Dynamic Presurgical Nasal Remodeling in Patients with Unilateral and Bilateral Cleft Lip and Palate: Modification to the Original Technique

2006 ◽  
Vol 43 (6) ◽  
pp. 639-648 ◽  
Author(s):  
Ricardo D. Bennun ◽  
Alvaro A. Figueroa
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Nasal Deformity ◽  
Nasal Tip ◽  
Palatal Plate ◽  
Bilateral Cleft Lip ◽  
Technical Modifications ◽  
Cleft Lip Repair ◽  
Nasal Tip Projection ◽  
Cleft Nasal Deformity

Objective: To present technical modifications to the original presurgical nasal remodeling appliance introduced in 1991. The purpose of the modifications is to improve the cleft nasal deformity before unilateral and bilateral cleft lip repair. Method: The principle behind this technique, known as dynamic presurgical nasal remodeling (DPNR), is the use of the force generated during suction and swallowing. A conventional intraoral plate is built with a nasal extension added to the labial vestibular flange. The nasal extension was modified and consists of three components. The palatal plate is left loose in the mouth to generate a discontinuous but controlled impact directed to the affected nasal structures during suction and swallowing. The principle aim of the DPNR technique in unilateral cases is to improve the deformation of nasal structures by straightening the columella, elevating the nasal tip, and remodeling the depressed cleft side alar cartilages. In bilateral cases, the aims are to elongate the columella and to obtain nasal tip projection. Conclusions: The modifications introduced in the appliance enhance the original DPNR technique and are effective in ameliorating the initial cleft nasal deformity. This facilitates primary surgical cleft lip and nose correction and improves surgical outcomes in patients with complete unilateral and bilateral cleft lip and palate.

Presurgical Nasoalveolar Molding Therapy for the Treatment of Bilateral Cleft Lip and Palate: A Preliminary Study

2006 ◽  
Vol 43 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Adam L. Spengler ◽  
Carmen Chavarria ◽  
John F. Teichgraeber ◽  
Jaime Gateno ◽  
James J. Xia
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Average Length ◽  
University Of Texas ◽  
Bilateral Cleft Lip ◽  
Before And After ◽  
Nasal Tip Projection ◽  
A Prospective Study ◽  
The University ◽  
Nasoalveolar Molding

Objective To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate. Design A prospective study with blinded measurements. Setting The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas. Patients Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004. Interventions The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days. Main Outcome Measures Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy. Results Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased. Conclusion The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.

Improved Nasal Tip Projection in the Treatment of Bilateral Cleft Nasal Deformity

2005 ◽  
Vol 16 (5) ◽  
pp. 834-839 ◽  
Author(s):  
Joe I Garri ◽  
Kevin O??Leary ◽  
Joubin S Gabbay ◽  
Andres F Urrego ◽  
Justin B Heller ◽  
...  
Keyword(s):  
Nasal Deformity ◽  
Nasal Tip ◽  
Tip Projection ◽  
Nasal Tip Projection ◽  
Cleft Nasal Deformity

scholarly journals Prosedur penatalaksanaan celah bibir inkomplit bilateral dan rinoplasti primer dengan modifikasi mulliken

2019 ◽  
Vol 49 (1) ◽  
pp. 93
Author(s):  
Al Hafiz ◽  
Debby Apri Grecwin
Keyword(s):  
Cleft Lip ◽  
Cochrane Library ◽  
Upper Lip ◽  
Literature Study ◽  
Nasal Tip ◽  
Tip Projection ◽  
Primary Rhinoplasty ◽  
Bilateral Cleft Lip ◽  
Modification Technique ◽  
Nasal Tip Projection

