• Archives of Plastic Surgery
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• v.35 no.2
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• pp.197-200
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• 2008

Purpose: A congenital lacrimal sac fistula is unusual and consists of a dimple opening below the medial canthal tendon that leads to the lacrimal sac. This anlage ducts occur when the lacrimal anlage cells proliferate and canalize rather than involute. And, the anomaly is usually not associated with any systemic abnormalities. Also congenital cleft of the earlobes is rarely seen among congenital ear anomalies. Therefore, we report rare case with symptomatic bilateral lacrimal fistula with the ear cleft. Methods: A 4-year-old boy was admitted with aggravated chronic maxillary sinusitis, recurrent chronic dacryocystitis, and epiphora. He had two minor anomalies including bilateral lacrimal fistula originated in lacrimal tear sac and unilateral transverse ear cleft. The patient had been operated with fistulectomy and perioperative antibiotics. A small vertical ellipse is made around the opening with sharp dissection. The tract is excised using the probe as the guide. Another probe is placed through the lower canaliculus to prevent the damage. A suture ligature of 6-0 Maxon is placed around the deepest point of the tract, which is then excised. Additional sutures are placed in the tissues to form a tight closure to prevent reestablishment of the fistula. The skin is closed with 6-0 Black Silk. Results: The patient recovered well without any complications such as infection, epiphora, and obstruction of lacrimal sac. Conclusion: Our case illustrates bilateral lacrimal anlage ducts in a patient with unilateral congenital ear cleft. We recommend careful evaluation of lacrimal system in these patients, especially bilateral case and other congenital anomalies. Finally, we recommend excision of the ducts when epiphora, infection, or chronic skin irritation occur.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.295-309
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• 2006

The present study was aimed to evaluate the incidence, etiological factors, and management of cleft lip and palate. Two hundred and twenty patients with cleft lip and/or cleft palate who were treated at Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital, during the period between January 1994 and December 2003 were reviewed. The ratios of cleft lip : cleft lip with cleft palate : and cleft palate were 0.4:1.1:1. Males were more common than females in cleft lip (1.3:1) and cleft lip and palate (2.5:1), while females were more common than males in cleft palate (1:1.3). In the cleft side, left clefts were more prevalent than right clefts (cleft lip 1.3:1, cleft lip and palate 1.6:1). Unilateral clefts were more common than bilateral clefts in cleft lip (79:21). Cleft lip and cleft palate were more common in those with blood type A (34.5%) than those with other types. There was no significant relationship between birth season and frequency of clefts. The clefts were common in the first-born (48.8%), and in mothers aged between 25 and 29 (51.7%). Medication (24.7%) and stress (16.7%) during the first trimester were noted. Positive familial history was noted in 13 cases (5.9%). Thirty-two cases (15%) were associated with other congenital anomalies, in which tonguetie (40.6%) and congenital heart disease (21.9%) were most common. Among 100 patients with cleft palate, 77 patients had middle ear disease (77%), which occurred predominently in the incomplete cleft palate. Seventy-six among the 77 patients received myringotomy and ventilation tube insertion, and the remaining one received antibiotic medication only. Cleft lips were treated primarily at 3 to 6 months, and cleft palates were at 1 to 2 years. Treatment regimens included modified Millard method mainly in the cleft lip, and Wardill V-Y, Dorrance method, and Furlow method in the cleft palate. The percentage of palatal lengthening as type of cleft palate was greater in the incomplete cleft palate group (11.2%) than in the complete cleft palate group (9.6%). The percentage of palatal lengthening as operating method was no difference between the Furlow method (10.9%) and the push back method (10.7%). As postoperative complications, hypertrophic scar was most frequent in the cleft lip, and oronasal fistula in the cleft palate. In summary, it was shown that medication and stress during the first trimester of pregnancy were frequently associated with cleft lip and cleft palate, adequate timing and selection of method of operation are important factors to obtain morphologically and functionally good results. Furthermore prevention and treatment of middle ear disease are important in cleft palate patients because of its high co-occurrence.

