The 3 operations as described in the book cleft lip surgery, a practical guide you can see on video. On the other hand, our method also presents an excellent approximation of both the deep and. Triangular flapthe triangular flap repair was initially described in 1952 by tennison, in 1959, randall described a mathematical approach to the triangular flap that was on the basis of precise measurements. Tissue engineering strategies combining molecular targets. Cleft deformities in adults and children aged over six years. Cleft care requires a collaborative multidisciplinary team. The method is a modification of that of millard and involves a small triangular flap on the end of the vermilion ridge. Tennisonrandalls triangular technique is the most widely used triangular technique due to its geometrical predictability and reliability and its consistency. It is also possibly more reliable for those performing and teaching a small number of cases. Shi b 2001 the study of operative design in unilateral cleft lip repair between individual procedural method as compaired to rotation advancement and triangular flap method. The technique has been adopted by surgeons in north america and has greatly expanded. There was no primary surgery performed to the nose.
Triangular with ala nasi tan repair of unilateral cleft. The inclusion criteria were a non syndromic patients. The operation is based on a redirection of ventricular outflows using an intracardiac baffle that tunnels the left ventricle to the aorta and an external valved conduit that connects the right ventricle and the pulmonary. A comparative study of immediate wound healing complications. Hopper cleft lip and palate are the most common congenital craniofacial anomalies. Cleft lip operation tennison randall vs millard free download as pdf file. Pdf comparison between millards rotational advancement.
Charles tennison disclosed a method with triangular flaps and zplasty. Preoperatively, age, sex, weight, height, and type of cleft were. This repair technique is conceptually similar to the rotation advancement repair. Unfortunately, adoption of this one size fits all approach can limit the arsenal of the surgeon facing the vast array of differing cleft lip deformities. The marcks zplasty modification of the tennison triangular flap cleft lip repair results in excellent preservation of the cupids bow. For some surgeons it seems simpler and easier to teach. A triangular flap is made on the lateral side of the cleft, where the vermilion height is the greatest, just before the. A number of surgical procedures for the repair of a unilateral cleft lip are well described, with a multitude of variations, including the lemesurier quadrilateral flap repair, randalltennison triangular flap repair, millard rotationadvancement repair, 14, 15 and skoog and kernahanbauer upper and lower lip zplasty repairs. The popularity of the triangular flap technique tennisonrandall dimin ished in the 1970 to 1980s with the gaining popularity of the millard proce dure. The tennisonrandal triangular technique, a popular cleft lip repair technique, was favored on one occasion because the defect was located in the upper lip. Cleft deformities in adults and children aged over six. Trauner has called his method a combination of the tennison and millard operations, although in actuality it is more of a combination of the.
Comparison between millards rotational advancement flap. A triangular flap operation for the primary repair of unilateral clefts of the lip. Pattern of presentation and management of lip injuries in a. Hagerty 1958, randall 1959, and cronin 1966 have added modifications to the triangular flap insert. Cleft lip operation tennisonrandall vs millard lip.
Measurements and markings nadir of cupids bow peak of cupids bow measurements and markings this point is chosen to create a. Some compromise among the criteria is required, especially for atypical cases, such as those with a long vertical height on the noncleft side and a short lateral lip element. Epidemiology differentiates between cleft lip with or with out cleft palate and isolated cleft palate, the most common form of which is thepalate and isolated cleft palate, the most common form of which is the cleft lip with cleft palate. A triangular flap is made on the lateral side of the cleft, where the. Variation trends of the postoperative outcomes for unilateral. Modified operation for wide unilateral cleft lips jama. Randall,2 in 1959, presented a mathematical interpretation of the tennison repair. The american cleft palatecraniofacial association has established standards for treating centers that. In addition, some operations specifically designed for congenital clefts require more complicated techniques. Rotation flap advancement flap lateral mobilization primary nasal correction primary alar cartilage dissection primary septal repositioning columella closure of the anterior hard palate at the time of cleft lip repair closure of lip postoperative care. Cleft lip operation tennisonrandall vs millard lip surgery. Randalltennisonsawhney triangular flap technique of unilateral cleft lip repair.
