Takako Okawachi

Three-dimensional analyses of facial soft tissue configuration of Japanese females with jaw deformity--a trial of polygonal view of facial soft tissue deformity in orthognathic patients.

In this study, we evaluated the three-dimensional (3D) soft tissue configuration of Japanese females with/without jaw deformity in order to establish the polygonal view of facial soft tissue deformity three-dimensionally. A polygonal chart was applied to assess the outcomes of orthognathic surgery for patients with mandibular hyperplasia with/without deviation. The study included 20 Japanese females with mandibular hyperplasia with/without deviation. All patients received mandibular setback surgery, and 3D measurements were carried out pre-operation, and at 1, 3 and 6 months postoperatively using a non-contact laser scanning system. Eighteen soft tissue landmarks were set on each 3D image and used to calculate a set of selected parameters. As controls, 20 Japanese females with class I occlusion were included. A polygonal chart was constructed based on the mean and S.D. of the control group. Patients with mandibular protrusion characteristically demonstrated significant variances in the items around the lower face. In asymmetric patients, deviation in the mental area disappeared postoperatively, but a small deviation remained when compared to the controls. The method used in this study seems to be a useful index for diagnosis and as a treatment plan for patients with mandibular hyperplasia with/without deviation.

Secondary correction of bilateral cleft lip nose deformity - Clinical and three-dimensional observations on pre- and postoperative outcome.

PURPOSE The purpose of this study was to describe the clinical and three-dimensional (3D) outcomes following secondary correction of bilateral cleft lip and nose by reverse-U incision, nasal tip cartilage graft, and medial-upward advancement of bilateral nasolabial components with vestibular expansion with a free mucosal graft. PATIENTS AND METHODS Secondary correction of the bilateral cleft lip and nose deformity was performed on 11 patients with complete bilateral cleft lip, alveolus and palate (BCLP). In four patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotating into the columella base was included to elongate the columella length. Pre- and postoperative nasal forms were recorded using photos and 3D data taken serially. RESULTS The nasal forms and lateral profiles were improved in all patients postoperatively. The pre- and postoperative 3D colour images demonstrated satisfactorily elongated columella length, symmetrically increased nasal tip projection, and enlarged alar groove. No serious complications were observed postoperatively. CONCLUSIONS Our secondary correction technique of the bilateral cleft lip and nose will provide successful results producing an adequate nasal tip projection and alar forms without damaging the upper lip tissue in patients with BCLP.

Surgical Technique for Secondary Correction of Unilateral Cleft Lip-Nose Deformity: Clinical and 3-Dimensional Observations of Preoperative and Postoperative Nasal Forms

PURPOSE Despite recent developments in cleft surgery, a surgical method for secondary correction of unilateral cleft lip-nose deformity has not yet been established. The purpose of this study was to describe the surgical techniques for secondary correction of unilateral cleft lip-nose deformity with 3-dimensional (3D) observations of preoperative and postoperative nasal forms. PATIENTS AND METHODS Secondary corrections of unilateral cleft lip-nose deformity were performed on 13 patients with a complete unilateral cleft lip and palate, and these patients were followed up for 1 year to more than 3 years. All patients were treated by open rhinoplasty through a bilateral reverse-U incision and transcolumellar incision, correction of the columella base with/without septoplasty, nasal tip cartilage graft, and medial-upward advancement of nasolabial components with vestibular expansion by free mucosal graft. Preoperative and postoperative nasal forms were observed by use of photos and 3D data obtained serially. RESULTS The postoperative nasal forms were improved in all patients. The preoperative 3D color images indicated asymmetry of the alar groove and nasal tip visually. The top of the alar groove on the cleft side was dislocated distally and downwardly, resulting in a small snub ala. The postoperative 3D color images showed symmetric nasal forms with the adequately recovered nasal tip projection and the appropriate circle of the nasal ala groove on the cleft side. There were no serious postoperative complications. CONCLUSIONS Repositioning of the nasalis muscle and sufficient expansion of the nasal vestibule as well as reconstruction of nasal cartilages are important for correction of unilateral cleft lip-nose deformity.

