Volume 04 Issue 02-2024
52
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
02
P
AGES
:
52-58
SJIF
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MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Comparative estimation of the results of primary labioplasty has been held on enow lesser clinical material; statements
to usage of each method inclusive of anatomic and aesthetic results have been defined. Clinical- anatomic changes
have been established after various methods of primary labioplasty which allowed proving the choice of operation
method inclusive of the degree and form of rhegma.
KEYWORDS
Assessment, cheiloplasty, cleft, lips, palate.
INTRODUCTION
Congenital cleft lip and palate (CCLP) is a severe
malformation of the dental system, which is
characterized by pronounced structural and functional
disorders. Perhaps there is no other congenital
deformity that significantly changes the shape of the
face and leads to such significant anatomical and
functional impairments [1,2,5,6,7,8,9,10,11].
Surgical treatment of congenital bilateral clefts
occupies a special place due to its relevance, variety of
surgical methods and many unresolved issues. Among
Research Article
EVALUATION OF THE RESULTS OF PRIMARY CHEILOPLASTY IN
CHILDREN WITH CONGENITAL BILATERAL CLEFT OF UPPER LIP AND
PALATE
Submission Date:
February 09, 2024,
Accepted Date:
February 14, 2024,
Published Date:
February 19, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue02-07
Ergasheva Niginabonu Ilkhomjon Kizi
Student Of The 3rd Course Of Master`S Degree, The Department Of Otorhinolaryngology And Dentistry,
Tashkent Medical Academy, Uzbekistan
Salomov Shoxabbos Nozimjon Ogli
Student Of Andijan State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 02-2024
53
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
04
ISSUE
02
P
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:
52-58
SJIF
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(2021:
5.
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(2022:
5.
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(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
the wide variety of methods for primary repair of
congenital cleft lip and palate, there is currently no
preference for any one technique. The use of new
methods of surgical treatment is not always rational
and does not make it possible to fully rehabilitate a
child with this pathology [3,4].
An analysis of the literature in recent years shows that
today more than a hundred types of cheiloplasty have
been developed and used. Each of these methods has
its own positive and negative aspects, which allows
surgeons to individualize the surgical approach in each
specific case.
In the domestic and foreign literature, insufficient
attention has been paid to the issue of primary
cheiloplasty with the choice of the most optimal
methods, taking into account the degree of
underdevelopment of the soft tissues of the median
fragment.
Despite a number of studies on improving the methods
of primary cheiloplasty, the issue of comparative
analysis of methods for eliminating congenital bilateral
clefts of the upper lip and palate has not received
sufficient attention. The relevance of the problem
posed and its insufficient coverage in the scientific
literature was the main motive for carrying out this
work.
The purpose of the study is to conduct a comparative
analysis of the long-term results of primary cheiloplasty
using the Limberg, Millard and Obukhova-Tennyson
methods, to determine the indications for their use,
taking into account the degree of underdevelopment
of the soft tissues of the median fragment.
MATERIAL AND RESEARCH METHODS
The material for our study was the results of surgical
treatment of children with congenital bilateral cleft lip
and palate. During the period from 2021 to 2023, 31
patients with congenital bilateral cleft lip and palate,
aged from 6 months to 6 years, were observed and
treated in the "Chinar" Private Hospital. Of these, 19
were boys and 12 were girls. Of the total number of
children with congenital cleft lip and palate, 8 children
were operated on using the Limberg method. Thirteen
children with cleft lip and palate were operated on
using the Millard method. The number of patients who
underwent cheiloplasty using the Obukhova-Tennyson
method was 10 children.
Using the anthropometric method, a comparative
analysis of the results of primary cheiloplasty using the
Limberg, Obukhova Tennyson and Millard methods
was carried out 1-2 years after the intervention. To do
this, measurements were taken on the nose and upper
lip, taking as a basis the methods of anthropometric
research by R.D. Novoselov (1978), T.V. Sharova, L.P.
Gerasimova (1991), S. Mahn (1980).
Volume 04 Issue 02-2024
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Publisher:
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Servi
Figure. Lip and nose measurement chart.
Lip measurements: A/A1 - width of the vestibule of the
nose, B/B1 - distance from the corner of the mouth to
the middle of the columella on both sides, C/C1 - height
from the lower edge of the upper lip to the entrance to
the vestibule of the nose, D/D1 - distance between the
protruding points of the Cupid's line, E/E1 - the distance
between the highest point of the Cupid's line to the
lower edge of the upper lip on each side. Lip height,
H/H1 height of the skin part of the upper lip, difference
between parameters C and E.
