xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)
MODIFIED ROTATIONAL ADVANCEMENT TECHNIQUE
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The muscle at the alar base on the cleft side is sutured with the muscle at the columella base to correct the nasal floor width, location of the nose base, and the columellar deviation. Then the whole muscle on both sides is sutured from top to bottom. In the Millard technique, the C-flap is rotated locally to fill the space created by the back-cut or the space made in the cleft side, whereas in the SM, the C-flap is rotated laterally to the nasal cavity to form the lateral columella wall and part of the nasal floor, resulting in increased columella length. On the cleft side, the ad vanced flap is rotated upward and medially and inserted to fill the back-cut space. The advanced flap on the cleft side also helps rotate point 4 to its natural position so that the lip height on the cleft side is lengthened while not sacrificing lip width. Then the skin at point 5 is subcutaneously sutured with the alar base at point 9 and the skin at points 3 to 4. Finally, the skin is com pletely sutured (Fig. 1; right). The nasal deformity is addressed by a Tajima incision on the ala of the cleft side. The subcutaneous dissection is performed along with the lower lateral cartilage to the lower edge of the nasal bone. To correct the collapsed nasal alar shape on the cleft side, the lower lateral carti lage is sutured reliably by a nonabsorbable suture with the ipsilateral upper lateral cartilage and with the contra lateral lower lateral cartilage. Measurement and analysis Frontal and basal views of standardized digital photo graphs taken by a specialist were imported into Adobe Photoshop CS6 software for measurements. 10–12 Then pixels ratios were used instead of the absolute distances to overcome the variations among the individual photo graphs. The lip and nose symmetry was assessed as ratios between the noncleft and cleft sides, considering a value close to 1 as symmetrical outcomes. The nose measure ments included five ratios and two angles (Fig. 2), whereas the lip measurements included five ratios and two angles (Fig. 3). Descriptive quantitative analysis of the lip and nose measurements, intraclass correlation coefficient (ICC) tests, and ANOVA were conducted using SPSS version 20 (Chicago, IL). Results In 72 patients, 44 males and 28 females (1:1.6) were trea ted by SM. Among them, 69.4% had left-side complete cleft lips and 30.6% right-side complete cleft lips. The age of the participants at the time of operation ranged between 3 months and 2 years (exception of one case aged 27 years) with a mean age of 11.8 – 3.6 months. The mean follow-up time was 1.899 – 1 years (range of 1–5 years). No dehiscence, necrosis, infection, and suture granuloma were observed during recovery time. Well aligned Cupid’s bow of the lip was shown by the cleft and noncleft side ratio of the vertical philtral height Downloaded by Travis T Tollefson from www.liebertpub.com at 03/02/25. For personal use only.
(VPh) 0.93. Considerable symmetry in horizontal lip width was also achieved (CPh-Ch ratio = 0.97). Columel lar height ratio and angle mean were 0.82 – 0.22 and 3.12 – 3.59, respectively. Satisfactory aesthetic lip and nose outcomes and ICC are shown in Table 1. An accept able straight scar resembling a normal philtral column Fig. 2. Nasal measurements (A) . CL; measured from highest to lowest points of the nostril. The measurement is performed at a position of 1 mm from columella on both sides, CA; angle between the long axis of columella and midline, NH; measured from highest to lowest points of the nostril, NW; measured from the widest lateral and medial points of nostril aperture, NA; the angle between vertical and horizontal axis of the nostril, AW; measured from the outmost alar point and columellar base. And (B) shows alar base angle; angle between the alar bases. AW, ala width; CA, columella angle; CL, columella length; NA, nostril angle; NH, nostril height; NW, nostril width; ABA, alar base angle.
Fig. 3. Lip measurement. Ab, alar base; BS, bisector; Ch, chelion; CPh, christa philtrum; HL, horizontal line; MCPh, middle christa philtrum; ML, midline; Sn, subnasal; VH, vermillion height; VPh, vertical pheltrum height; white triangle, angle between Cphs.
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