Primary Rhinoplasty in Unilateral Cleft Patients: The “Limited Open” Approach and Other Technical Considerations

2006 ◽  
Vol 43 (4) ◽  
pp. 492-498 ◽  
Author(s):  
Rajeev B. Ahuja
Keyword(s):  
Cleft Lip ◽  
Open Rhinoplasty ◽  
Open Approach ◽  
Mattress Suture ◽  
Absolute Increase ◽  
Primary Rhinoplasty ◽  
Transcolumellar Incision ◽  
Cleft Lip Repair ◽  
Presurgical Orthopedics

Objective To validate a method of primary anatomic alar repositioning using a “limited open rhinoplasty” approach, along with cleft lip repair, without presurgical orthopedics. Methods The cleft lip deformities were repaired using a modified Tennison technique, and primary muscle union and gingivoperiosteoplasty were achieved in all cases. The alar cartilages were visualized using an inverted “U” incision on the cleft side and a rim incision on the noncleft side, without joining the two with a transcolumellar incision. The domes of the cartilages were approximated by a single horizontal mattress suture. Patients Thirty-five patients were operated on by this technique between March 1999 and February 2004. The patients ranged in age from 4 to 36 months (mean, 6 months). The follow-up ranged from 4 months to 4.5 years (mean, 18 months). Results Overall, the results for nasal shape and symmetry have been extremely good. Conclusions The technique used here provides an exposure just short of an “open” rhinoplasty without scarring the columella or nasal tip. Arch alignment and a symmetric and stable bony platform are generally achieved by 2 to 3 months after the surgery. In severe cases of complete clefts, we have observed an absolute increase in alar arch length as a result of tissue stretch.

scholarly journals A modified presurgical orthopedic (nasoalveolar molding) device in the treatment of unilateral cleft lip and palate

2016 ◽  
Vol 10 (03) ◽  
pp. 435-438 ◽  
Author(s):  
Chitravelu Siva Subramanian ◽  
N. K. K. Koteswara Prasad ◽  
Arun B. Chitharanjan ◽  
Eric Jein Wein Liou
Keyword(s):  
Functional Outcome ◽  
Surgical Procedures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Technique ◽  
Patient Needs ◽  
Nasal Cartilage ◽  
Primary Rhinoplasty ◽  
Cleft Lip Repair ◽  
Nasoalveolar Molding

ABSTRACTNasoalveolar molding (NAM) can be done effectively to reshape the nasal cartilage and mold the maxillary dentoalveolar arch before surgical cleft lip repair and primary rhinoplasty. Presurgical NAM helps as an adjunct procedure to enhance the esthetic and functional outcome of the surgical procedures. We have developed a modified NAM device to suit to the needs of the patients coming from distant places for the treatment. This device helps in reducing the number of frequent visits the patient needs to take to the craniofacial center. The purpose of this presentation is to report this treatment technique and discuss its application.

scholarly journals The Effect of DynaCleft® on Cleft Width in Unilateral Cleft Lip and Palate Patients

2017 ◽  
Vol 41 (6) ◽  
pp. 442-445 ◽  
Author(s):  
LaQuia Vinson
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cross Sectional Study ◽  
Clinic Visit ◽  
Design Data ◽  
Cross Sectional ◽  
Alveolar Cleft ◽  
Cleft Lip Repair ◽  
Presurgical Orthopedics ◽  
Digital Caliper

Objective: The specific aim of this retrospective cross-sectional study was to assess the efficacy of DynaCleft® as a method of presurgical orthopedics with infants with a unilateral cleft lip and cleft palate who used an oral obturator. Study design: Data was collected from 25 infants all of comparable age diagnosed with a unilateral complete cleft lip and palate. Eight patients used DynaCleft ® and an obturator (Group Alpha) and seventeen patients only had an obturator (Group Beta). Maxillary impression casts were obtained from each patient at the initial clinic visit and at the time of cleft lip repair. Differences in alveolar cleft width were compared between the two groups. Casts were measured twice by one observer using a digital caliper. Results: Group Alpha began treatment on an average age of 24.25 days and Group Beta an average of 15.35 days of age. The average cleft width of Group Alpha was 8.13 mm and after treatment it was 4.59 mm. The average cleft width of Group Beta was 8.09 mm and 6.92 mm after treatment. Results of paired t-tests and two-sample t-test showed that cleft width changes between the two groups were significant (P = .03). Conclusions: DynaCleft ® significantly decreased the size of the alveolar cleft width compared to infants who did not use it. Providers should consider using DynaCleft® for patients who may not have access to infant maxillary orthopedics.