Latar belakang: Celah bibir dengan atau tanpa celah lelangit merupakan abnormalitas perkembangan kraniofasial yang paling sering terjadi. Kelainan ini bisa unilateral atau bilateral, dan mungkin disertai dengan anomali kongenital lain. Celah bibir bilateral berpotensi mengubah struktur dan bentuk wajah serta menyebabkan gangguan dalam perkembangan makan, bicara, gigi geligi, dan kosmetik. Celah bibir selalu disertai dengan deformitas hidung, termasuk pada kasus celah bibir inkomplit. Mulliken adalah pionir yang melakukan perbaikan celah bibir bilateral dan rinoplasti primer dalam satu tahap operasi. Tujuan: Mengetahui keberhasilan operasi celah bibir inkomplit bilateral dan rinoplasti primer dengan teknik modifikasi Mulliken. Laporan kasus: Dilaporkan satu kasus celah bibir inkomplit bilateral pada anak laki-laki usia 7 bulan yang ditatalaksana dengan teknik modifikasi Mulliken. Metode: Telaah literatur berbasis bukti mengenai perbaikan celah bibir inkomplit bilateral dan rinoplasti primer dengan teknik modifikasi Mulliken melalui database Cochrane library, Pubmed Medline, dan hand searching. Hasil: Pertumbuhan nasal tip projection, nasal width, columellar length, upper lip height, cutaneous lip height, dan vermilion-mucosal height mendekati nilai normal. Kesimpulan: Prosedur celah bibir inkomplit bilateral disertai rinoplasti primer dengan teknik modifikasi Mulliken memberikan hasil yang baik. Introduction: Cleft lip with or without cleft palate is the most common disorder of craniofacial development. This disorder could be occurred unilaterally or bilaterally, and sometimes were also accompanied by other type of congenital disorders. Bilateral cleft lip potentially could change the face structure and shape, causing interference in eating, speech, dental development, and aesthetics. Cleft lip always occurred with nasal deformity, even in incomplete cleft lip. Mulliken is a pioneer in performing a repair in bilateral cleft lip and primary rhinoplasty altogether at the same time. Purpose: To find out the result of surgery procedure in bilateral incomplete cleft lip and primary rhinoplasty using Mulliken modification technique. Case report: A bilateral incomplete cleft lip case in a 7 months old boy and managed by Mulliken modification technique. Method: Evidence based literature study of bilateral incomplete cleft lip and primary rhinoplasty with Mulliken modification technique through Cochrane library, Pubmed Medline, and hand searching. Result: The growth of nasal tip projection, nasal width, collumellar length, upper lip height, cutaneus lip height, and vermilion mucous height were close to normal size. Conclusion: Procedure of bilateral incomplete cleft lip and primary rhinoplasty repair using Mulliken modification technique delivered a good outcome.

Intraoral-Appliance Modification to Retract the Premaxilla in Patients with Bilateral Cleft Lip

1996 ◽  
Vol 33 (6) ◽  
pp. 497-500 ◽  
Author(s):  
Alvaro A. Figueroa ◽  
David J. Reisberg ◽  
John W. Polley ◽  
Mimis Cohen
Keyword(s):  
Cleft Lip ◽  
Palatal Plate ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Repair ◽  
Soft Denture Liner

Management of the protrusive premaxilla in patients with bilateral cleft lip is challenging for the reconstructive team. Several intra- and extraoral orthopedic techniques to reposition the protrusive premaxilla prior to bilateral cleft lip repair have been presented In the literature. A modification to a previously described tissue-borne palatal plate with a latex strap is presented. In the modified plate, the latex strap is replaced by an orthodontic elastomeric chain, and the chain over the prolablum is covered with soft denture liner. This appliance Is effective in retracting the premaxilla, noninvasive, easy to construct and adjust, economic, well tolerated by the patient, and accepted by the parents.

Correction of the Bilateral Cleft Lip Nasal Deformity: Evolution of a Surgical Concept

1992 ◽  
Vol 29 (6) ◽  
pp. 540-545 ◽  
Author(s):  
John B. Mulliken
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Interim Report ◽  
Nasal Deformity ◽  
Bilateral Cleft Lip ◽  
Cleft Nasal Deformity

The origin of the nasal deformity of a bilateral complete cleft lip is both primary (deformation/malformation) and secondary (postoperative distortion). This is an interim report of a personal evolution from staged correction of the bilateral cleft nasal deformity to synchronous repair of the nose and the lip and premaxillarymaxillary clefts. The anatomic concept is that, because of the maIpositioned alar cartilages, the columella only appears to be short in an infant with bilateral cleft lip. The technical stratagems to model the nose are: (1) alignment of the premaxilla and (2) anatomic placement of the alar cartilages with sculpturing of the overlying soft tissue.

