Secondary Cleft Nasolabial Deformities

Sittah, Ghassan Abu; Ghanem, Odette Abou; Hamdan, Usama S.; Ramia, Paul; Zgheib, Elias

doi:10.1597/16-064

Cited by 13 publications

(20 citation statements)

References 15 publications

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“…These techniques can correct asymmetries and irregularities of the vermilion border and Cupid’s bow, repair vermillion mucosal excess or deficiency, and potentially lengthen or shorten the upper lip. They can also help to remove irregular scarring (hypertrophied, wide, and depressed) and redundant tissue of the lip 2,7 Figure 1A. shows a patient presenting with mucosal scarring and asymmetric Cupid’s bow on the cleft side; Figure 1B shows the patient’s lip after type I repair.…”

Section: Methodsmentioning

confidence: 99%

“…This will allow the lip to regain its fullness and regain its proper functioning. The muscle should be properly and effectively realigned with the upper lip 2,7 Figure 1C. shows a patient presenting with an orbicularis oris muscle deficiency with a relatively symmetrical cupid’s bow; Figure 1D shows how the orbicularis oris has been realigned to gain its normal anatomic structure after type II repair.…”

Section: Methodsmentioning

confidence: 99%

“…It deals with deformities of the skin , subcutaneous tissue , orbicularis oris , and surrounding mucosa without any nasal correction. Many cases might require cleft rhinoplasty, but those procedures should be delayed in order not to compromise the healing of the lip revision 2,7 . Type III deformities can be subcategorized into unilateral and bilateral.…”

Section: Methodsmentioning

confidence: 99%

“…Secondary CL deformities may occur due to patient-specific factors that contribute to deformities during the healing process or because of complications directly and/or indirectly associated with the primary repair. These complications vary and may include postoperative hematoma, infections, lip dehiscence, Cupid’s bow malalignment, improper nasal repair, improper/insufficient release of the orbicularis oris muscle or inadequate closure/suturing of said muscle, improper repair of the nasal ala, or postoperative trauma 1,2 . Consequently, these complications can lead to residual CL deformities that affect the nose, such as shortened columella, alar rim notching, thickened alar lobule, under-projected nasal tip, obliteration of the alar crease, alar valve constriction, or nasal asymmetry.…”

mentioning

confidence: 99%

“…In 2013, Hamdan and colleagues described a comprehensive classification system for CL revision that included 4 distinct classes based on the extent of involvement of the defect. This system proved to be effective and beneficial in clinical and especially in outreach settings 2,3 . In 2015, a fifth class was added by the first author to the pre-existing 4 classes, which allowed for a more comprehensive classification.…”

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confidence: 99%

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A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities

Hamdan,

Najjar,

Younan

et al. 2024

Journal of Craniofacial Surgery

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Secondary cleft lip (CL) deformities are commonly encountered in cleft management. Various attempts have been made to create a classification system that can comprehensively encapsulate residual CL deformities after primary repair. The aim of this study is to reinforce valid classification systems and to introduce a new classification subtype (Type V Revision). A longitudinal retrospective analysis was done in 35 outreach programs in 4 countries (Ecuador, Lebanon, Peru, and El Salvador) between 2015 and 2023. Two hundred sixty-nine patients, between the ages of 9 months and 45 years, with residual CL deformities after primary lip repair, were classified into one of the 5 classification types. Patients with syndromes were excluded from the study. Patients received one of 5 revision types depending on their initial preoperative evaluation and intraoperative analysis of anatomic involvement. The mean age at surgery was 12.86 years. Twenty-five patients received type I revision, 29 patients received type II revision, 81 patients received type III revision, 106 patients received type IV revision, and 28 patients received type V revision. As the surgical complexity advanced from type I to V, there was a gradual increase in the average surgical time. The Congruence between preoperative and postoperative revision types was substantial. Residual CL defects cause a significant burden on both the patient and cleft care provider. This classification system, with the newly introduced type V revision, enhances and eases the categorization and management of secondary CL deformities.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities

Hamdan,

Najjar,

Younan

et al. 2024

Journal of Craniofacial Surgery

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Cleft and Craniofacial Surgery

Costello¹,

Caccamese²,

Ruiz³

2022

Management of Complications in Oral and Maxillofacial Surgery

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Children's Visual Perception of Facial Scarring and Cleft Lip Deformity Using Eye Tracking Data

Roby,

Ebert,

Zavala

et al. 2024

The Laryngoscope

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ObjectiveThe purpose of this study is to determine children's perception of secondary cleft lip deformity (SCLD) using objective eye tracking technology and subjective responses on a survey to understand pediatric perceptions of facial scarring.DesignCross‐sectional study of participants aged 5–17 years old.MethodsParticipants viewed images of children's faces with an eye tracking device. Sixteen images were displayed, 12 with unilateral SCLD and four with no facial scarring. Eye tracking data were obtained. Gaze samples were analyzed for areas of interest (AOIs). Immediately after viewing each image, participants answered two survey questions relating to facial asymmetry attitude toward the child pictured. For analysis, participants were divided into age groups.ResultsA total of 259 participants were enrolled (42.5% female). Mean age was 10.5 years and 78% identified as White. In all age groups, total fixation time was greater for SCLD compared to control images. Early elementary age children spent significantly less time assessing the nose AOI compared to other groups, and also spent the least total fixation time and had the lowest visit count on all AOIs. Subjective survey questions showed similar trends with elementary age not noticing facial asymmetry compared to older age groups.ConclusionThis study demonstrates the successful use of eye tracking technology in children as young as 5 years old. This study suggests that SCLD is perceived as less noticeable in elementary age children and becomes more noticeable to older groups. Understanding peer perception on SCLD from this study may impact decision on revision surgery for SCLD.Level of EvidenceIV Laryngoscope, 2024

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Secondary Cleft Nasolabial Deformities

Cited by 13 publications

References 15 publications

A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities

A Modified and Refined Classification System for Secondary Cleft Nasolabial Deformities

Cleft and Craniofacial Surgery

Children's Visual Perception of Facial Scarring and Cleft Lip Deformity Using Eye Tracking Data

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