Two Cases of Tessier No. 4 Cleft with Anophthalmia

2005 ◽  
Vol 42 (4) ◽  
pp. 448-452 ◽  
Author(s):  
Kazuyuki Tokioka ◽  
Takashi Nakatsuka ◽  
Susam Park ◽  
Masayuki Okouchi ◽  
Emiko Aiba
Keyword(s):  
Soft Tissue ◽  
Cleft Lip ◽  
Lower Eyelid ◽  
Advancement Flap ◽  
Palpebral Fissure ◽  
Flap Technique ◽  
First Case ◽  
Nasal Ala ◽  
Unilateral Case ◽  
Rotation Advancement

Objective Tessier no. 4 cleft is a very rare craniofacial anomaly, and the primary surgical procedure has not been definitely standardized. The cheek advancement flap, technique, which was first reported by Van der Meulen (1985), has produced cosmetically favorable results. In this report, two cases with Tessier no. 4 cleft, which were treated with the cheek advancement flap technique, are presented. Design and Patients The first case was unilateral and the second was bilateral, and both were accompanied with anophthalmia on the cleft side. At the primary operation, dissection of the nasal soft tissue, medial canthopexy, and reconstruction of the lower eyelid and conjunctival fornix were performed. Cleft lip was repaired according to the rotation-advancement procedure. Results and Conclusions Postoperative appearances were acceptable in both cases, because the resulting scars were made along the esthetic facial units. However, the soft tissue deficiency of the lower eyelid was prominent. Furthermore, in the unilateral case, caudal displacement of the palpebral fissure and cephalic deviation of the nasal ala was recognized.

scholarly journals Beyond Fifty Years of Millard’s Rotation-Advancement Technique in Cleft Lip Closure: Are There Many “Millards”?

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Renato da Silva Freitas ◽  
Pedro Bertoco Alves ◽  
Gisele Keiko Machado Shimizu ◽  
Júlia Fortes Schuchovski ◽  
Marlon Augusto Câmara Lopes ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Cleft Lip ◽  
Advancement Flap ◽  
Basic Principles ◽  
Initial Procedure ◽  
Different Shapes ◽  
Rotation Advancement

In 1955, Millard developed the concept of rotation-advancement flap to treat cleft lip. Almost 6 decades later, it remains the most popular technique worldwide. Since the technique evolved and Millard published many technical variations, we decided to ask 10 experienced cleft surgeons how they would mark Millard’s 7 points in two unilateral cleft lip patient photos and compared the results. In both pictures, points 1 and 2 were marked identically among surgeons. Points 3 were located adjacent to each other, but not coincident, and the largest distances between points 3 were 4.95 mm and 4.03 mm on pictures 1 and 2, respectively. Similar patterns were obtained for points 4, eight of them were adjacent, and the greatest distance between the points was 4.39 mm. Points 5 had the most divergence between the points among evaluators, which were responsible for the different shapes of the C-flap. Points 6 also had dissimilar markings, and such difference accounts for varying resection areas among evaluators. The largest distances observed were 11.66 mm and 7 mm on pictures 1 and 2, respectively. In summary, much has changed since Millard’s initial procedure, but his basic principles have survived the inexorable test of time, proving that his idea has found place among the greatest concepts of modern plastic surgery.

Augmented Facelift Flap for Aesthetic Reconstruction of Posttraumatic Facial Defects

2020 ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Lower Eyelid ◽  
Advancement Flap ◽  
Venous Stasis ◽  
Short Term ◽  
Patient Satisfaction Scores ◽  
Facial Defects ◽  
Aesthetic Results ◽  
Flap Design ◽  
Rotation Advancement

Introduction:Reconstructing posttraumatic facial defects to achieve aesthetically pleasing results is challenging. Different flaps, including many modifications of cheek flaps, are commonly performed, but several problems persist.Aim:To evaluate the effectiveness of an augmented facelift flap for reconstructing posttraumatic facial defects. Fundamentally a rotation-advancement flap inspired by extended facelift markings and deep-plane facelift dissection, it incorporates retroauricular and cervical tissues whenever necessary. Materials and Methods:Ten patients (eight males, two females) with cheek, lateral orbit, and lower eyelid defects were reconstructed with augmented facelift flaps between January 2009 and December 2019. Size of defects ranged between 10.5 to 27 cm2, and patients age between 21 to 78 years (mean, 49.3). Deep-plane facelift dissection was performed for extensive facial defects and subcutaneous dissection for smaller ones. Flap design was based on the principles of extended facelift surgery with necessary extensions. Meticulous dissection and anchoring ‘key sutures’ in four different facial regions were vital in preventing complications.Results:Augmented facelift flap aptly reconstructed defects over the medial cheek, lateral orbit, and lower eyelid with aesthetically pleasing results. Nine patients (90%) healed well without any long-term complications. Among short-term complications, superficial necrosis was found in one patient (10%) and mild venous stasis in three patients (30%). Flap loss and infection were absent. Lower eyelid ectropion and deep marginal necrosis occurred in one patient (10%). Overall, patient satisfaction scores ranged between 50-90 percent (mean, 78%).Conclusion:Augmented facelift flap successfully reconstructed posttraumatic facial defects over the cheek, lateral orbit, and lower eyelids with satisfying aesthetic results.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

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