The Method of Surgical Lip Repair Affects Speech Outcomes in Children With Bilateral Cleft Lip and Palate

2020 ◽  
pp. 105566562095687
Author(s):  
Holly Peryer ◽  
Rona Slator ◽  
Jenny Thomson ◽  
Bruce Richard
Keyword(s):  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Case Note ◽  
Retrospective Case ◽  
Fisher Test ◽  
Speech Characteristics ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Repair ◽  
Repair Group

Objective: It was hypothesized that lip repair protocols in children with bilateral cleft lip and palate (BCLP) would affect development of bilabial consonants /m/ /b/ /p/. This study compared speech outcomes in 2 surgical groups. Design: A retrospective case note investigation. Setting: UK Cleft Centre (2000-2009). Patients: Forty-nine children with complete BCLP, of whom 26 had a 1-stage and 23 a 2-stage bilateral cleft lip repair. Interventions: One-stage cleft lip repair versus a 2-staged cleft lip repair. Main Outcome Measures: Bilabial consonant production at 18 months, 3 and 5 years of age. Cleft Speech Characteristics (CSCs) at age 5. Results: At age 18 months, 81% of the 1-stage lip repair group and 4% of the 2-stage lip repair group produced bilabial consonants ( P <·0001, Fisher test). At age 3 years, 81% of the 1-stage and 26% of the 2-stage lip repair groups produced bilabial consonants ( P =·0133, Fisher test). At age 5 years, both groups had similar bilabial consonant production, but children in the 2-stage lip repair group had more frequent and severe CSCs ( P = ·0037, χ2). Conclusion: A 1-stage lip repair for children with complete BCLP resulted in better bilabial consonant production at 18 months and 3 years of age than a 2-stage lip repair. At age 5 years both groups had bilabial consonants but children in the 2-stage lip repair group had worse CSCs. The surgical protocol for bilateral cleft lip repair affected speech outcome in children with BCLP.

Photometric Evaluation in Adolescence of Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening

2017 ◽  
Vol 55 (4) ◽  
pp. 568-573 ◽  
Author(s):  
Maria Costanza Meazzini ◽  
Carlo Chiavenna ◽  
Luca Autelitano ◽  
Giovanna Garattini ◽  
Roberto Brusati
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Matched Control ◽  
The Other ◽  
Nasal Tip ◽  
Other Hand ◽  
Nasolabial Angle ◽  
Bilateral Cleft Lip ◽  
Nasoalveolar Molding ◽  
Photographic Records

Objective: Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip. Design: The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM). Setting and Patients: 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents. Results: Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample. Conclusions: NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.

scholarly journals Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 602 ◽  
Author(s):  
Hyung Joon Seo ◽  
Rafael Denadai ◽  
Lun-Jou Lo
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Three Dimensional ◽  
Normal Subjects ◽  
Width Ratio ◽  
Nasal Dorsum ◽  
Nasal Tip ◽  
Primary Rhinoplasty ◽  
Bilateral Cleft Lip

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

scholarly journals Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty: An anthropometric study

2017 ◽  
Vol 50 (02) ◽  
pp. 180-186 ◽  
Author(s):  
Percy Rossell-Perry
Keyword(s):  
Cleft Lip ◽  
Good Alternative ◽  
Cross Sectional Study ◽  
Dome Height ◽  
Nasal Deformity ◽  
Cross Sectional ◽  
Primary Rhinoplasty ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Cleft Nasal Deformity

ABSTRACT Background: Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities. Methods: A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively. Results: Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively. Conclusions: The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip.

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