Abstract: One Stage Repair of Binderoid Complete Cleft Lip/Palate Including Primary Aveolar Bone Grafting Followed by Secondary Nasal Repair Using Costal Cartilage and Reverse Fork Flap (Plastic Surgery 2011 (September 23-27, 2011))

Saturday, September 24, 2011: 9:50 AM

Non-Physical Computer Presentation -- Kiosks on Exhibit Floor

Katsuyuki Torikai, MD , Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan

Hiroki Naganishi, MD , Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan

Toshihiko Satake, MD , Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan

Kazuko Arimura, MD , Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Japan

Takashi Hirakawa, DDS , Hirakawa Orthodontic Office, Yokohama, Japan

Takeshi Kijima, DDS , Oral and Maxillofacial Surgery, Tokyo West Tokushukai Hospital, Akishima, Japan

Presentation PDF file

E-Poster

Background: Binderoid cleft lip/palate(CLP) was first described by Mulliken et al. in 2003 and it is characterized by nasolabiomaxillary hypoplasia and orbital hypotelorism .Children born with Binderoid CLP are very difficult to treat because of hypoplastic nasolabial elements. (1) We have been performing one satage repair of cleft lip/palate including primary alveolar bone grafting (PABG) not only to unilateral CLP but also bilateral CLP (BCLP).

Methods: The following is a brief description of one stage repair for BCLP.1. At lip repair, white lip is designed linearly and vermillion lip is repaired using lateral lip. 2.Philtumplasty is performed by original method making philtrum ridge and hollow.3. External nose repair is done by suspending alar cartilage in normal position with absorbable thread after periosteal expansion. 4. Periosteoplasty of piriform aperture rim is performed. 5. PABG　from hard palate and/or inferior nasal concha is performed with gingivoperiosteoplasty (GPP ) or gingivomucoperiosteal flap (GMPF). 6. Hard palate can be closed directly when cleft width of posterior margin is under 8 mm and when it is over 9 mm, submucoperiosteal relaxing incision is added. 7.Soft palate is closed by modified Furlow method.　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Case:　　　　　　　　　　　　　　

A female baby was referred to our hospital for the treatment of BCLP. She had marked nasolabiomaxillary hypoplasia and orbital hypotelorism (Figure 1.).Holoprosencephaly had already been ruled out before the referral and she was diagnosed as Binderoid complete CLP. After presurgical orthopedics, she underwent one stage repair of cleft lip and palate including PABG from inferior nasal concha at 6 months old. At the age of 5, we performed external nose repair using costal cartilage and reverse fork flap.

Results: Her nasolabiomaxillary hypoplasia has been improved (Figure 2).At alveolar cleft, some amount of bone formation is observed. There have been no major complications such as marked maxillary growth impairment, necrosis of premaxila, oronasal fistula, or velopharyngeal imcompetence.

Conclusions: Our one stage repair can be applied with benefit and safety to Binderoid complete BCLP patients, who are among the most difficult types of CLP to treat.　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　

Reference

1. Mulliken, J. B., Burvin, R. , Padwa,. Binderoid Complete Cleft Lip/Palate.Plast Reconstr Surg 111(3):1000-1010,2003.

19345 One Stage Repair of Binderoid Complete Cleft Lip/Palate Including Primary Aveolar Bone Grafting Followed by Secondary Nasal Repair Using Costal Cartilage and Reverse Fork Flap