients ; Rhinoplasty ; Silicones* ; Skin ; Tissue Donors ; Transplants

No abstract available.
Abdominoplasty* ; Classification*

No abstract available.
Transplants*

No Abstract Available.
Mandible* ; Osteotomy*