FIGURE 2 - uploaded by Takeshi Mitsuyasu
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Schematic demonstration of correction of primary unilateral cleft lip repair. a: The intercartilaginous incision. b: Three-dimensional upward advancement of the nasolabial component. c: Raw area is covered with bilateral hinged cleft margin flaps. d: Orbicular oris muscle was reconstructed by different techniques (overlapping, interdigitation, edge-to-edge suturing).
Source publication
Objective:
To prevent the occurrence of postoperative long lip, longitudinal postoperative changes in nasolabial forms of patients with unilateral cleft lip who underwent primary lip repair with or without upward advancement of the nasolabial components were compared.
Patients:
Forty-three subjects (24 unilateral cleft lip and palate [UCLP] and...
Context in source publication
Context 1
... the incomplete cleft lip patients, a free cleft margin flap was used to reconstruct the raw area caused by upward advance- ment. 4. For reconstruction of the orbicular oris muscle, the pars peripheralis and the pars marginalis were connected individually in different manners: over- lapping, interdigitation, and edge-to-edge suturing, as shown in Figure 2d. The edge of the nasalis muscle was connected at the bottom of the nostril floor. ...
Similar publications
Background:
Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspe...
Background
Rehabilitation 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 continu...
Objective:
Rhinoplasty in patients with complete unilateral cleft lip and palate (UCLP) is challenging, and the surgical outcome of the nose is complicated to evaluate. The aim of this study was to assess the nasolabial appearance of patients with UCLP compared with a control group.
Design:
Cross-sectional study.
Setting:
Riga Cleft Lip and Pa...
Citations
... Quantitative methods were used by the majority of the studies in this review, with only one study using a 3D optical scanner (Yamada et al., 2002a,b). Focus should be placed on emerging 3D technology (Loon et al., 2011), the 3dMD Face system (Perdanasari et al., 2020), and 3D Rugle V software (Matsunaga et al., 2016). These are recommended for more effective and reproducible results. ...
The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip-nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon.
... Patient: a 44-year-oldman. Figure 6(b)) [12] [13] [14]. After the skin incision was made, the orbicular or is muscle of the upper lip was sutured to achieve reconstruction in the anatomical position ( Figure 6(c)). ...
... The lip findings were similar to those in patients with incomplete unilateral cleft lip, including elevation of the vermilion border toward the nasal base and narrowing of the white lip. Therefore, we selected Cronin's triangular-flap and a triangular skin flap [12] [13] [14] was designed 2 mm above the peak of Cupid's bow. The postoperative appearance of the upper lip was satisfactory. ...
Objective
To quantitatively assess three-dimensional (3D) soft tissue facial asymmetry in patients with unilateral cleft lip and palate (UCLP) who have undergone primary lip repair.
Design
Clinical, retrospective, comparative, methodological study.
Patients/Participants
Twenty patients with UCLP were selected after a review of the records.
Inclusion Criteria
Complete UCLP; surgically treated without secondary repair. An age-matched and sex-matched Control group was employed.
Main Outcome Measures
A 3D facial symmetry plane (FSP) was obtained by superimposing the point clouds of the original 3D facial image excluding the surgical site and including lip and nose areas and those of a mirrored facial image using the iterative closest point (ICP) adjustment method. The discrepancies in the depth and angle of the normal vector of the facial surface of each point cloud between right and left sides (cleft and non-cleft sides in the UCLP group, respectively) based on FSP were calculated.
Results
Facial asymmetry in the UCLP group was significantly greater than in the Control group regarding both the discrepancies in the depth (1.34 ± 0.62, 0.73 ± 0.32 pixels, respectively) ( P = .0004) and surface angle (18.0 ± 5.88, 12.8 ± 4.0°, respectively) ( P = .0024). Biaxial assessment of the discrepancies in the depth and surface angle allowed us to visually extract UCLP patients with greater facial asymmetry.
Conclusions
Facial asymmetry analysis based on 3D FSP effectively facilitates the facial asymmetry quantification and soft tissue surgical outcome evaluation in patients with UCLP.
OBJECTIVE:
To visualize and quantitatively analyze facial surface asymmetry following primary cleft lip repair in patients with unilateral cleft lip and palate (UCLP) and to compare this with noncleft controls.
DESIGN:
Retrospective comparative study.
PATIENTS:
Twenty-two patients with complete UCLP who underwent primary lip repair from 2009 to 2013 were enrolled in this study. The preserved 3-dimensional (3D) data of 23 healthy Japanese participants with the same age were used as controls.
INTERVENTIONS:
All patients had received primary labioplasty in accordance with Cronin triangular flap method with orbicular oris muscle reconstruction.
MAIN OUTCOME MEASURES:
Shadow and zebra images established from moiré images, which were reconstructed from 3D facial data using stereophotogrammetry, were bisected and reversed by the symmetry axes (the middle line of the face). The discrepancies of the gravity and density between cleft and noncleft sides in 2 regions of interest, facial and lip areas, were then calculated and compared with those of healthy participants.
RESULTS:
In the UCLP group, the mean discrepancies of gravity on shadow and zebra images were 1.76 ± 0.70 and 2.63 ± 1.72 pixels, respectively, in the facial area and 1.31 ± 0.36 and 3.83 ± 2.08 pixels, respectively, in the lip area. There was a significant difference in the mean discrepancies of gravity and density on zebra images in the lip area between the UCLP and control groups.
CONCLUSIONS:
Our image analysis of digital facial surface asymmetry in patients with UCLP provides visual and quantitative information, and it may contribute to improvements in muscle reconstruction on cleft lip repair.
