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    UnilateralCle+LipRepair

    AnatomicSubunitApproach

    VivekPanchapakesanBScMDFRCSCDABPS

    Toronto,Canada

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    GoalsofUnilateralCle+LipRepair

    SymmetricLipLength

    LevelCupidsBow

    AdequateVermilionThickness InconspicuousScar

    RestoreMuscleConKnuity

    AddressNasalDeformity

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    HistoricalBackground

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    ROSE-THOMPSONEFFECT

    W.ROSE

    OnHarelipandCle-Palate.London:H

    Lewis,1891

    J.E.THOMPSON

    AnarKsKcandmathemaKcallyaccurate

    methodofrepairingthedefectincases

    ofharelip.

    SurgGynaecolObstet14:498,1912

    PicturefromPatelP.,UnilateralCle-LipRepairTreatment&

    Management

    h[p://emedicine.medscape.com/arKcle/1279641-treatment#a1133

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    THEREPAIROFTHE

    UNILATERALCLEFTLIPBY

    THESTENCILMETHOD

    C.TENNISON

    SanAntonio,Texas

    PlastReconstrSurg9:115,1952

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    ATRIANGULARFLAP

    OPERATIONFORTHEPRIMARY

    REPAIROFUNILATERALCLEFTS

    OFTHELIP

    P.RANDALL

    Philadelphia,Pennsylvania

    PlastReconstrSurg23:331,1959

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    COMPLETEUNILATERAL

    CLEFTSOFTHELIP

    D.RALPHMILLARD

    Miami,Florida

    Plast.Reconstr.Surg.25:595,1960

    ThePrimaryCamouflageofthe

    UnilateralHare-look.Transaconsof

    theInternaonalSocietyofPlasc

    Surgeons,FirstCongress,Stockholm

    (1955);1957.pp.160e166

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    ROTATION-ADVANCEMENT

    MODIFICATIONS

    MillardDR,RefinementsinrotaKon-

    advancementcle+liptechnique.Plast

    ReconstrSurg33:26,1964

    MillardDR,ExtensionsoftherotaKon-

    advancementprincipleforwide

    unilateralcle+lips.Plast.Reconstr.Surg

    42:535,1968

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    ROTATION-ADVANCEMENT

    MODIFICATIONS

    MillardDR,RefinementsinrotaKon-

    advancementcle+liptechnique.Plast

    ReconstrSurg33:26,1964

    MillardDR,ExtensionsoftherotaKon-

    advancementprincipleforwide

    unilateralcle+lips.Plast.Reconstr.Surg

    42:535,1968

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    L.R.MOHLER

    Columbus,Ohio

    PlastReconstrSurg,Vol80(4):1960,

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

    NoordhoffsPoint

    TheRedLine

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

    NoordhoffsPoint

    TheRedLine

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

    NoordhoffsPoint

    TheRedLine

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus

    1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus1997NoordhoffCraniofacial

    FoundaKon

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    UNILATERALCLEFTLIP

    REPAIR

    M.S.NOORDHOFF

    Taipei,Taiwan

    TheSurgicalTechniquefortheUnilateral

    Cle-LipNasalDeformityOperave

    Syllabus1997NoordhoffCraniofacial

    FoundaKon

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    QUADRILATERALMIRAULT

    FLAPOPERATION

    A.B.LEMESURIER

    Toronto,Ontario

    PlastReconstrSurg16:425,1955

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a b

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a b

    c

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a b

    c

    abc

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a b

    c

    abc

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIP

    REPAIR

    H.G.THOMSON

    Toronto,Canada

    OperTechPlas.Reconstr.Surg 2:175,

    1995.

    a b

    c

    abc

    Tuesday, 22 November, 11

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    THESUBUNITPRINCIPLEIN

    NASALRECONSTRUCTION

    G.C.BURGET,F.J.MENIC

    Chicago,Illinois&Tuscon,Arizona

    PlastReconstrSurg76:239,1985

    Tuesday, 22 November, 11

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    IdealLineofRepair

    Ascendsfromcle+sideof

    cupidsbow

    Mirrorsthenon-cle+-side

    philtralcolumn

    Reachesbaseofthenose

    ConKnuessuperolaterally

    Borderslip-columellar

    crease,ascendingtothenostrilsill

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    d l f

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    IdealLineofRepair

    Ascendsfromcle+sideofcupidsbow

    Mirrorsthenon-cle+-side

    philtralcolumn

    Reachesbaseofthenose

    ConKnuessuperolaterally

    Borderslip-columellar

    crease,ascendingtothenostrilsill

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIPREPAIR:

    ANANATOMICALSUBUNIT

    APPROXIMATIONTECHNIQUE

    DAVIDM.FISHER

    Toronto,Canada

    PlastReconstrSurg116:61,2005

    Tuesday, 22 November, 11

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    UNILATERALCLEFTLIPREPAIR:

    ANANATOMICALSUBUNIT

    APPROXIMATIONTECHNIQUE

    DAVIDM.FISHER

    Toronto,Canada

    PlastReconstrSurg116:61,2005

    ab1mm=c

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    Markings

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    LesserLipHeight(Basewidthofinferiortriangle)

    l h h

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    =TotalLipHeightGreaterLipHeight1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    T t l Li H i ht G t Li H i ht 1

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    =TotalLipHeightGreaterLipHeight1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    Total Lip Height Greater Lip Height 1mm

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    =TotalLipHeightGreaterLipHeight1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    = Total Lip Height Greater Lip Height 1mm

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    =TotalLipHeight GreaterLipHeight 1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    = Total Lip Height Greater Lip Height 1mm

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    TotalLipHeight GreaterLipHeight 1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    =TotalLipHeightGreaterLipHeight1mm

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    p g p g

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    LesserLipHeight(Basewidthofinferiortriangle)

    =TotalLipHeightGreaterLipHeight1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    =TotalLipHeightGreaterLipHeight1mm

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    LesserLipHeight(Basewidthofinferiortriangle)

    =TotalLipHeightGreaterLipHeight1mm

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    Protocol(Sickkids)

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    PresurgicalNAM LipRepair/Rhinoplasty

    PalatoplastyM&T

    LipRevision

    VPICorrecKon

    LobuleRhinoplasty

    AlveolarBoneGra+

    Septorhinoplasty OrthognathicSurgery

    2weeksLipRepair 35months

    1114months

    >3yearsprn

    >4yearsprn

    >6yearsprn

    812years

    >12yearsprn SkeletalMaturityprn

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    PrimaryRhinoplasty

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    ConservaKveGoal=Improvement CentralizaKonofcolumellarbase

    SymmetricalalarbasereposiKoning

    Nostrilmarginsofequalcircumference

    ReleaseLLC-ACCfrompiriform

    Anteromedialadvancementofcle+-sidelateral

    crus

    CreaKonofULC-LLCoverlap NodissecKonofdome

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    Conclusions

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    Reliable Basedonpreviouslydescribedrepairsand

    principles

    Rose-Thomsonlengtheningallowsforasmaller

    triangle

    TriangleposiKonedaccordingtoNoordhoffsdescripKon

    Repairalonglinesofanatomicalsubunits ConservaKveapproachtothenose

    Tuesday, 22 November, 11


P F R H B EN C (PROFORHCOM F II)

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