Our report describes a simple method of functional reconstruction of the philtral ridge in patients with repaired cleft lip. Philtral reconstruction was performed in 21 children with dehiscence of the orbicularis oris in repaired cleft lip. Prominent groove at the philtral column and lateral bulging during maximal "pucker" were the indications. First, the abnormally inserted orbicularis muscle is freed and realigned in a normal horizontal orientation. The muscle is vertically incised and repaired with vertical mattress sutures, spreading out the muscle to increase the thickness of the philtral ridge. The philtral ridge is accentuated by deepening the dimple with a dermal suture at the midline. Postoperative evaluation was performed at 8-18 months (mean; 13.1 months). The philtrum was evaluated by a panel using two visual scales. Eminence of the philtral ridge was scored by a five-point grading scale and the philtral dimple was scored by a three-point grading scale, both at resting and at maximal pucker. Preoperative scores showed the philtral ridge to be from "prominent groove" to "flat" at maximal pucker and at rest, respectively. Postoperative scores showed improvement of the philtral ridge to "less prominent than the normal philtral ridge" both at rest and at maximal pucker. The philtral dimple preoperative scores ranged from "no dimple" to "slight dimple" and postoperative improvement to "slight dimple" to "prominent dimple." This technique of functional reconstruction of the philtrum gave satisfactory results in formation of the philtral ridge and dimple, both at rest and at maximal pucker.

No abstract

The aim of this study was to see the histological nature of the alar web and to introduce a featheredged rolled-in flap to reduce the alar web.On a cadaver, the perpendicular section of the alar web revealed a thickened dermis portion on both the skin side and the nasal side distal to the alar cartilage. According to histological results, we thought the thinning and rolling in of the distal margin of the end of the open rhinoplasty incision could reduce the alar web. An open rhinoplasty incision was made just distal to the hair-bearing vestibular skin and a V-Y shape incision created at the alar base. After the cartilage work, the skin of the distal end of the flap was featheredged to a 0.5-mm thickness. The distal margin was rolled in and sutured to the nasal lining. A bolster dressing was applied using a 4-0 nylon suture.Thirteen patients (8 males, 5 females) were operated on, and 8 patients were followed up for more than 12 months. Their preoperative and postoperative worm's eye views were compared. Four anthropometric distances were measured preoperatively and postoperatively. The columellar length increased significantly after the operation (P = 0.001 [independent 2-sample t test]) on the cleft side. Preoperatively, the alar width was significantly greater (P = 0.02 [paired-samples t test]) on the cleft side (0.17 ± 0.03 of an intercanthal distance) than the noncleft side (0.14 ± 0.03). After the operations, they became similar (0.16 ± 0.03 on cleft side, 0.16 ± 0.04 on the noncleft side; P = 1.00 [paired-samples t test]).We think this featheredged rolling-in flap might be a good method for the correction of an alar web since this technique increased the columellar length and decreased the alar width on the cleft side.

The aim of this study was to introduce a safe ostectomy method for the correction of prominent mandibular angles via a "burring and holes connecting technique." A subperiosteal dissection was conducted, and the mandibular angle was exposed. Using a 7-mm-diameter burr, 3 to 5 holes were made on the predicted ostectomy line. The consecutive holes were connected using an oscillating saw. A bone fragment was removed, and irregularities were smoothened through light burring. Twenty-three patients (2 men, 21 women; mean age, 28.4 y) were operated on. The mean trace observation period was 11 months. Among the 23 patients, no subcondylar fracture or hematoma occurred. In x-ray comparisons, there was no excessive or insufficient reduction of the mandibular angle. We think this burring and holes connecting ostectomy might be a safe method for the correction of prominent mandible angles even for inexperienced surgeons.

The aim of the present study is to introduce a method of which the medial mucosal flap is used in a deepening of the gingivolabial sulcus in a complete cleft lip repair. An incision was made on the lateral vestibular lining and the contracture was released. The defect produced was filled by transposing the lateral mucosal flap (l-flap). The transposed l-flap was sutured except for the proximal part of the lateral side. The medial mucosal flap (m-flap) was elevated with its base above on the alveolus. The m-flap was turned over and crossed over the cleft thereafter and the distal end of the m-flap was sutured to the proximal part of the lateral side of the l-flap. The width of the m-flap was 4 to 5 mm, and the length depended on the width of the cleft. The raw surface of the m-flap faced the outer side and was covered with the repaired muscle layer. Thereafter, the m-flap became a part of the deepened gingivolabial sulcus. A total of 12 patients (8 men, 4 women) with a unilateral complete cleft lip (left 9, right 3) were operated on using this technique and at least 2 mm deepening effect of upper gingivolabial sulcus was observed in 8 patients followed up. The authors think this cleft crossing medial mucosal flap technique may be of use in the primary repair of a unilateral cleft lip.