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Unilateral Cle+ Lip Repair Anatomic Subunit Approach Vivek Panchapakesan BSc MD FRCSC DABPS Toronto, Canada Tuesday, 22 November, 11

Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

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Page 1: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Unilateral  Cle+  Lip  RepairAnatomic  Subunit  Approach

Vivek  Panchapakesan  BSc  MD  FRCSC  DABPSToronto,  Canada

Tuesday, 22 November, 11

Page 2: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Goals  of  Unilateral  Cle+  Lip  Repair

• Symmetric  Lip  Length

• Level  Cupid’s  Bow

• Adequate  Vermilion  Thickness

• Inconspicuous  Scar

• Restore  Muscle  ConKnuity

• Address  Nasal  Deformity

Tuesday, 22 November, 11

Page 3: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Historical  Background

Tuesday, 22 November, 11

Page 4: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

ROSE-­‐THOMPSON  EFFECT

W.  ROSE  

On  Harelip  and  Cle-  Palate.  London:  HK  Lewis,  1891

J.E.  THOMPSON

An  arKsKc  and  mathemaKcally  accurate  method  of  repairing  the  defect  in  cases  

of  harelip.Surg  Gynaecol  Obstet  14:  498,  1912

Picture  from  Patel  P.K,  Unilateral  Cle-  Lip  Repair  Treatment  &  Managementh[p://emedicine.medscape.com/arKcle/1279641-­‐treatment#a1133

Tuesday, 22 November, 11

Page 5: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

THE  REPAIR  OF  THE  UNILATERAL  CLEFT  LIP  BY  THE  STENCIL  METHOD

C.  TENNISON

San  Antonio,  Texas

Plast  Reconstr  Surg  9:  115,  1952

Tuesday, 22 November, 11

Page 6: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

A  TRIANGULAR  FLAP  OPERATION  FOR  THE  PRIMARY  REPAIR  OF  UNILATERAL  CLEFTS  

OF  THE  LIP

P.  RANDALL

Philadelphia,  Pennsylvania

Plast  Reconstr  Surg  23:  331,  1959

Tuesday, 22 November, 11

Page 7: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

COMPLETE  UNILATERAL  CLEFTS  OF  THE  LIP

D.  RALPH  MILLARD

Miami,  Florida

Plast.  Reconstr.  Surg.  25:  595,  1960

The  Primary  Camouflage  of  the  Unilateral  Hare-­‐  look.  TransacGons  of  the  InternaGonal  Society  of  PlasGc  Surgeons,  First  Congress,  Stockholm  

(1955);  1957.  pp.  160e166

Tuesday, 22 November, 11

Page 8: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

ROTATION-­‐ADVANCEMENT  MODIFICATIONS

Millard  DR,  Refinements  in  rotaKon-­‐advancement  cle+  lip  technique.  Plast  

Reconstr  Surg  33:26,  1964

Millard  DR,  Extensions  of  the  rotaKon-­‐advancement  principle  for  wide  

unilateral  cle+  lips.  Plast.  Reconstr.  Surg  42:  535,  1968

Tuesday, 22 November, 11

Page 9: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

ROTATION-­‐ADVANCEMENT  MODIFICATIONS

Millard  DR,  Refinements  in  rotaKon-­‐advancement  cle+  lip  technique.  Plast  

Reconstr  Surg  33:26,  1964

Millard  DR,  Extensions  of  the  rotaKon-­‐advancement  principle  for  wide  

unilateral  cle+  lips.  Plast.  Reconstr.  Surg  42:  535,  1968

Tuesday, 22 November, 11

Page 10: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

L.R.  MOHLER

Columbus,  Ohio

Plast  Reconstr  Surg,  Vol  80(4):  1960,

Tuesday, 22 November, 11

Page 11: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 12: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

“The  Red  Line”

Tuesday, 22 November, 11

Page 13: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

“The  Red  Line”

Tuesday, 22 November, 11

Page 14: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

“Noordhoff’s  Point”

“The  Red  Line”

Tuesday, 22 November, 11

Page 15: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

“Noordhoff’s  Point”

“The  Red  Line”

Tuesday, 22 November, 11

Page 16: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

“Noordhoff’s  Point”

“The  Red  Line”

Tuesday, 22 November, 11

Page 17: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 18: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 19: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 20: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 21: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 22: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 23: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 24: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 25: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

M.S.  NOORDHOFF

Taipei,  Taiwan

The  Surgical  Technique  for  the  Unilateral  Cle-  Lip-­‐Nasal  Deformity  OperaGve  

