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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2013, Vol. 7 Issue (4) : 510-516    https://doi.org/10.1007/s11684-013-0299-6
RESEARCH ARTICLE
Sufficient downward rotation of the christa philtri on the cleft side: a modified technique
Yi Xu, Jingtao Li, Bing Shi()
Department of Oral and Maxillofacial Surgery and State Key Laboratory of Oral Disease, West China College of Stomatology, Sichuan University, Chengdu 610041, China
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Abstract

Cleft lip and palate (CLP) is the most common craniofacial congenital deformity. The etiology of CLP is multifactorial and involves complex interactions between environmental and genetic factors. Millard’s rotation-advancement technique has long been considered as state-of-the-art for unilateral cleft lip repair. However, this method may leave the christa philtri on the cleft side insufficiently downward rotated, especially in wide complete clefts. In this study, we introduce a modified technique to better rotate the christa philtri on the cleft side down. The skin, muscle, and mucosa in the deformed region were dissected and separately maneuvered. Sixty patients with unilateral complete cleft lip and palate were operated with this technique. The lip height, lip length, and relative height of the christa philtri were measured for symmetry evaluation. No significant difference was observed between the relative height of the christa philtri on both sides, either immediate (P = 0.214) or 10 months after surgery (P = 0.344). The difference observed in the lip height and lip length immediately after surgery became statistically insignificant after 10 months (P = 0.104 for lip height and 0.121 for lip length). These results suggested that sufficient and stable downward rotation of the christa philtri on the cleft side can be achieved using our technique.

Keywords cleft lip and palate      rotation advancement      sufficient rotation      christa philtri geometrically justified     
Corresponding Author(s): Shi Bing,Email:shibingcn@vip.sina.com   
Issue Date: 05 December 2013
 Cite this article:   
Yi Xu,Jingtao Li,Bing Shi. Sufficient downward rotation of the christa philtri on the cleft side: a modified technique[J]. Front Med, 2013, 7(4): 510-516.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-013-0299-6
https://academic.hep.com.cn/fmd/EN/Y2013/V7/I4/510
Fig.1  Surgical markings. The end of back cut incision (point 5) is located on the bisecting line of angle 213 in our technique.
Fig.2  (A) Dissection of the orbicularis oris muscle to the alar base on the cleft side. The black arrow shows the artery at the end of dissection. (B) Dissection of the orbicularis oris muscle to the bisector line of angle 213 on the non-cleft side.
Fig.3  (A) Reconstruction of the nasal floor; (B) Reconstruction of the orbicularis oris muscle.
Fig.4  (A, B) Release of abnormal attachment between the lower lateral cartilage and the overlying skin through the lateral crus and medial crus. (C, D) Suspension of the freed low lateral cartilage to the ipsilateral upper lateral cartilage and contralateral low lateral cartilage. (E) Accentuating the alar groove on the cleft side.
Fig.5  Sequential (T1, T2, and T3) casts of a patient with right complete cleft lip and palate who received cheiloplasty and primary rhinoplasty at 5 months old and palatoplasty at 13 months old.
Cleft sideNon-cleft sideP value*
Lip lengthT114.693±1.74817.868±2.4310.000
T217.996±1.91319.531±2.1870.000
T319.500±2.19419.965±2.5050.121
Lip heightT18.084±1.10210.402±1.6270.000
T29.695±1.38511.206±1.3470.000
T311.170±1.21311.764±1.4380.104
Tab.1  Differences in lip length and height on both sides at T1, T2, and T3 (mean±SD)
Cleft sideNon-cleft sideP value*
T10.921±0.0991.034±0.1130.000
T21.081±0.1011.104±0.1030.214
T31.126±0.1061.143±0.1040.344
Tab.2  Differences in the heights of christa philtri on both sides (1, 2) at T1, T2, and T3 (mean±SD)
Fig.6  Step-rotation-downward theory: a, bisector of the angle 213; b, rotation incision of the skin; c, rotation incision of the orbicularis oris muscle; and d, rotation incision of the mucosa.
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