A Prospective Comparative Study of ALA Repair between Modified Tajima Suture and Cinch Suture in Unilateral Cleft Lip Patients

Document Type : Original Article

Authors

The Department of Plastic Surgery, Faculty of Medicine, Ain Shams University

Abstract

Background: Despite previous concerns of growth disturbances,
primary correction of the cleft nose deformity is an
internationally accepted and approved concept. In the evolution
of cleft lip and nose deformity surgery, a move from a protocol
without primary nasal reconstruction to a second one, but the
patients had to have secondary nasal reconstruction in the
growing period due to insufficient primary repair.
Aim of the Work: The aim of this work is to assess Cinch
suture as technique for ALA repair in unilateral cleft lip < br />regarding aesthetic outcome in comparison with modified
Tajima suture.
Patients and Methods: Prospective comparative study
that was conducted on 20 children at Ain Shams University
Hospitals throughout 6 months to assess Cinch suture.
Results: From the results presented of the comparison
between Cinch group and Tajima group regarding postoperative
assessment of the studied patients, there was no
statistically significant difference found between Cinch and
Tajima regarding assessment of the studied patients except
patients with straight on the philtral border was found with
higher percentage in Cinch than Tajima with p-value=0.010.
In further comparison between Cinch and Tajima regarding
nose results among the patients, there was statistically significant
difference found between Cinch and Tajima regarding
hypoplastic flattened ALA, excessive wrapping of ALA,
Narrow sil, large sill and defect of upper rim with pvalue=
0.010, 0.001, 0.003, 0.025 and 0.010 respectively while
no statistically significant difference found between both
groups regarding septal deviation, insufficient wrapping of
ALA, columellar base too wide, low position and high position.
In addition, the relation between Mortier score post-operative
and the other studied parameters in Tajima, there was no
statistically significant relation found between Mortier score
post-operative and the other studied parameters in Cinch
except only relation with patients with straight on the philtral
border with p-value =0.006. Finally, in relation between
Mortier score post-operative and the other studied parameters
in Cinch, there was no statistically significant relation found
between Mortier score post-operative and the other studied
parameters in Cinch except only relation with patients with
low position with p-value=0.003.

