Median Cleft of the Lower Lip and Mandible: Clinical Experience and Surgical Treatment.

Median cleft of lower lip and mandible is a rare congenital craniofacial malformation and has been described as isolated clinical reports. Fewer than 100 cases have been reported in the world literature so far, and the first case was reported by French scholar Monroe in 1819. The authors report a patient with median complete cleft of the lower lip and mandible which we made a special repair surgery for him, surgical effect satisfied with the restoration of appearance and function ideal. Therefore, the appropriate period and method of surgical management are very important.

Three-dimensional reconstruction of maxillae using spiral computed tomography and its application in postoperative adult patients with unilateral complete cleft lip and palate.

PURPOSE: To establish a method to analyze malformed maxillae of postoperative adult patients with unilateral complete cleft lip and palate in 3 dimensions. MATERIALS AND METHODS: A total of 35 landmarks were defined and used to reconstruct 3-dimensional maxillary images of healthy Chinese Han subjects and 30 postoperative Chinese Han adult patients (17 men and 13 women, with mean age of 19.07 years) with unilateral complete cleft lip and palate. This was done using spiral computed tomography, and their corresponding parameters were analyzed using SimPlant software, version 11.04, and compared by t test using SAS software, version 6.12. RESULTS: Of the 7 centered landmarks, A and ANS in the patients were obviously deviated to the nonoperative side (P < .01) and the symmetrical landmark pairs INM'-INM, SNM'-SNM and SPr'-SPr, but not MA'-MA, SoF'-SoF, and LPAC-LPA in the infraorbital region and piriform aperture peritreme in healthy subjects were shifted toward the coordinate sagittal plane S. The data also showed that the maxillae in the patients' operative side were hypoplastic, especially in the posteroanterior direction compared with the nonoperative side and healthy subjects. CONCLUSIONS: The proposed method can precisely measure the distances of the maxillary landmarks to 3-dimensional coordinates and has application potential in evaluating maxillary deformity in patients with postoperative unilateral complete cleft lip and palate.

Influence of alveolar-bone grafting on the nasal profile: unilateral cleft lips, alveoli, and palates.

PURPOSE: Secondary bone grafting plays an important role in the multimodal therapy of patients with cleft lips, alveoli, or palates. Through a comparative study of the nasal profile before and after alveolar bone grafting, this article aimed to determine the appropriate timing of operation and keys to success. METHODS: In the study, 38 cases (23 boys and 15 girls aged 9-13 years, with an average of 11.4 years) were examined of patients with unilateral cleft lips or palates, upon whom secondary bone grafting was performed under general anesthesia. Comparative studies are conducted on their nostril widths and heights in both the cleft side and the noncleft side as well as the widths and angles of the alar bases measured in the preoperative, postoperative, and follow-up (6 months) periods respectively. RESULTS: Of the 29 cases examined 6 months after the operation, 4 indicate failure as the amount of bone loss exceeds 50%, whereas in the other 25 cases, both the nostril widths of the cleft side have increased, and the nostril heights of the cleft side have decreased significantly (P < 0.01). CONCLUSIONS: As shown in the study, the nasal profile after alveolar bone grafting is changed obviously; thus, it is recommended that patients not receive rhinoplasty before bone grafting or have both operations at the same time.

Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps: Case series.

RATIONALE: Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a "whistling" deformity. The object of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF). PATIENT CONCERNS: Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia. DIAGNOSES: Secondary deformity of bilateral cleft lip forming a "whistling" deformity were diagnosed in all the patients. INTERVENTIONS: Bilateral VMSF were designed and used to reconstruct the median labial tubercles by sliding downward so as to eliminate the whistling deformity. OUTCOMES: During the 10 to 37 months of follow-up, the reconstructed vermilion tubercles had stable morphology showing no whistling deformity and the overall lip shapes were satisfactory. LESSONS: Reconstructing MVTD and eliminating whistling deformity using the scar tissues that need to be removed previously on the vermilion musculomucosa has achieved stable and satisfactory results and is worthy of clinical application.

[Measurement of the volume absorption of alveolar bone grafting].

PURPOSE: To determine the bone absorption at different time after alveolar autogenous bone grafting using spiral CT three-dimensional reconstruction. METHODS: Twenty unilateral cleft lip and palate patients(15 males,5 females) were chosen to undergo three-dimensional CT scans after alveolar bone graft, region of interest(ROI) volume measurement of GE AW 4.1 software was used to calculate the capacity of alveolar cleft at 1 week, 3 months, 6 months after surgery. RESULTS: An average bone loss of 35.74% was found after 3 months, 55.89% after 6 months. In labial and palatal direction, labial bony bridge was more obvious than palatal bony bridge. CONCLUSIONS: Bone resorption is present after alveolar bone graft, and becomes more severe with time going on.

[Classification and surgical treatment of the deviated nose with unilateral cleft lip].

OBJECTIVE: To present a classification of the deviated nose with unilateral cleft lip and the associated surgical correction. METHODS: A total of 176 cases of nasal deformities with unilateral cleft lip treated in Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine & Shanghai Research Institute of Stomatology & Shanghai Key Laboratory of Stomatology from 2007 to 2009 were analyzed. Depending on the relationship between the external pyramid and the facial midline, the nasal deviations with cleft lip were classified into 3 types: I, deviated bony pyramid, II, deviated cartilaginous pyramid; III, deviated lobular. The surgical treatment included surgical correction of deviated bony pyramid, deviated cartilaginous pyramid, deviated lobular and deviated septa. RESULTS: Among the 176 patients, there were 97 males and 79 females, aging from 16 to 42 years with a mean of 20. There were 93 patients without deviated and 83 patients with deviated. Among the 83 deviated patients, deviated bony pyramid was found in 8 (10%), deviated cartilaginous pyramid in 29 (35%), deviated lobular in 46 (55%). Most patients who underwent surgical correction were satisfied. CONCLUSIONS: There were nearly half of the unilateral cleft lip nasal deformity presenting with deviated noses. There was least deviated bony pyramid and most deviated lobular in the unilateral cleft lip deviated nose. The proposed classification for the deviated nose with unilateral cleft lip could serve as a practical guide for surgical planning.