Comparison between millards rotational advancement flap and tennison randall flap techniques for surgical correction of unilateral cleft lip. Comparison between millards rotational advancement flap and tennisonrandall flap techniques for surgical correction of unilateral cleft lip. The tan repair lengthens the vertical lip using a triangular flap, resulting in a nonlinear, zigzag scar on the philtral ridge and forming a symmetrical cupids bow, superiorities of the tennisonrandall repair. After suturing was complete, the skin wound was dressed with sofratulle gauze, over which dry gauze was placed, and plaster was ap. Until now, the two commonly used techniques for ucl repair have been millards rotationadvancement and tennisonrandalls triangular flap repairs.
Standardized steps or criteria for designing a triangular flap do not always fit for all types of cleft lip repair. The most widely accepted technique is that described by millard 10 in the 1950s. Subsequently, randall used the same design as tennison but, reduced size of triangular flap 4. The technique involves reconstituting lip height, realignment of the orbicularis muscle, recreating the cupids bow of the lip by aligning the white roll, creating a vermillion tubercle, releasing and realigning the nostril while maintaining. In the paint program nostril height, width, area and columellar lenght was assessed by comparing with noncleft side using kruskalwallis test. The tan repair lengthens the vertical lip using a triangular flap, resulting in a nonlinear, zigzag scar on the philtral ridge and forming a symmetrical cupids bow, superiorities of the tennison randall repair. Triangular flap repair of the congenital earlobe cleft. In 1958 skoog described a repair employing two smaller triangles and gave credit in principle to trauner and gillies although actually the small turnin flap at the floor of the nostril was present in the collis operation of 1868.
Variation trends of the postoperative outcomes for. Materials and methods this was a prospective, randomized, controlled study of the treatment outcomes of surgical repair of unilateral cleft lip using either the tennisonrandall or millard techniques. Feb 17, 2019 the rastelli procedure is a surgical procedure to correct certain combinations of cardiovascular defects in patients with cyanotic congenital heart disease. Comparison between millards rotational advancement flap and. Although gillies and millards principles of surgery can serve as a framework for reconstruction, 1 overall care has broadened to a multidisciplinary team approach with a focus on the patient and family. Gi disorders upper mouth, esophagus, teeth lower stomach l. Cleft lip surgery a practical guide the cleft surgery organisation. Operative techniques buzzo reported his experience with the labiaplasty.
These techniques have been repeatedly used and have withstood the test of time. Both these techniques resulted in scars impinging on the lower. He is best known for his many contributions to cleft surgery, including his popularization of the lip adhesion technique for wide clefts before definitive lip repair 1965, and for his mathematical analysis of the tennison triangular lip repair, published in 1959, for which he earned top billing in the randalltennison triangular lip repair. The popularity of the triangular flap technique tennison randall dimin. A number of surgical procedures for the repair of a unilateral cleft lip are well described, with a multitude of variations, including the lemesurier quadrilateral flap repair, randall tennison triangular flap repair, millard rotationadvancement repair, 14, 15 and skoog and kernahanbauer upper and lower lip zplasty repairs. The tennisonrandall technique involves a backcut that extends from the cleft. Tennison randall s triangular technique is the most widely used triangular technique due to its geometrical predictability and reliability and its consistency. Unilateral cleft lips were repaired using either millard rotation advancement technique in 29 31. The older methods aimed at closure of the defect in primitive fashion, with insufficient regard for the cosmetic result.
In a 2008 survey, 46% of north american surgeons used a rotationadvancement technique or common hybrid, while triangle flap repairs were the second most common 9%. Primary or secondary lip surgery for bilateral cleft lip defects was achieved using fork flap technique figure 5. This approach provides continuity of the vermilion ridge, and promotes a natural appearance of the upper part of the philtrum on the cleft side. Technical strategies triangular with ala nasi tan repair of. The popularity of the triangular flap technique tennisonrandall diminished in the 1970 to 1980s with the gaining popularity of the. Approximately one in children is born with a cleft palate, cleft lip, or with both anomalies. Results were evaluated statistically by anova using asher mcdade. This surgical technique is applicable for all complete or incomplete unilateral cleft lips. The two main techniques in unilateral cleft lip surgery are the triangular flap technique tennison. Numerous procedures have been described for repair of congenital clefts of the lip. However, a number of surgeons prefer a triangular technique, since it seems simpler to lay out and perform and is less of a cut as you go free hand performance. Surgical techniques for treatment of unilateral cleft lip intechopen. Palatal fistula repair was the most common secondary cleft repair table 3.