Fifteen-Year Follow-Up Results of Presurgical Orthopedics Followed by Primary Correction for Unilateral Cleft Lip Nose in Program SEHATI in Indonesia

2013 ◽  
Vol 50 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Farida Kamil Sulaiman ◽  
Inge Gustiningsih Haryanto ◽  
Syafrudin Hak ◽  
Norifumi Nakamura ◽  
Masaaki Sasaguri ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Presurgical Orthopedics ◽  
Cleft Lip Nose

Bilateral Complete Cleft Lip Repair and Primary Semi-open Rhinoplasty

2016 ◽  
pp. 227-230
Author(s):  
Ting-Chen Lu ◽  
Un-Chang See ◽  
Philip Kuo-Ting Chen ◽  
M. Samuel Noordhoff
Keyword(s):  
Cleft Lip ◽  
Open Rhinoplasty ◽  
Cleft Lip Repair

scholarly journals Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

2019 ◽  
Vol 40 (1) ◽  
pp. 34-48 ◽  
Author(s):  
Aaron M Kosins ◽  
Rollin K Daniel
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Open Rhinoplasty ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
Primary Rhinoplasty ◽  
Proper Patient Selection ◽  
Total Preservation ◽  
One Year

Abstract Background Preservation rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. Objectives The aim of this study is to discuss a single-surgeon case series utilizing PR techniques. Methods One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least 1 year of follow-up. Technical details were recorded, including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum vs traditional reduction. These 100 cases can be categorized as either complete preservation rhinoplasty (PR-C) or partial preservation rhinoplasty (PR-P). Results All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, and in 36 the entire soft tissue envelope and ligaments were preserved. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-C (skin, dorsum, and alars): 24; PR-P (skin and dorsum): 2; PR-P (alars and dorsum): 2; and PR-P (skin and alars): 7. Conclusions In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique when proper patient selection is undertaken, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped. Level of Evidence: 4

Associations between Severity of Clefting and Maxillary Growth in Patients with Unilateral Cleft Lip and Palate Treated with Infant Orthopedics

2001 ◽  
Vol 38 (6) ◽  
pp. 582-586 ◽  
Author(s):  
Timo Peltomäki ◽  
Bruno L. Vendittelli ◽  
Barry H. Grayson ◽  
Court B. Cutting ◽  
Lawrence E. Brecht
Keyword(s):  
New York ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
New York University ◽  
Maxillary Growth ◽  
Reconstructive Plastic Surgery ◽  
Cephalometric Measurements ◽  
Presurgical Orthopedics

Objective: The purpose of this study was to examine possible associations between severity of clefting in infants and maxillary growth in children with complete unilateral cleft lip and palate. Design: This was a retrospective study of measurements made on infant maxillary study casts and maxillary cephalometric variables obtained at 5 to 6 years of follow-up. Setting: The study was performed at the Institute of Reconstructive Plastic Surgery of New York University Medical Center, New York, New York. Patients: Twenty-four consecutive nonsyndromic unilateral complete cleft lip and palate patients treated during the years 1987 to 1994. Interventions: All the patients received uniform treatment (i.e., presurgical orthopedics followed by gingivoperiosteoplasty to close the alveolar cleft combined with repair of the lip and nose in a single stage at the age of 3 to 4 months). Closure of the palate was performed at the age of 12 to 14 months. Results: Infant maxillary study cast measurements correlated in a statistically significant manner with maxillary cephalometric measurements at age 5 to 6 years. Conclusions: The results demonstrate the large variation in the severity of unilateral cleft lip and palate deformity at birth. Patients with large clefts and small arch circumference, arch length, or both demonstrated less favorable maxillary growth than those with small clefts and large arch circumference or arch length at birth.

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