3-Dimensional Analyses of Outcomes Following Secondary Treatment of Unilateral Cleft Lip Nose Deformity

OBJECTIVE To analyze the 3-dimensional nasal forms after secondary treatment of unilateral cleft lip nose deformity. PATIENTS AND METHODS Thirteen Japanese adolescents with severe nose deformity associated with unilateral complete cleft lip with/without palate underwent definitive nose correction at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, and were followed for 1 to 3 years. Twenty healthy Japanese age-matched adolescents were included as controls. All patients were treated by open rhinoplasty through bilateral reverse-U incision and transcolumellar incision, correction of the columellar base with/without septoplasty, columellar strut graft, and medial-upward advancement of nasolabial components with vestibular expansion using a free mucosal graft. Pre- and postoperative nasal forms were measured using a 3-dimensional noncontact laser scanner. Angular and linear measurements, symmetry of the alar groove arch, and deviation of the nasal midline were analyzed. RESULTS Comparison of pre- with postoperative 3-dimensional nasal forms showed that postoperative nasal height was significantly increased (P < .01) but still shorter than that of controls. The significant preoperative differences in the nasal dorsal angle (P < .05) and bilateral alar groove arch (P < .01) disappeared after the operation. The deviation of the nasal midline was improved in the lower half of the nose (P < .05) postoperatively. There were no serious complications in any patients. CONCLUSIONS These surgical procedures can provide a symmetric and protruded nasal form, but there remain some differences between postoperative patients and healthy Japanese subjects.

Three-Dimensional Analyses of Nasal Forms After Secondary Treatment of Bilateral Cleft Lip–Nose Deformity in Comparison to Those of Healthy Young Adults

PURPOSE To 3-dimensionally analyze outcomes after the secondary treatment of bilateral cleft lip-nose deformity at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan. PATIENTS AND METHODS Ten Japanese male young adults with bilateral cleft lip with or without palate (BCL±P) who had undergone definitive nose correction and were followed up for 1 to 4 years were enrolled in this study. Ten unaffected race- and gender-matched young adults were used as controls. All patients underwent secondary correction of the nose by open rhinoplasty through a bilateral reverse-U incision, columellar strut graft, and medial-upward advancement of the nasolabial components with vestibular expansion by use of a free mucosal graft. In 3 patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotated into the columellar base was added for columella lengthening. Nasal forms were periodically measured by use of a 3-dimensional noncontact laser scanner. The angular and linear measurements and the curvature of the alar groove arch were compared between patients and control subjects. RESULTS Comparison of the preoperative and postoperative nasal forms showed significant improvements in the nasal dorsum and tip angles, as well as nasal height. The size of the nasal alar grooves was also increased to the same size range as the control subjects. There were persistent differences between postoperative columellar angle and nasal width in patients and those in the control subjects. CONCLUSIONS Our surgical procedures can provide an acceptably protruded nasal form for patients with BCL±P without damaging the upper lip tissue, but further improvement to prevent nasal tip overprojection may be useful.

Outcome Following Secondary Autogenous Bone Grafting Before and After Canine Eruption in Patients With Unilateral Cleft Lip and Palate

Objective To determine whether the long axis and eruption of the cleft-adjacent canine affect postoperative outcomes in secondary autogenous bone grafting (SABG). Design Retrospective longitudinal study. Setting Multidisciplinary long-term follow-up at Kagoshima University Hospital. Subjects and Methods Twenty-five patients with complete unilateral cleft lip and palate (11 male, 14 female) were compared between unerupted and erupted groups for canine developmental stage, canine angle, and vertical height at bone grafting at 1 year and more than 4 years after SABG. The interalveolar septal heights at 1 and more than 4 years were evaluated by orthopantomograms. Results All patients in both groups accomplished dental rehabilitation with orthodontic treatment alone without prosthetic appliances. Although the rate of an acceptable bone bridge tended to be lower in the unerupted group (62.5%) than in the erupted group (88.8%), the difference was not significant (P = .158). The canine angle at bone grafting was significantly different between acceptable (69.2° ± 12.2°) and poor cases (77.3° ± 6.2°) at more than 4 years in the unerupted group (P = .049). The acceptable bone bridge rate might reflect mechanical stress added by natural eruption and orthodontic force. Conclusions We suggest that SABG should be planned in accordance with the canine angle, crown and root development, the eruption position of the cleft-adjacent canine, and the timing of added mechanical stress in the alveolar cleft, considering the bone formation in the alveolar cleft.