Randall,2 in 1959, presented a mathematical interpretation of the tennison repair. The tennisonrandall technique involves a backcut that extends from the cleft. 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%. Hopper cleft lip and palate are the most common congenital craniofacial anomalies. Tennison randall procedure and the millard procedure.
The method is a modification of that of millard and involves a small triangular flap on the end of the vermilion ridge. 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. Cleft care requires a collaborative multidisciplinary team. 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.
Pdf comparison between millards rotational advancement flap. Approximately one in children is born with a cleft palate, cleft lip, or with both anomalies. For some surgeons it seems simpler and easier to teach. The tennisonrandal triangular technique, a popular cleft lip repair technique, was favored on one occasion because the defect was located in the upper lip. Patients treated using tennisonrandall flap triangular flap technique 30 patients. Pattern of presentation and management of lip injuries in a. Primary or secondary lip surgery for bilateral cleft lip defects was achieved using fork flap technique figure 5. Measurements and markings nadir of cupids bow peak of cupids bow measurements and markings this point is chosen to create a. Tennison the method of triangular repair most often described is p.
The techniques described for the repair of acquired clefts are not always appropriate for congenital clefts. The popularity of the triangular flap technique tennison randall dimin. Both these techniques resulted in scars impinging on the lower. Cleft lip operation tennisonrandall vs millard free download as pdf file. Unilateral cleft lip repair was achieved using millards rotation advancement technique or tennisonrandall triangular technique figure 4. 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. Tennison randall s triangular technique is the most widely used triangular technique due to its geometrical predictability and reliability and its consistency. Triangular with ala nasi tan repair of unilateral cleft. Pattern of presentation and management of lip injuries in. Comparison between millards rotational advancement flap and tennisonrandall flap techniques for surgical correction of unilateral cleft lip. For example, the lemesurier 7 quadrangular flap, and the tennison 8 randall 9 triangular flap. Surgical techniques for treatment of unilateral cleft lip intechopen. Preoperatively, age, sex, weight, height, and type of cleft were.
Numerous procedures have been described for repair of congenital clefts of the lip. Successful treatment requires technical skill, knowledge of the abnormal anatomy, and appreciation of threedimensional facial aesthetics. Cleft lip operation tennison randall vs millard free download as pdf file. For example, the modified triangular flap, or tennisonrandall repair, can be of value when presented with the wider unilateral cleft lip. Randall and the rotation advancement technique millard, which have similar outcomes. A triangular flap is made on the lateral side of the cleft, where the. In the paint program nostril height, width, area and columellar lenght was assessed by comparing with noncleft side using kruskalwallis test. The 3 operations as described in the book cleft lip surgery, a practical guide you can see on video. Randalltennisonsawhney triangular flap technique of unilateral 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. Triangular cleft repair vanderbilt university medical center. The flaps are quadrangular in lemesurier, may and trauner techniques, triangular in tennison, randall, lemos and spina, and of rotation and advancement in millards. On the other hand, our method also presents an excellent approximation of both the deep and. 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.
Variation trends of the postoperative outcomes for. Until now, the two commonly used techniques for ucl repair have been millards rotationadvancement and tennisonrandalls triangular flap repairs. The technique has been adopted by surgeons in north america and has greatly expanded. Cleft lip surgery a practical guide the cleft surgery organisation.
Standardized steps or criteria for designing a triangular flap do not always fit for all types of cleft lip repair. Variation trends of the postoperative outcomes for unilateral. 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. Triangular flap repair of the congenital earlobe cleft.
Comparison between millards rotational advancement flap. Randall p 1959 a triangular flap operation for the primary repair of unilateral clefts of the lip. Modified operation for wide unilateral cleft lips jama. 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. 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. 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. Cleft lip operation tennisonrandall vs millard lip. 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. The two main techniques in unilateral cleft lip surgery are the triangular flap technique tennison. 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. In addition, some operations specifically designed for congenital clefts require more complicated techniques. 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.
Charles tennison disclosed a method with triangular flaps and zplasty. Results were evaluated statistically by anova using asher mcdade. 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. Pdf comparison between millards rotational advancement. Trauner has called his method a combination of the tennison and millard operations, although in actuality it is more of a combination of the. The american cleft palatecraniofacial association has established standards for treating centers that. Cleft deformities in adults and children aged over six years. Operative techniques buzzo reported his experience with the labiaplasty. The popularity of the triangular flap technique tennisonrandall diminished in the 1970 to 1980s with the gaining popularity of the. The most widely accepted technique is that described by millard 10 in the 1950s. The popularity of the triangular flap technique tennisonrandall dimin ished in the 1970 to 1980s with the gaining popularity of the millard proce dure.