Keywords

Main Subjects

References

1- Parker S.E., Mai C.T., Canfield M.A., Rickard R., Wang
Y., Meyer R.E. and National Birth Defects Prevention
Network: Updated national birth prevalence estimates for
selected birth defects in the United States, 2004-2006.
Birth Defects Research Part A: Clinical and Molecular
Teratology, 88 (12): 1008-1016, 2010.
2- James W.H.: Are oral clefts a consequence of maternal
hormone imbalance? Evidence from the sex ratios of sibs
of probands. Teratology, 62 (5): 342-345, 2000.
322 Vol. 46, No. 3 / ALA Repair by Modified Tajima Suture Vs Cinch Suture
3- Dixon M.J., Marazita M.L., Beaty T.H. and Murray J.C.:
Cleft lip and palate: Understanding genetic and environmental
influences. Nat. Rev. Genet, 12 (3): 167-78, 2011.
4- Desmedt D.J., Maal T.J. and Kuijpers M.A.: Nasolabial
symmetry and esthetics in cleft lip and palate: Analysis
of 3D facial images. Clin. Oral Investig., 19: 1833-1842,
2015.
5- Millard T. and Richman L.C.: Different cleft conditions,
facial appearance, and speech: Relationship to psychological
variables. The Cleft palate-craniofacial journal, 38
(1): 68-75, 2001.
6- Lithovius R.H., Lehtonen V., Autio T.J., Harila V., Anttonen
V., Sándor G.K. and Ylikontiola L.P.: The association of
cleft severity and cleft palate repair technique on hearing
outcomes in children in northern Finland. Journal of
Cranio-Maxillofacial Surgery, 43 (9): 1863-1867, 2015.
7- Chow I., Purnell C.A., Hanwright P.J., A.K. J.P. Gosain
and R. Surgery: "Evaluating the rule of 10s in cleft lip
repair: do data support dogma?" 138 (3): 670-679, 2016.
8- Mossey P.A., Little J., Munger R.G., Dixon M.J. and W.C.
J.T.L.: "Cleft lip and palate", 374 (9703): 1773-1785,
2009.
9- Tajima S.A.D.A.O. and Maruyama M.A.S.A.R.U.: Reverse-
U incision for secondary repair of cleft lip nose.
Plastic and Reconstructive Surgery, 60 (2): 256-261, 1977.
10- Millard D.R.: The alar cinch in the flat, flaring nose.
Plastic and Reconstructive Surgery, 65 (5): 669-672, 1980.
11- Collins P.C. and Epker B.N.: The alar base cinch: A
technique for prevention of alar base flaring secondary
to maxillary surgery. Oral Surgery, Oral Medicine, Oral
Pathology, 53 (6): 549-553, 1982.
12- Mortier P.B., Martinot V.L., Anastassov Y., Kulik J.F.,
Duhamel A. and Pellerin P.N.: Evaluation of the results
of cleft lip and palate surgical treatment: Preliminary
report. The Cleft palate-craniofacial journal, 34 (3): 247-
255, 1997.
13- Allam E., Windsor L. and Stone C.: Cleft lip and palate:
Etiology, epidemiology, preventive and intervention strategies.
Anat. Physiol., 4 (3): 1-6, 2014.
14- Ammar H., Elprince N.H., Khalil A.A.F. and Sweedan A.O.:
Comparison of rotation-advancement and straight-line
methods for repairing of unilateral cleft lip (a randomized
controlled clinical trial). Alexandria Dental Journal, 2022.
15- Losee J.E., Kirschner R.E., Smith D.M., Straub A.E. and
Lawrence C. (Eds.): Comprehensive Cleft Care: Family
Edition. CRC Press/Taylor & Francis Group, 2015.
16- Jackson I., Michael L. Bentz, Bruce S. Bauer, Ronald M.
Zuker (Eds): Principles and practice of pediatric plastic
surgery, 2008.
17- Marc C.S. and David M.F.: Cleft lip. In: Ross Farhadieh,
Neil Bulstrode, Sabrina Cugno (ed) Plastic and Reconstructive
Surgery: Approaches and Techniques, 1st ed.
Pondicherry, India Wiley Blackwell, 2015.
18- Kuna S.K., Srinath N., Naveen B.S. and Hasan K.: Comparison
of outcome of modified Millard's incision and
Delaire's functional method in primary repair of unilateral
cleft lip: A prospective study. Journal of maxillofacial
and oral surgery, 15 (2): 221-228, 2016.
19- Reddy S.G., Reddy R.R., Bronkhorst E.M., Prasad R.,
Jagtman A.M.K. and Bergé S.: Comparison of three
incisions to repair complete unilateral cleft lip. Plastic
and Reconstructive Surgery, 125 (4): 1208-1216, 2010.
20- Roussel L.O., Myers R.P. and Girotto J.A.: The Millard
rotation-advancement cleft lip repair: 50 years of modification.
The Cleft Palate-Craniofacial Journal, 52 (6): 188-
195, 2015.
21- Mbuyi-Musanzayi S., Katombe F.T., Tshilobo P.L., Kayamba
P.K.M., Devriendt K. and Reychler H.: Anthropometric
and aesthetic outcomes for the nasolabial region in 101
consecutive African children with unilateral cleft lip one
year after repair using the anatomical subunit approximation
technique. International Journal of Oral and Maxillofacial
Surgery, 46 (10): 1338-1345, 2017.
22- Funayama E., Yamamoto Y., Furukawa H., Murao N.,
Shichinohe R., Hayashi T. and Oyama A.: A new primary
cleft lip repair technique tailored for Asian patients that
combines three surgical concepts: Comparison with rotation-
advancement and straight-line methods. Journal of
Cranio-Maxillofacial Surgery, 44 (1): 27-33, 2016.
23- Patel T.A. and Patel K.G.: Comparison of the Fisher
anatomical subunit and modified Millard rotationadvancement
cleft lip repairs. Plastic and Reconstructive
Surgery, 144 (2): 238e-245e, 2019.
24- Othman S.A., Majawit L.P., Wan Hassan W.N., Wey M.C.
and Mohd Razi R.: Anthropometric study of threedimensional
facial morphology in Malay adults. PloS
one, 11 (10): e0164180, 2016.
25- Zreaqat M., Hassan R. and Halim A.S.: Facial dimensions
of Malay children with repaired unilateral cleft lip and
palate: A three dimensional analysis. International
journal of oral and maxillofacial surgery, 41 (6): 783-
788, 2012.

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