scholarly journals Premaxillary Deficiency: Techniques in Augmentation and Reconstruction

2020 ◽  
Vol 34 (02) ◽  
pp. 092-098 ◽  
Author(s):  
Tom Shokri ◽  
Weitao Wang ◽  
Jason E. Cohn ◽  
Sameep Kadakia ◽  
Yadranko Ducic
Keyword(s):  
Aging Process ◽  
Cleft Lip ◽  
Free Tissue Transfer ◽  
Ethnic Communities ◽  
Nasal Deformity ◽  
Facial Aging ◽  
Nasal Tip ◽  
Alloplastic Implants ◽  
Nasolabial Angle ◽  
Injectable Filler

AbstractProgressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

scholarly journals Evaluation of Modified Unilateral Nasoplasty in Patient with Post Operation of Unilateral Labioplasty at Malahayati Hospital Banda Aceh: Cohort Study from 2017 until 2019

2021 ◽  
Vol 5 (1) ◽  
pp. 23
Author(s):  
Devyana Enggar Taslima ◽  
Muhammad Taufik ◽  
Muhammad Jailani ◽  
Syamsul Rizal ◽  
Mirnasari Amirsyaha
Keyword(s):  
Cohort Study ◽  
Clinical Features ◽  
Cleft Lip ◽  
Nasal Deformity ◽  
Demographic Information ◽  
Nasal Tip ◽  
Post Operation ◽  
The Common ◽  
Nasal Length ◽  
Banda Aceh

Background : Nasal deformity associated with cleft lip has been viewed as one of the most challenging reconstructive problems in rhinoplasty.(1) The common clinical features associated with cleft lip nasal deformity are its lack of symmetry, alar collapse on the affected side, short nasal length, loss of tip definition, obtuse nasal labial angle, and altered columella show among others.(2) The complexity of cleft lip rhinoplasty is demonstrated by the abundance of technique that is available for its correction.(3) In this case we used the technique that modified by Dr. Muhammad Jailani, SpBP-RE in Aceh.Methods: We conducted a retroperspective study involving 139 patients who is done the rhinoplasty unilateral operation at Malahayati Hospital from January 2017 to November 2019. Demographic information was recorded such as ratio between pre – operation and post – operation, gender and age.Results : Our results has shown the result of comparison between cleft nose before rhinoplasty and cleft nose after rhinoplasty is ±0.26 : ±0.58, and the patients who came to the hospital to do the rhinoplasty unilateral surgery are 81% from 139 patients. Woman (61.2%) experience rhinoplasty more dominant compare to man (38.8%), and the highest age average is between 1 years old until 7 years old (71%)Conclusions: Improvement in procedure’s duration and better positioning of both nasal tip and nostril. Expected improvements in terms of aesthetic and functions were observed but further documentations still needed.

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.

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.

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

2021 ◽  
pp. 105566562110240
Author(s):  
Maria Costanza Meazzini ◽  
Francesca Parravicini ◽  
Vera Donati ◽  
Roberto Brusati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Young Adults ◽  
Young Adulthood ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Adult Patients ◽  
Nasal Tip ◽  
Nasolabial Angle ◽  
Primary Rhinoplasty ◽  
Bilateral Cleft Lip ◽  
Nasoalveolar Molding

A short columella and a flattened nasal tip are the characteristic stigmata of patients with complete bilateral cleft lip and palate (BCLP). Objective: The aim of this study was to assess the nasal shape of young adults with BCLP treated with primary surgical columella lengthening and nasoalveolar molding (NAM). Setting and Patients: A group of 28 young adult patients with BCLP (mean age: 19.1±1.4 years) was compared through normalized photogrammetry to a control of 28 age- and sex-matched noncleft young adults. Results: Nasal protrusion and length of the columella were not different from noncleft young adults. On the other hand, nasolabial angle, columellar width, interalar, and nasal tip width were significantly wider than the noncleft controls. Thus, 27% of the patients have requested at this time secondary correction of the excessive nasal width. Conclusions: Both NAM and primary rhinoplasty in patients with BCLP resulted in a near normal length of the columella and nasal projection until young adulthood. Nevertheless, width of all nasal features was significantly wider than the noncleft population and required secondary nasal correction in one-third of the sample.