Scribd is the worlds largest social reading and publishing site. West china technique of unilateral cleft lip repair. The marcks zplasty modification of the tennison triangular flap cleft lip repair results in excellent preservation of the cupids bow. Dua teknik yang sering digunakan yaitu teknik triangular tennison randall dan teknik rotasi millard 3,5 tennison randall menggunakan flap triangular dari sisi lateral, dimasukkan ke sudut di sisi medial dari celah tepat di atas batas vermillion, melintasi collum philtral sampai ke puncak cupid. There was no primary surgery performed to the nose. Comparison between millards rotational advancement flap and. Technical strategies triangular with ala nasi tan repair of. 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. Cleft management pedo orthodontics dentistry branches. For example, the modified triangular flap, or tennison randall repair, can be of value when presented with the wider unilateral cleft lip. Randall, p a triangular flap operation for the primary repair of unilateral clefts of the lip. 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.
The maximum width of the cleft lips documented in the files ranged from 4 to 10 mm. 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. 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. Many papers have described surgery for congenital and acquired clefts. Tennisonrandall procedure and the millard procedure. The techniques that utilize the principle excision in arched lines are the rosethompson, ladd, braun and veau. A schematic representation of the incisions for a tennison. This repair technique is conceptually similar to the rotation advancement repair. 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. A triangular flap operation for the primary repair of unilateral clefts of the lip. It is also possibly more reliable for those performing and teaching a small number of cases. Tissue engineering strategies combining molecular targets. The inclusion criteria were a non syndromic patients.
Nasolabial symmetry following tennisonrandall lip repair. 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. 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 noordhoff technique utilizes a lateral lip triangular flap to reconstruct the dry.
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. A triangular flap is made on the lateral side of the cleft, where the vermilion height is the greatest, just before the. Cleft deformities in adults and children aged over six. Tennison1 was the first author to introduce the triangular flap for correction of the unilateral cleft lip in 1952. The older methods aimed at closure of the defect in primitive fashion, with insufficient regard for the cosmetic result. 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. Surgical techniques for treatment of unilateral cleft lip. A comparative study of immediate wound healing complications. Celah bibir dapat terjadi hanya pada satu sisi kanan atau kiri bibir unilateral, namun. Tennison cw 1952 the repair of the unilateral cleft lip by the stencil method. Palatal fistula repair was the most common secondary cleft repair table 3.
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. This approach provides continuity of the vermilion ridge, and promotes a natural appearance of the upper part of the philtrum on the cleft side. Surgical outcome and complications following cleft lip and. Subsequently, randall used the same design as tennison but, reduced size of triangular flap 4. This is done by using the triangular flap repair developed by tennison and randall. Triangular flap technique group t figure 1 millards rotational advancement flap technique group m figure 2 and was performed for 30 patients each. Tennison, randall and skoog should be highlighted as icons in the evolution of the treatment of. Unilateral cleft lips were repaired using either millard rotation advancement technique in 29 31. Gi disorders upper mouth, esophagus, teeth lower stomach l. Open rhinoplasty for correction of the secondary nasal. Unilateral cleft lip thieme medical publishers, india. This surgical technique is applicable for all complete or incomplete unilateral cleft lips. Karapandzic flap was used in one of the electrical burn patient due to the involvement of the oral commissure. Tennisonrandalls triangular technique is the most widely used triangular technique due to its geometrical predictability and reliability and its consistency.
Hagerty 1958, randall 1959, and cronin 1966 have added modifications to the triangular flap insert. Comparison between millards rotational advancement flap and tennison randall flap techniques for surgical correction of unilateral cleft lip. Feb 17, 2019 the rastelli procedure is a surgical procedure to correct certain combinations of cardiovascular defects in patients with cyanotic congenital heart disease. 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. Cleft lip operation tennisonrandall vs millard lip surgery. Open rhinoplasty for correction of the secondary nasal deformity due to the marcks triangular flap cleft lip repair. After suturing was complete, the skin wound was dressed with sofratulle gauze, over which dry gauze was placed, and plaster was ap. Surgical management of cleft lip involves changing techniques and evolving principles. These techniques have been repeatedly used and have withstood the test of time. 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.
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