Han, Kihwan
(Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
,
Park, Jeongseob
(Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
,
Lee, Seongwon
(Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
,
Jeong, Woonhyeok
(Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed sur...
Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.
Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.
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문제 정의
The authors of the current study have used a modified Millard rotation-advancement technique based on many years of experience. This article introduces a unique complete unilateral cleft lip repair method developed by the senior author (K.H.).
제안 방법
All patients recovered eventually after surgery; however, two patients have a minor complications; (wound infection in one patient, wound disruption due to trauma in the other patient). The means of the scores was computed for nasal form, nasal deviation, nasal profile and the vermilion border. The means of the total of the four components were also computed.
대상 데이터
Eighty-two patients included in the study. Besides the frontal view photographs, profile photographs of each patients were assessed, resulting in 164 photographs to be assessed.
이론/모형
There is a limitation in our study. Although a statistical comparison with the standard method is required, the author did not perform the standard Millard method.
08, fair to good appearance. Favorable aesthetic results were obtained using this modified Millard technique (Fig. 8). The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement.
The Cohen’s kappa statistics was used to measure the degree of agreement between judges (interobserver scores) as well as to determine the intraobserver scores.
The method of assessment we used in this study was a AsherMcDade aesthetic index; one of the most commonly used methods used to measure the aesthetic results of surgical cleft lip and nose repair [5]. When using this scoring system, favorable aesthetic results can be achieved with this modified Millard technique.
성능/효과
The reliability has been expressed in the form of kappa values. In this study, the assessment scale showed substantial to almost perfect intraobserver agreement and moderate to almost perfect interobserver agreement. There is a limitation in our study.
683). The highest intraobserver reliability score was found in the assessment of the nasal form; almost perfect agreement (mean, 0.848; range, 0.815 to 0.881). The lowest intraobserver reliability score was found in the assessment of deviation of nose; substantial to almost perfect agreement (mean, 0.
938). The lowest interobserver reliability score was found in the assessment of the deviation of nose; moderate to substantial agreement (mean, 0.634; range, 0.562 to 0.683). The highest intraobserver reliability score was found in the assessment of the nasal form; almost perfect agreement (mean, 0.
881). The lowest intraobserver reliability score was found in the assessment of deviation of nose; substantial to almost perfect agreement (mean, 0.738; range, 0.637 to 0.839).
참고문헌 (13)
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3 Asher-McDade C Brattstrom V Dahl E McWilliam J Molsted K Plint DA A six-center international study of treatment outcome in patients with clefts of the lip and palate. Part 4: assessment of nasolabial appearance Cleft Palate Craniofac J 1992 29 409 12 1472518
5 Mosmuller DG Bijnen CL Kramer GJ Disse MA Prahl C Kuik DJ The Asher-McDade aesthetic index in comparison with two scoring systems in nonsyndromic complete unilateral cleft lip and palate patients J Craniofac Surg 2015 26 1242 5 26080166
9 Janiszewska-Olszowska J Gawrych E Wedrychowska-Szulc B Stepien P Konury J Wilk G Effect of primary correction of nasal septal deformity in complete unilateral cleft lip and palate on the craniofacial morphology J Craniomaxillofac Surg 2013 41 468 72 23273648
10 Anderl H Hussl H Ninkovic M Primary simultaneous lip and nose repair in the unilateral cleft lip and palate Plast Reconstr Surg 2008 121 959 70 18317145
11 Chang CS Por YC Liou EJ Chang CJ Chen PK Noordhoff MS Long-term comparison of four techniques for obtaining nasal symmetry in unilateral complete cleft lip patients: a single surgeon’s experience Plast Reconstr Surg 2010 126 1276 84 20885247
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