Sufficient downward rotation of the christa philtri on the cleft side: a modified technique
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
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.
Corresponding Author(s):
Shi Bing,Email:shibingcn@vip.sina.com
引用本文:
. Sufficient downward rotation of the christa philtri on the cleft side: a modified technique[J]. Frontiers of Medicine, 2013, 7(4): 510-516.
Yi Xu, Jingtao Li, Bing Shi. Sufficient downward rotation of the christa philtri on the cleft side: a modified technique. Front Med, 2013, 7(4): 510-516.
Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, Devine O, Petrini J, Ramadhani TA, Hobbs CA, Kirby RS. National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol 2006; 76(11): 747–756 doi: 10.1002/bdra.20294 pmid:17051527
2
Liang J, Wang YP, Zhou GX, ZhuJ, MiaoL, WuYQ, Xiao KZ. Dynamic variation of incidence of nonsyndromic cleft lip with or without cleft palate during 1988 to 1992 in China. J Oral Maxillofac Surg (Kou Qiang He Mian Wai Ke Za Zhi) 2000; 10(4): 299–301 (in Chinese)
3
Jugessur A, Murray JC. Orofacial clefting: recent insights into a complex trait. Curr Opin Genet Dev 2005; 15(3): 270–278 doi: 10.1016/j.gde.2005.03.003 pmid:15917202
4
Chung KC, Kowalski CP, Kim HM, Buchman SR. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate. Plast Reconstr Surg 2000; 105(2): 485–491 doi: 10.1097/00006534-200002000-00001 pmid:10697150
5
Little J, Cardy A, Arslan MT, Gilmour M, Mossey PA. Smoking and orofacial clefts: a United Kingdom-based case-control study. Cleft Palate Craniofac J 2004; 41(4): 381–386 doi: 10.1597/02-142.1 pmid:15222794
6
Yazdy MM, Honein MA, Rasmussen SA, Frias JL. Priorities for future public health research in orofacial clefts. Cleft Palate Craniofac J 2007; 44(4): 351–357 doi: 10.1597/06-233.1 pmid:17608558
7
Zucchero TM, Cooper ME, Maher BS, Daack-Hirsch S, Nepomuceno B, Ribeiro L, Caprau D, Christensen K, Suzuki Y, Machida J, Natsume N, Yoshiura K, Vieira AR, Orioli IM, Castilla EE, Moreno L, Arcos-Burgos M, Lidral AC, Field LL, Liu YE, Ray A, Goldstein TH, Schultz RE, Shi M, Johnson MK, Kondo S, Schutte BC, Marazita ML, Murray JC. Interferon regulatory factor 6 (IRF6) gene variants and the risk of isolated cleft lip or palate. N Engl J Med 2004; 351(8): 769–780 doi: 10.1056/NEJMoa032909 pmid:15317890
8
Ardinger HH, Buetow KH, Bell GI, Bardach J, VanDemark DR, Murray JC. Association of genetic variation of the transforming growth factor-alpha gene with cleft lip and palate. Am J Hum Genet 1989; 45(3): 348–353 pmid:2570526
9
Maestri NE, Beaty TH, Hetmanski J, Smith EA, McIntosh I, Wyszynski DF, Liang KY, Duffy DL, VanderKolk C. Application of transmission disequilibrium tests to nonsyndromic oral clefts: including candidate genes and environmental exposures in the models. Am J Med Genet 1997; 73(3): 337–344 doi: 10.1002/(SICI)1096-8628(19971219)73:3<337::AID-AJMG21>3.0.CO;2-J pmid:9415696
10
Lidral AC, Murray JC, Buetow KH, Basart AM, Schearer H, Shiang R, Naval A, Layda E, Magee K, Magee W. Studies of the candidate genes TGFB2, MSX1, TGFA, and TGFB3 in the etiology of cleft lip and palate in the Philippines. Cleft Palate Craniofac J 1997; 34(1): 1–6 doi: 10.1597/1545-1569(1997)034<0001:SOTCGT>2.3.CO;2 pmid:9003904
Sitzman TJ, Girotto JA, Marcus JR. Current surgical practices in cleft care: unilateral cleft lip repair. Plast Reconstr Surg 2008; 121(5): 261e–270e doi: 10.1097/PRS.0b013e31816a9feb pmid:18453938
13
Brusati R, Mannucci N, Biglioli F, Di Francesco A. Analysis on photographs of the growth of the cleft lip following a rotation-advancement flap repair: preliminary report. J Craniomaxillofac Surg 1996; 24(3): 140–144 doi: 10.1016/S1010-5182(96)80046-1 pmid:8842903
Holtmann B, Wray RC. A randomized comparison of triangular and rotation-advancement unilateral cleft lip repairs. Plast Reconstr Surg 1983; 71(2): 172–178 doi: 10.1097/00006534-198302000-00003 pmid:6823476
16
Pool R. The configurations of the unilateral cleft lip, with reference to the rotation advancement repair. Plast Reconstr Surg 1966; 37(6): 558–565 doi: 10.1097/00006534-196606000-00014 pmid:5932417
17
Saunders DE, Malek A, Karandy E. Growth of the cleft lip following a triangular flap repair. Plast Reconstr Surg 1986; 77(2): 227–237 doi: 10.1097/00006534-198602000-00009 pmid:3945686
Mulliken JB, Martínez-Pérez D. The principle of rotation advancement for repair of unilateral complete cleft lip and nasal deformity: technical variations and analysis of results. Plast Reconstr Surg 1999; 104(5): 1247–1260 doi: 10.1097/00006534-199910000-00003 pmid:10513903
20
Samuel Noordhoff M, Chen YR, Chen KT, Hong KF, Lo LJ. The surgical technique for the complete unilateral cleft lip nasal deformity. Oper Tech Plast Reconstr Surg. 1995; 2(3): 167–174 doi: 10.1016/S1071-0949(95)80006-9
Byrd HS, Salomon J. Primary correction of the unilateral cleft nasal deformity. Plast Reconstr Surg 2000; 106(6): 1276–1286 doi: 10.1097/00006534-200011000-00007 pmid:11083556
23
Noordhoff MS. Reconstruction of vermilion in unilateral and bilateral cleft lips. Plast Reconstr Surg 1984; 73(1): 52–60 doi: 10.1097/00006534-198401000-00011 pmid:6691075
24
McComb H. Primary correction of unilateral cleft lip nasal deformity: a 10-year review. Plast Reconstr Surg 1985; 75(6): 791–797 doi: 10.1097/00006534-198506000-00003 pmid:4001197
25
Tennison CW. The repair of the unilateral cleft lip by the stencil method. Plast Reconstr Surg (1946) 1952; 9(2): 115–120 doi: 10.1097/00006534-195202000-00005 pmid:14920211
26
Randall P. A triangular flap operation for the primary repair of unilateral clefts of the lip. Plast Reconstr Surg Transplant Bull 1959; 23(4): 331–347 doi: 10.1097/00006534-195904000-00003 pmid:13645250
27
Brauer RO, Wolf LE. Design for unilateral cleft lip repair to prevent a long lip. Plast Reconstr Surg 1978; 61(2): 190–197 doi: 10.1097/00006534-197802000-00006 pmid:622409