Nose measurements: F/F1 - columella length on both
sides, G/G1 - philtrum length on both sides (figure).
The results of anthropometric studies in operated
patients using three methods were compared with
control average age indicators in children.
The resulting digital indicators were assessed on a 6-
point scale: 1-2 points - unsatisfactory result - the
difference in the comparative assessment of any
parameter between operated patients and healthy
control children exceeds 4 mm; 3-4 points - satisfactory
result; the difference in the comparative assessment of
any parameter between operated patients and healthy
control children is 3-4 mm; 5-6 points - a good result.
The difference in comparative assessment is 1-2 mm.
In addition, the results of cheiloplasty were assessed
based on a survey of parents on a 5-point scale.
RESEARCH RESULTS AND DISCUSSION
A photometric study showed that the width of the
nasal vestibule (A) in children operated on by the
Obukhova-Tennison method was 1.1±0.01 cm, in the
control group 0.71±0.02 cm. Comparing the results
obtained, we obtained a difference in average at 3.9
mm. According to the point system, this amounted to
3-4 points - a satisfactory result. Analyzing the data
obtained during primary cheiloplasty according to
Millard D.R. noted: in operated children 0.64±0.01 cm,
in children of the control group 0.71±0.02 cm. The
width of the nasal vestibule had a difference of 0.7 mm,
5-6 points - a good result. The width of the nasal
vestibule in children operated on by the Limberg
method was 0.66±0.02 cm, in the control group it was
0.71±0.02 cm. Comparing the results obtained, we
Volume 04 Issue 02-2024
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International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
04
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SJIF
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(2021:
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(2023:
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
found a difference of 0.5 mm on average. According to
the point system, this amounted to 5-6 points - a good
result.
Distance from the corner of the mouth to the middle of
the base of the columella on both sides (B). According
to this indicator, during the Obukhova-Tennyson
operation, the difference in the control and operated
groups was 0.6 mm, 5-6 points. This is a good result.
With cheiloplasty using the Millard and Limberg
methods, almost identical parameters were noted in
both the control and operated groups. The result can
be regarded as good.
Height from the lower edge of the upper lip to the
entrance to the vestibule of the nose (C). According to
the Obukhova-Tennyson method, in operated children
this figure was 2.61 ± 0.02 cm, in children of the control
group - 2.2 ± 0.02 cm. The difference between them
was 4.1mm.
–
unsatisfactory result, 1-2 points.
As for this parameter according to Millard D.R., in the
operated children it was 1.9 ± 0.02 cm, in the control
group - 2.2 ± 0.02 cm. The difference between them
was 3mm, a satisfactory result. Using the Limberg
method, this indicator in operated children was 1.85 ±
0.02 cm, in healthy children - 2.2 ± 0.02 cm. The
difference was 3.5 mm, 5-6 points, a satisfactory result.
The distance between the vertical points of the Cupid's
line (D).
The data obtained from both operated and healthy
children using all three methods did not reveal any
differences. According to the Obukhova-Tennison
method, this figure was 0.66 ± 0.01 cm. both in the
control and after cheiloplasty. For cheiloplasty using
the Millard D.R. method. and Limberg this distance was
0.66±0.01*cm in the control, after surgery 0.65±0.01
cm, the difference was 0.1mm, 5-6 points is a good
result.
Height of the red border at the projecting points (E).
With cheiloplasty according to Obukhova-Tennison,
this indicator in operated children was 0.63±0.02 cm, in
control children - 0.65±0.04 cm.
The difference was up to 1mm, 5-6 points, a good
result. With cheiloplasty according to Millard D.R. this
distance was 1.03±0.02 cm, in the control - 0.65±0.04
cm. The difference was 3.8 mm, 3-4 points - a
satisfactory result. Using the Limberg method, this
figure in operated children was 0.95±0.03 cm and
0.65±0.02 cm. in healthy children. The difference was
0.3mm, 5-6 points - a good result.
Height of the skin part of the nasal septum (F).
Significant differences were found after cheiloplasty
using the Obukhova-Tennyson method. The data was
0.31±0.01 cm. in operated patients and 0.53±0.01 cm. in
control children. The difference was 2.2mm. According
to the method of Millard D.R. 0.44±0.01cm. in operated
children and 0.53±0.01 cm. in healthy people, 5-6
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(2023:
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Publisher:
Oscar Publishing Services
Servi
points, a good result. According to the Limberg
method, in the operated group this distance was
0.46±0.02 cm, in the control group it was 0.53±0.01 cm,
5-6 points, a good result.
