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Primary bilateral cleft lip-nose repair: the Tawanchai Cleft Center's integrated and functional reconstruction.
J Med Assoc Thai 2010; 93 Suppl 4:S46-57JM

Abstract

BACKGROUND

The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary cleft palate, the problems of scar and secondary deformities have been addressed.

OBJECTIVES

To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present the preliminary outcomes of this technique and its advantages.

MATERIAL AND METHOD

An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities; 2) interdisciplinary management and use of Tawanchai Center's protocol for cleft lip and palate care; 3) pre-surgical orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and, 5) final skin closure.

RESULTS

Between 2002 and 2010, this technique was performed and evaluated on 42 patients who received primary bilateral cleft lip-nose repair, including 31complete, 6 incomplete and 5 right complete and left incomplete, 27 males and 15 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.69) and Cupid' bow symmetry (0.76) while the mean of the less satisfactory rating scale was found in scar (1.13) and nasal asymmetry (0.96). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated.

DISCUSSION AND CONCLUSION

The authors introduced the Tawanchai Center's integrated concepts and functional reconstruction technique for bilateral cleft lip-nose repair. The technique offers the advantages of an integrated assessment for all of the deformities of the primary cleft palate, the design of an integrated technique together with proper peri-operative care, presurgical orthodontic treatment, and a well-coordinated, holistic, interdisciplinary management. A satisfactory preliminary outcome was demonstrated but more improvement of the outcome can be achieved by: 1) continuing assessment of this group of patients until they reach maturity; 2) refining techniques; 3) improving interdisciplinary care; and, 4) setting benchmarks for the outcome.

Authors+Show Affiliations

Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. bowcho@kku.ac.thNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21302389

Citation

Chowchuen, Bowornsilp, et al. "Primary Bilateral Cleft Lip-nose Repair: the Tawanchai Cleft Center's Integrated and Functional Reconstruction." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 93 Suppl 4, 2010, pp. S46-57.
Chowchuen B, Viwattanatipa N, Wangsrimongkol T, et al. Primary bilateral cleft lip-nose repair: the Tawanchai Cleft Center's integrated and functional reconstruction. J Med Assoc Thai. 2010;93 Suppl 4:S46-57.
Chowchuen, B., Viwattanatipa, N., Wangsrimongkol, T., & Pradubwong, S. (2010). Primary bilateral cleft lip-nose repair: the Tawanchai Cleft Center's integrated and functional reconstruction. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 93 Suppl 4, pp. S46-57.
Chowchuen B, et al. Primary Bilateral Cleft Lip-nose Repair: the Tawanchai Cleft Center's Integrated and Functional Reconstruction. J Med Assoc Thai. 2010;93 Suppl 4:S46-57. PubMed PMID: 21302389.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary bilateral cleft lip-nose repair: the Tawanchai Cleft Center's integrated and functional reconstruction. AU - Chowchuen,Bowornsilp, AU - Viwattanatipa,Nita, AU - Wangsrimongkol,Tasanee, AU - Pradubwong,Suteera, PY - 2011/2/9/entrez PY - 2011/2/9/pubmed PY - 2011/6/3/medline SP - S46 EP - 57 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 93 Suppl 4 N2 - BACKGROUND: The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary cleft palate, the problems of scar and secondary deformities have been addressed. OBJECTIVES: To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present the preliminary outcomes of this technique and its advantages. MATERIAL AND METHOD: An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities; 2) interdisciplinary management and use of Tawanchai Center's protocol for cleft lip and palate care; 3) pre-surgical orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and, 5) final skin closure. RESULTS: Between 2002 and 2010, this technique was performed and evaluated on 42 patients who received primary bilateral cleft lip-nose repair, including 31complete, 6 incomplete and 5 right complete and left incomplete, 27 males and 15 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.69) and Cupid' bow symmetry (0.76) while the mean of the less satisfactory rating scale was found in scar (1.13) and nasal asymmetry (0.96). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated. DISCUSSION AND CONCLUSION: The authors introduced the Tawanchai Center's integrated concepts and functional reconstruction technique for bilateral cleft lip-nose repair. The technique offers the advantages of an integrated assessment for all of the deformities of the primary cleft palate, the design of an integrated technique together with proper peri-operative care, presurgical orthodontic treatment, and a well-coordinated, holistic, interdisciplinary management. A satisfactory preliminary outcome was demonstrated but more improvement of the outcome can be achieved by: 1) continuing assessment of this group of patients until they reach maturity; 2) refining techniques; 3) improving interdisciplinary care; and, 4) setting benchmarks for the outcome. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/21302389/Primary_bilateral_cleft_lip_nose_repair:_the_Tawanchai_Cleft_Center's_integrated_and_functional_reconstruction_ L2 - https://medlineplus.gov/plasticandcosmeticsurgery.html DB - PRIME DP - Unbound Medicine ER -