الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Summary
Orofacial clefts include a wide range of congenital deformities, the commonest of which is cleft lip with or without cleft palate (CLP) or isolated cleft palate.
The incidence of oral clefts in any form occurs in about one in every 700 live births. Cleft lip is consistently more common in males at a 2:1 ratio, in contrast to cleft palate which has a similar ratio in favor of females.
Epidemiologic and etiologic features of CLP differ in the syndromic and non-syndromic forms. Non-syndromic forms occur in 70% of cases. The causes are multifactorial and involve genetics, environmental factors, and teratogens.
The unilateral cleft typically results in a disruption of Cupid’s bow and the absence of one philtral column. The continuity of the orbicularis oris circumferentially is compromised, with abnormal insertions. In the lateral lip element, the upper part of cutaneous orbicularis (Pars’ Superficialis) inserts in the lateral aspect of the alar base and the nasolabial fold, while the lower part inserts into the nostril base periosteum of the pyriform rim. In the medial lip element, the cutaneous orbicularis (pars superficialis) inserts into the anterior nasal spine and columella. The deep orbicularis (pars marginalis) is simply interrupted by the cleft deficiency and results in a diminished vermilion cutaneous ridge at the cleft margin. Anatomical characteristics of unilateral cleft lip include nasal deformities of the tip, columella, nostril, alar base, septum, and skeleton.
Management of CLP patients requires multidisciplinary team approach that begins with an antenatal diagnosis and continues to adulthood. The patient may be under active treatment by several members of the team at once. Sometime this occurs at the same time and place in multidisciplinary clinics. At other times specialist treatment, for example speech and language therapy, ENT or psychological treatment, is provided in a separate environment.
Closure of the cleft in the lip and palate requires a surgical intervention. There are a variety of surgical techniques and timings. Any surgical protocol has to satisfy several requirements that include cosmetic restoration of a normal appearance to the baby at an appropriate time, functional restoration of the lip and particularly the palate to provide normal eating and drinking and produce a functionally adequate palate to allow the development of normal speech and optimum facial growth and development to prevent deformity developing in association with impaired growth.
Focusing on the outcomes of cleft lip repair techniques, a common complication is usually found in formation of notch at vermilion. The most obvious reason for this notching remains the straight line closure of the vermilion. However, unequal width of the lateral and medial cleft segments would also play its role depending upon the disparity of the thickness on both sides. Studies have also mentioned about the inadequate rotation of the medial element and turning in of the sutured edges as other causes of notching.
The deficiency of vermilion on the medial side of the cleft can be augmented by procedures which use excess vermilion from the lateral side as described in various other studies .This study is the first to assess the modified v- advancement vermilion flap described by Power et.al by comparing his technique to Tennison technique alone regarding vermilion aesthetic outcomes.
The new modification was assessed by comparing the results of 10 consecutive cases operated by this technique with another 10 cases operated by Tennison technique alone. The surgical outcome as assessed by scoring system constructed based on the principle of giving points to each element characterizing both cleft and nasal deformities adopted by Mortier et,al.
During the surgical procedure, the use of Tennison technique was found to be simpler to perform than the Tennison with modified v –vermilion flap technique as it found to be mathematically precise.
In our study, we found that repair of unilateral cleft lip patient with modified v-advancement vermilion flap combined with Tennison technique has better aesthetic outcome regarding length of white lip. Also there’s noticeable decrease at postoperative bulge and deficiency at lateral part of vermilion.
Conclusion
The choice of a technique for surgical correction of UCL should be based on an evidence that shows the best functional and aesthetic outcomes. Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another, but in this study it is found that both the techniques of repair can be used satisfactorily for correction of unilateral cleft lip deformity.
The study shows statistically significant difference between the two groups as regard the white lip length which was more symmetrical in cases repaired by Tennison technique combined with modified v-advancement vermillion flap.
The bulge and deficiency at lateral vermilion were decreased in the group treated by Tennison technique with modified v-advancement vermilion flap. However, the difference was statistically insignificant.