Retraction of the base of the nasal wing, (G). According
to the Obukhova-Tennyson method, this indicator in
the operated children was 0.68±0.01 cm, in the control
group - 0.42±0.02 cm. The difference was 2.6 mm, 3-4
points - a satisfactory result. For cheiloplasty using the
Millard D.R. method. this distance was 0.40±0.01 cm.
and 0.42±0.02cm. in control children. The difference
was up to 1mm, a good result. During surgery using the
Limberg method, this figure was 0.41 ± 0.01 cm and
0.42 ± 0.01 cm in the control. A difference of 0.1 mm is
a good result.
Height of the skin part of the upper lip (H). According
to this indicator, during the Obukhova-Tennyson
operation, the difference in the control and operated
groups was 2.6 mm, 3-4 points. Can be regarded as a
satisfactory result. With cheiloplasty using the Millard
method, this figure in the operated children was 0.87 ±
0.01 cm, in the control group it was 1.45 ± 0.02 cm. The
difference is 5.8mm, the result is unsatisfactory. With
the Limberg method, this distance in the operated
children was 0.91±0.02 cm, in the control group it was
1.45±0.02 cm. The difference was 5.4 mm. The result
can be regarded as unsatisfactory.
Results of a subjective survey of parents: after surgical
treatment using the Millard method: the scar is not
noticeable in 10 (76.9%) patients, the scar is noticeable
in 3 (23.1%), the red border is continuous in 9 (69.2%) ),
the red border is discontinuous - in 4 (30.8%), the height
of the upper lip is restored - in 8 (61.5%), the height of
the upper lip is not restored - in 5 (38.5%), the height of
the upper lip is symmetrical on both sides - in 6 (46.1%),
the height of the upper lip is not symmetrical on both
sides - in 7 (53.9%), there is no flattening of the wing of
the nose - in 11 (84.6%), the wing of the nose is flattened
- in 2 ( 15.4%).
After surgical treatment using the Tennyson-Obukhova
method: the scar is not noticeable in 3 (30.0%) patients,
the scar is noticeable in 7 (70.0%), the red border is
continuous in 8 (80.0%), the red border is
discontinuous
–
in 2 (20.0%), the height of the upper lip
is restored
–
in 9 (90.0%), the height of the upper lip is
not restored
–
in 1 (10.0%), the height of the upper lip is
symmetrical on both sides
–
in 6 (60.0%), the height of
the upper lip is not symmetrical on both sides - in 4
(40.0%), there is no flattening of the wing of the nose -
in 2 (20.0%), the wing of the nose is flattened - in 8
(80.0% ).
After surgery using the Limberg method: the scar is not
noticeable in 5 (62.5%) patients, the scar is noticeable
in 3 (37.5%), the red border is continuous in 5 (62.5%);
the red border is discontinuous
–
in 3 (37.5%), the
height of the upper lip is restored
–
in 4 (50.0%), the
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Publisher:
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Servi
height of the upper lip is not restored
–
in 4 (50.0%), the
height of the upper lip is symmetrical on both sides
–
in
3 (37.5%), the height of the upper lip is not symmetrical
on both sides - in 5 (62.5%), there is no flattening of the
wing of the nose - in 6 (75.0%), the wing of the nose is
flattened - in 2 (25, 0%).
Thus, the linear Millard and Limberg methods and the
Obukhova-Tennyson technique used in primary
cheiloplasty, with the correct choice of indications for
their implementation, can successfully restore the
anatomical and functional integrity of the defect area.
When choosing a technique for bilateral primary
cheiloplasty, the determining factor is the degree of
underdevelopment of the soft tissues of the median
fragment.
When the soft tissues of the median fragment are
underdeveloped by 2/3 of its height, the most
appropriate method is to move a triangular flap
according to Obukhova-Tennyson, which gives the
best results taking into account the restoration of the
correct Cupid's bow and the anatomical integrity of the
upper lip with normalization of the mobility of the
orbicularis ores muscle.
In children with congenital bilateral cleft lip and palate
with underdevelopment of the soft tissues of the
median fragment at 1/3 or 1/2 of its height, it is advisable
to use the linear methods of Millard and Limberg. In
this case, less noticeable scars are observed and the
tissue of the upper lip is preserved as much as possible,
which is the key to the successful completion of final
reconstructive surgery in adult patients.
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