This is done by using the triangular flap repair developed by tennison and randall. Successful treatment requires technical skill, knowledge of the abnormal anatomy, and appreciation of threedimensional facial aesthetics. Tennison, randall and skoog should be highlighted as icons in the evolution of the treatment of. Tennison triangular flap randall modification the triangular flap is but one of several methods of creating a flap in an otherwise straight line closure of the lip closure may be high or low and various surgeons promote their specific choice of location. Randall and the rotation advancement technique millard, which have similar outcomes. Both techniques recognize the importance of repositioning the lip muscle orbicularis oris in a correct anatomic orientation that results in an aesthetic as well as a functional improvement. For example, the modified triangular flap, or tennisonrandall repair, can be of value when presented with the wider unilateral cleft lip. Surgical management of cleft lip involves changing techniques and evolving principles. Tennison the method of triangular repair most often described is p. The noordhoff technique utilizes a lateral lip triangular flap to reconstruct the dry.
After suturing was complete, the skin wound was dressed with sofratulle gauze, over which dry gauze was placed, and plaster was applied over the dry gauze. West china technique of unilateral cleft lip repair. Nasolabial symmetry following tennisonrandall lip repair. Pdf comparison between millards rotational advancement flap.
Celah bibir dapat terjadi hanya pada satu sisi kanan atau kiri bibir unilateral, namun. Cleft lip operation tennisonrandall vs millard free download as pdf file. The tennison randal triangular technique, a popular cleft lip repair technique, was favored on one occasion because the defect was located in the upper lip. Surgical techniques for treatment of unilateral cleft lip. Pattern of presentation and management of lip injuries in. A schematic representation of the incisions for a tennison. The techniques described for the repair of acquired clefts are not always appropriate for congenital clefts. He intended to obtain symmetrical vertical height of the cupids bow by designing triangles with equal limbs.
Randall p 1959 a triangular flap operation for the primary repair of unilateral clefts of the lip. The technique involves reconstituting lip height, realignment of the orbicularis muscle, recreating the cupids bow of the lip by aligning the white roll, creating a vermillion tubercle, releasing and realigning the nostril while maintaining an adequate labial sulcus. Cleft management pedo free download as powerpoint presentation. Many papers have described surgery for congenital and acquired clefts. Unilateral cleft lip repair was achieved using millards rotation advancement technique or tennisonrandall triangular technique figure 4. Surgical outcome and complications following cleft lip and. Scribd is the worlds largest social reading and publishing site. Tennison cw 1952 the repair of the unilateral cleft lip by the stencil method. Tennison randall procedure and the millard procedure. Primary closure of the lip was according to tennisonrandall and an early hard palate closure with a singlelayer vomer flap at a mean age of 4. The flaps are quadrangular in lemesurier, may and trauner techniques, triangular in tennison, randall, lemos and spina, and of rotation and advancement in millards.
He is best known for his many contributions to cleft surgery, including his popularization of the lip adhesion technique for wide clefts before definitive lip repair 1965, and for his mathematical analysis of the tennison triangular lip repair, published in 1959, for which he earned top billing in the randall tennison triangular lip repair. Tennison1 was the first author to introduce the triangular flap for correction of the unilateral cleft lip in 1952. Karapandzic flap was used in one of the electrical burn patient due to the involvement of the oral commissure. The techniques that utilize the principle excision in arched lines are the rosethompson, ladd, braun and veau. Cleft management pedo orthodontics dentistry branches. The maximum width of the cleft lips documented in the files ranged from 4 to 10 mm. Triangular flap technique group t figure 1 millards rotational advancement flap technique group m figure 2 and was performed for 30 patients each. Randall, p a triangular flap operation for the primary repair of unilateral clefts of the lip. Patients treated using tennisonrandall flap triangular flap technique 30 patients. Open rhinoplasty for correction of the secondary nasal. Open rhinoplasty for correction of the secondary nasal deformity due to the marcks triangular flap cleft lip repair. Jun 15, 2018 a number of surgical procedures for the repair of a unilateral cleft lip are well described, with a multitude of variations, including the lemesurier quadrilateral flap repair, randall tennison triangular flap repair, millard rotationadvancement repair, 14, 15 and skoog and kernahanbauer upper and lower lip zplasty repairs. Unilateral cleft lip thieme medical publishers, india.
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