Syllabus©  1997  Noordhoff  Craniofacial  

FoundaKon

Tuesday, 22 November, 11

Page 26: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

QUADRILATERAL  MIRAULT  FLAP  OPERATION

A.B.  LE  MESURIER

Toronto,  Ontario

Plast  Reconstr  Surg  16:425,  1955  

Tuesday, 22 November, 11

Page 27: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

Tuesday, 22 November, 11

Page 28: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

Tuesday, 22 November, 11

Page 29: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

Tuesday, 22 November, 11

Page 30: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

Tuesday, 22 November, 11

Page 31: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a

Tuesday, 22 November, 11

Page 32: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a b

Tuesday, 22 November, 11

Page 33: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a b

c

Tuesday, 22 November, 11

Page 34: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a b

c

a  ≥  b  +  c

Tuesday, 22 November, 11

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UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a b

c

a  ≥  b  +  c

Tuesday, 22 November, 11

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UNILATERAL  CLEFT  LIP  REPAIR

H.G.  THOMSON

Toronto,  Canada

Oper  Tech  Plas.  Reconstr.  Surg  2:  175,  1995.

a b

c

a  ≥  b  +  c

Tuesday, 22 November, 11

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THE  SUBUNIT  PRINCIPLE  IN  NASAL  RECONSTRUCTION

G.C.  BURGET,  F.J.  MENICK

Chicago,  Illinois  &  Tuscon,  Arizona

Plast  Reconstr  Surg  76:  239,  1985

Tuesday, 22 November, 11

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Ideal  Line  of  Repair

• Ascends  from  cle+  side  of  cupid’s  bow

• Mirrors  the  non-­‐cle+-­‐side  philtral  column

• Reaches  base  of  the  nose

• ConKnues  superolaterally

• Borders  lip-­‐columellar  crease,  ascending  to  the  nostril  sill

Tuesday, 22 November, 11

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Ideal  Line  of  Repair

• Ascends  from  cle+  side  of  cupid’s  bow

• Mirrors  the  non-­‐cle+-­‐side  philtral  column

• Reaches  base  of  the  nose

• ConKnues  superolaterally

• Borders  lip-­‐columellar  crease,  ascending  to  the  nostril  sill

Tuesday, 22 November, 11

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UNILATERAL  CLEFT  LIP  REPAIR:  AN  ANATOMICAL  SUBUNIT  

APPROXIMATION  TECHNIQUE

DAVID  M.  FISHER

Toronto,  Canada

Plast  Reconstr  Surg  116:  61,  2005

Tuesday, 22 November, 11

Page 41: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

UNILATERAL  CLEFT  LIP  REPAIR:  AN  ANATOMICAL  SUBUNIT  

APPROXIMATION  TECHNIQUE

DAVID  M.  FISHER

Toronto,  Canada

Plast  Reconstr  Surg  116:  61,  2005a  –  b  –  1mm  =  c

Tuesday, 22 November, 11

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Markings

Tuesday, 22 November, 11

Page 43: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

Page 44: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

Page 45: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

Page 46: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

Page 47: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

Page 48: Unilateral Cleft Lip Repair Anatomic Subunit Approach Lip... · Unilateral)Cle+)Lip)Repair Anatomic)SubunitApproach Vivek)Panchapakesan)BSc)MD)FRCSC)DABPS Toronto,)Canada Tuesday,

Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Lesser  Lip  Height  (Base  width  of  inferior  triangle)

=  Total  Lip  Height  –  Greater  Lip  Height  –  1mm

Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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ModificaKons

Fisher  D.M.,  Plast  Reconstr  Surg  2005;  116(1):  61-­‐71.

Tuesday, 22 November, 11

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ModificaKons

Fisher  D.M.,  Plast  Reconstr  Surg  2005;  116(1):  61-­‐71.

Base  width  of  Inferior  Triangle:μ  =  1.24mm  (0  –  2mm)

Tuesday, 22 November, 11

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Protocol  (Sickkids)

• Presurgical  NAM• Lip  Repair/  Rhinoplasty• Palatoplasty  ±  M&T• ±  Lip  Revision• ±  VPI  CorrecKon• ±  Lobule  Rhinoplasty• Alveolar  Bone  Gra+• ±  Septorhinoplasty• ±Orthognathic  Surgery

• 2  weeks  –  Lip  Repair• 3  –  5  months• 11  –  14  months• >  3  years  prn• >  4  years  prn• >  6  years  prn• 8  –  12  years• >  12  years  prn• Skeletal  Maturity  prn

Tuesday, 22 November, 11

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Primary  Rhinoplasty

• ConservaKve…Goal  =  Improvement– CentralizaKon  of  columellar  base– Symmetrical  alar  base  reposiKoning– Nostril  margins  of  equal  circumference– Release  LLC-­‐ACC  from  piriform– Anteromedial  advancement  of  cle+-­‐side  lateral  crus

– CreaKon  of  ULC-­‐LLC  overlap– No  dissecKon  of  dome

Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Tuesday, 22 November, 11

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Conclusions

• Reliable– Based  on  previously  described  repairs  and  principles

• Rose-­‐Thomson  lengthening  allows  for  a  smaller  triangle

• Triangle  posiKoned  according  to  Noordhoff’s  descripKon

• Repair  along  lines  of  anatomical  subunits• ConservaKve  approach  to  the  nose

Tuesday, 22 November, 11