scholarly journals The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

2020 ◽  
Vol 5 (1-2) ◽  
pp. 53-62
Author(s):  
Badr M. I. Abdulrauf
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Nasal Bone ◽  
Case Series ◽  
Nasal Deformity ◽  
Challenging Issue ◽  
Primary Surgery ◽  
Novel Concept ◽  
Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

The Performance of Secondary Nasal Alar Base Revision for Unilateral Cleft Lip by Single YV-Plasty (the Importance of Overcorrection During Surgery)

2021 ◽  
pp. 105566562110106
Author(s):  
Yoshitaka Matsuura ◽  
Hideaki Kishimoto
Keyword(s):  
Cleft Lip ◽  
Minimum Degree ◽  
Nasal Deformity ◽  
Simple Method ◽  
Primary Surgery ◽  
Base Revision ◽  
Alar Base ◽  
Anterior Nasal Spine ◽  
Nasal Floor ◽  
Case Basis

Although primary surgery for cleft lip has improved over time, the degree of secondary cleft or nasal deformity reportedly varies from a minimum degree to a remarkable degree. Patients with cleft often worry about residual nose deformity, such as a displaced columella, a broad nasal floor, and a deviation of the alar base on the cleft side. Some of the factors that occur in association with secondary cleft or nasal deformity include a deviation of the anterior nasal spine, a deflected septum, a deficiency of the orbicularis muscle, and a lack of bone underlying the nose. Secondary cleft and nasal deformity can result from incomplete muscle repair at the primary cleft operation. Therefore, surgeons should manage patients individually and deal with various deformities by performing appropriate surgery on a case-by-case basis. In this report, we applied the simple method of single VY-plasty on the nasal floor to a patient with unilateral cleft to revise the alar base on the cleft side. We adopted this approach to achieve overcorrection on the cleft side during surgery, which helped maintain the appropriate position of the alar base and ultimately balanced the nose foramen at 13 months after the operation. It was also possible to complement the height of the nasal floor without a bone graft. We believe that this approach will prove useful for managing cases with a broad and low nasal floor, thereby enabling the reconstruction of a well-balanced nose.

Computational Analysis of Olfactory Airspace in Patients With Unilateral Cleft Lip Nasal Deformity

2020 ◽  
pp. 105566562098275
Author(s):  
Reanna Shah ◽  
Jeffrey R. Marcus ◽  
Dennis O. Frank-Ito
Keyword(s):  
Cleft Lip ◽  
Computational Analysis ◽  
Normal Subjects ◽  
Nasal Deformity ◽  
Normal Anatomy ◽  
3 Dimensional ◽  
Computed Tomography Images ◽  
High Prevalence ◽  
Dimensional Reconstruction ◽  
The Impact

Objectives: To evaluate the magnitude of olfactory recess opacity in patients with unilateral cleft lip nasal deformity (uCLND). Design: Subject-specific 3-dimensional reconstruction of the nasal airway anatomy was created from computed tomography images in 11 (4 males and 7 females) subjects with uCLND and 7 (3 males, and 4 females) normal subjects. The volume and surface area of each subject’s unilateral and bilateral olfactory airspace was quantified to assess the impact of opacification. Qualitatively speaking, patients with 75% to 100% olfactory recess opacification were classified as extreme, 50% to 75% as severe, 25% to 50% as moderate, and 0% to 25% as mild. Results: Of the 11 subjects with uCLND, 5 (45%) were classified as having extreme olfactory recess opacification, 3 (27%) subjects had severe opacification, and 3 (27%) subjects had moderate opacification. Mean (±SD) bilateral olfactory recess volume was significantly greater in normal subjects than in subjects with uCLND (0.9668 cm3 ± 0.4061 cm3 vs 0.3426 cm3 ± 0.1316 cm3; P < .001). Furthermore, unilateral olfactory airspace volumes for the cleft and non-cleft sides in subjects with uCLND were considerably less than unilateral olfactory volume in subjects with normal anatomy (uCLND cleft side = 0.1623 cm3 ± 0.0933 cm3; uCLND non-cleft side = 0.1803 cm3 ± 0.0938 cm3; normal = 0.4834 cm3 ± 0.2328 cm3; P < .001). Conclusions: Our findings indicate a high prevalence of olfactory recess opacification among subjects with uCLND when compared to subjects with normal anatomy. The majority of subjects with uCLND had extreme olfactory recess opacity, which will likely influence their sense of smell.

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