Reconstruction of Philtrum Using Partial Splitting and Folding of Orbicularis Oris Muscle in Secondary Unilateral Cleft Lip

Choi

et al. 2020

Preprint

We performed an animal study to identify the techniques associated with the best muscle healing outcomes in cleft lip/palate surgery. The right triceps of thirty adult male Sprague-Dawley rats were cut and repaired by three different suture techniques: simple (n=10), overlapping (n=10), and splitting sutures (n=10). Muscle tissues were isolated from 5 rats per group 1 and 8 weeks postoperation. The inflammatory response and muscle fiber healing were evaluated by hematoxylin and eosin (H&E) staining, western blotting, immunohistochemistry for TNF-α and IL-1β, and immunofluorescence for laminin and MyoD. Grip strength (N/100 g) and spatial gait symmetry were evaluated before surgery and 1, 2, 4 and 8 weeks postoperation. Eight weeks postoperation, grip force per weight was significantly higher in the simple suture (median, 3.49; IQR, 3.28-3.66) and overlapping groups (median, 3.3; IQR, 3.17-3.47) than the splitting group (median, 2.91; IQR, 2.76-3.05). There was no significant difference in range of motion between groups. The simple group exhibited significant remission of inflammation by H&E staining and lower expression of TNF-α and IL-1β than the other groups by western blotting and immunohistochemistry. Immunofluorescence revealed stronger expression of MyoD and weaker expression of laminin in the splitting group than in the other groups at week 8, indicating prolonged inflammation and healing followed by poor muscle fiber remodeling. Simple interrupted sutures and overlapping sutures showed similar muscle healing in this study. Therefore, there was some limitation to reconstructing the philtral column using overlapping sutures alone, and additional procedures could be needed.

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

An Evaluation of Muscle Repair Techniques: Implications in Musculoskeletal Healing and Corollaries in Oral-Facial Clefting

Choi

et al. 2020

Preprint

J of Cosmetic Dermatology

“…Ultimately, 32 items did not meet all of the previously set inclusion criteria. Finally, nine works met the inclusion criteria and have been included in the systematic review 11‐19 . These articles were divided according to presented cleft lip scar management methods into nonsurgical methods—4 items, and surgical methods—5 items.…”

Section: Resultsmentioning

confidence: 99%

“…Another method of correction of a post‐cleft scar is tissue graft, which replenishes upper lip tissue deficiency eliminating tension within the upper lip allowing for correction of unesthetic cleft scars 16 . Deep surgical correction involving orbicularis oris muscle reconstruction improves function of this muscle and additionally cause relief of skin tension which limiting widening of cleft scars 17‐19 . Literature shows that there is no standard regarding the care and correction of cleft lip scars.…”

Section: Discussionmentioning

confidence: 99%

Scar management in patients after cleft lip repair–Systematic review Cleft lip scar management

Bartkowska

Komisarek²

2020

Background Cleft lip is a commonly occurring congenital development defect. Primary cleft lip repair leads to cleft scar formation. The resulting scar often undergoes hypertrophy, which negatively affects facial esthetics, function, and the patient's mental health. Aims The systematic review presented here was carried out to answer the following question: What cleft lip scar management options exist and how effective are they? Methods The systematic review of the articles on scar management methods in cleft lip patients was done in accordance with the PRISMA checklist. The literature search was conducted via the PubMed and Google Scholar databases. Results A total of 95 items were obtained. Finally, nine works have been included in the systematic review. Among the obtained works, there is a variety of cleft lip scar management methods. All the presented methods of cleft lip scar management proved to be effective in cleft scar therapy. Conclusions Cleft lip scar management should be considered as a constant and mandatory element of the treatment plan in cleft patients. It is also worth considering creating detailed protocols of conduct for cases of cleft lip scaring which pay attention to existing needs, prevention/correction and problems of superficiality and depth.

“…The philtrum is a unique structure composed of a ridge called the philtral column and a central depression called the philtral dimple. To mimic the shape of the philtral column and dimple in the cleft lip, the cleft surgeon utilizes various muscle suture techniques ranging from interrupted sutures [ 4 ] to buried horizontal mattress sutures [ 5 ], overlapping sutures [ 6 ], coronal splitting sutures [ 7 ], interdigitating sutures [ 8 ], and splitting sutures with the folding technique [ 9 ]. The use of overlapping suturing of the LVP muscle to strengthen the velopharyngeal closure force following palatoplasty has increased in popularity [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Muscle Repair Techniques: Implications in Musculoskeletal Healing and Corollaries in Oral-Facial Clefting

Choi

et al. 2021

JCM

We performed an animal study to identify the techniques associated with the best muscle healing outcomes in cleft lip/palate surgery. The right triceps of thirty adult male Sprague–Dawley rats were cut and repaired by three different suture techniques: simple (n = 10), overlapping (n = 10), and splitting sutures (n = 10). Muscle tissues were isolated from 5 rats per group 1 and 8 weeks postoperation. The inflammatory response and muscle fiber healing were evaluated by hematoxylin and eosin (H&E) staining, Western blotting, immunohistochemistry for TNF-α and IL-1β, and immunofluorescence for laminin and MyoD. Grip strength (N/100 g) and spatial gait symmetry were evaluated before surgery and 1, 2, 4 and 8 weeks postoperation. Eight weeks postoperation, grip force per weight was significantly higher in the simple suture (median, 3.49; IQR, 3.28–3.66) and overlapping groups (median, 3.3; IQR, 3.17–3.47) than the splitting group (median, 2.91; IQR, 2.76–3.05). There was no significant difference in range of motion between groups. The simple group exhibited significant remission of inflammation by H&E staining and lower expression of TNF-α and IL-1β than the other groups by Western blotting and immunohistochemistry. Immunofluorescence revealed stronger expression of MyoD and weaker expression of laminin in the splitting group than in the other groups at week 8, indicating prolonged inflammation and healing followed by poor muscle fiber remodeling. Simple and overlapping sutures demonstrated similar functional healing, although greater inflammation and failure to maintain a thicker muscle belly were observed in the overlapping suture group compared with the simple suture group. Therefore, reconstruction of the philtral column with overlapping sutures alone may result in limited long-term fullness, and additional procedures may be needed.