• Korean Journal of Cleft Lip And Palate
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• v.10 no.2
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• pp.89-96
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• 2007

Otitis media with effusion is known to be very common among children with cleft palate and is the common cause of acquired hearing loss in childhood. The purpose of the present study was to examine the anatomic variances, incidence and treatment of middle ear disease in children with cleft palate. In Korea, before 4-year-old age, the prevalence of otitis media was as high as 91.7%. Common treatments for otitis media were conservative or surgical treatment. The medical treatment options include the use of decongestants, antihistamines, antibiotics and mucolytics. Surgical treatment options include grommet insertion, myringotomy. Unlike the case for children without clefts, cleft patient has a higher incidence of recurrence, so surgical treatment between the age of 3 month and 6 month was recommended. The effect of palatoplasty on middle ear disease has remained controversial. Early and periodic evaluation on the symptomatic infection or significant of hearing loss was recommended.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.600-603
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• 2010

Oblique facial cleft is extremely rare. The frequency was reported 1/1300 cases of facial cleft. The cleft appears to be bilateral in approximately 20% and more often on the right when unilateral. Oblique facial cleft is nearly always associated with cleft lip and palate. Thus, the case that is unilateral on the left and not associated with cleft lip or palate is very rare. We experienced a case of 2 years 6 months old Philippine girl who had oblique facial cleft that is not associated with cleft lip or palate. The probable cause and treatment is discussed with a review of literatures.

• BMB Reports
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• v.32 no.1
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• pp.25-27
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• 1999

Otitis media with effusion (OME) is an inflammatory disease of the middle ear cleft. Oxygen free radicals have been implicated in a variety of inflammatory disorders. Oxygen free radicals may also be involved in the pathogenesis of OME. To evaluate the involvement of oxygen free radicals in the pathogenesis of OME, the level of malondialdehyde, which gives an index of lipid peroxidation by oxygen free radicals, was measured by the reaction with thiobarbituric acid. Malondialdehyde level in the middle ear fluid from the OME group was higher than that in the normal control group. Malondialdehyde level in the middle ear fluid from a mucoid subgroup was higher than that in the serous subgroup. Malondialdehyde levels in the middle ear fluid from the serous subgroup was significantly correlated with symptom duration. The Pearson correlation coefficient between malondialdehyde levels in the middle ear fluid from the serous subgroup and symptom duration was 0.842 (P<0.05). These results indicate that lipid peroxidation by oxygen free radicals may be involved in the pathogenesis of human OME.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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• pp.422-428
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• 2007

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.277-281
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• 2017

Traumatic cleft earlobes are a common problem encountered by plastic and reconstructive surgeons. Various techniques have been reported for the repair of traumatic cleft earlobes. Usually, the techniques of split earlobe repair are divided into two categories, namely straight- and broken-line repairs. Straight-line repair is simple and easy, but scar contracture frequently results in notching of the inferior border of the lobule. It can be avoided by the broken-line repair such as Z-plasty, L-plasty, or a V-shaped flap. Between April 2016 and February 2017, six patients who presented with traumatic cleft earlobe underwent surgical correction using a combination of the inverted V-shaped excision technique and vertical mattress suture method. All the patients were female and had a unilateral complete cleft earlobe. No postoperative notching of the inferior border the lobule occurred during 6-16 months of follow-up. Without the use of a broken-line repair, both the patients and the operators attained aesthetically satisfactory results. Therefore, the combination of the inverted V-shaped excision technique and vertical mattress suture method is considered useful in the treatment of traumatic cleft earlobes.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.190-191
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• 2022

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.187-189
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• 2022

Patients with pixie ear have an attached, tapering, and low-set earlobe. Traditional methods usually describe excision of the caudal portion of the lobule and reattachment in a more superior position. The present report suggests a simplified skin redraping method for correction of pixie ear. The procedure provides easy method to design and perform, which only requires elevation and trimming of the skin. Other ancillary procedures, such as flap design, anchoring, plication, and subdermal fixation, are not required. This method produces satisfactory results. Postoperative scar is invisible because the incision is on the retroauricular region, and the corrected earlobe has a more natural appearance than the repositioned earlobe. Moreover, skin redraping avoids tension, which contributes to minimization of the postoperative scar.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.5
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• pp.270-277
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• 2023

Objectives: Concha cartilage is recommended for correction of cleft nasal deformities. Morbidities at the donor site have been reported in esthetic rhinoplasty cases. Reports on cleft patients are limited, so we investigated the complications of concha cartilage harvesting using the retroauricular approach in cleft rhinoplasty and their management. Materials and Methods: This was a retrospective review of the charts of 63 patients with cleft deformities who underwent septorhinoplasty with concha cartilage. All cases were harvested using a retroauricular approach. Data on patient demographics, surgery type, amount of cartilage harvested, and complications were gathered. Results: Sixty-three patients were enrolled (21 males and 42 females). The mean age of patients was 20.2±5.9 years. Complications were observed in 6 cases (9.5%) and included delayed wound healing (4.8%), prolonged postoperative pain (1.6%), postoperative paresthesia (1.6%), and prominauris (1.6%). Conclusion: The rate of complications associated with concha cartilage harvesting using a retroauricular approach is low. The use of meticulous surgical techniques, especially hemostasis control and adequate wound dressing, is key to minimizing postoperative complications.