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Secondary RhinoCheiloplasty In Unilateral Cleft Lip And Palate Patient . Dept. of Oral & Maxillofacial Surgery Gachon Medical School, Gil Medical Center 최세훈* , 정종철 , 송민석 , 전창훈 , 김현민. Introduction. Primary surgery If needed, but almost needed Secondary surgery. Review of Literatures.
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Secondary RhinoCheiloplasty In Unilateral Cleft Lip And Palate Patient Dept. of Oral & Maxillofacial Surgery Gachon Medical School, Gil Medical Center 최세훈*,정종철,송민석,전창훈,김현민
Introduction • Primary surgery If needed, but almost needed • Secondary surgery
Review of Literatures • The correction of secondary cleft lip nasal deformity YK Kim, HH Yeo(1995) • Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap R Agarwal(1998) • Correction of secondary deformity of cleft lip nose S Samuel(2001) • Levator septi nasi muscle and its clinical significance T Harashina(2003)
Timing • Intermediate surgery • Definitive surgery • Millard-6 years • Ahuja- after growth completed • Dutton & Bumsted-after puberty
Considerations • Corrective anatomy • Motional deficiency • Asymmetry • Etc.
General Findings • Nostril asymmetry • Lip scar • Alar base depression • Columella shortening • Discrepancy of muscle continuity • Etc.
Nostril Asymmetry &Alar Base Depression • Primary surgery • Philtrum asymmetry • Cartilage disposition • Incomplete rotation • Alveolus cleft
Alar unit rotation Correction of alar base
Cartilage Deformity • Severe depression of lateral cartilage • Deficiency of cartilage
Reposition of cartilage Graft augmentation
Discrepancy of Muscle Continuity • Orbicularis oris disposition
Prognosis • Follow up • Esthetic evaluation • Functional evaluation
Case 1 • 8 years /F • Unilateral cleft lip and palate • After primary surgery, • fall down accident C/C: severe deviated nostril • Treatment plan 1. rhinocheiloplasty
Case 2 • F/ 10 years • Unilateral cleft lip and palate • C/C: nostril asymmetry • Treatment plan 1. Rhinoplasty 2. Cleft alveolus correction 3. Bone graft
Case 3 • 27 years/F • Unilateral cleft lip and alveolus • Treatment plan 1. Rhinocheiloplasty 2. Cleft alveolus – bone graft
Summary • Correction of deviated septal cartilage • Repositioning of depressed lower lateral cartilage