Pattern of presentation and management of lip injuries in a. The concept underlying the technique can be similarly compared to a z plasty reconstruction of the lip. Most current techniques in north american focus on variations of the triangular flap technique of randalltennison,9, 10 or the rotation flap technique of millard11, 12. A history of cleft lip and cleft palate surgery pocket. The triangular flap technique recognizes that cupids bow is high on the cleft side. A triangular flap is made on the lateral side of the cleft, where the vermilion height is the greatest, just before the red line converges to meet the white roll at the cleft edge noordhoffs point. The tennisonrandall technique involves a backcut that extends from the cleft. Cleft lip and palate at university of british columbia. Millard rotationadvancement repair and tennisonrandall triangular flap technique. This approach provides continuity of the vermilion ridge, and promotes a natural appearance of the upper part of the philtrum on the cleft side.
Comparison between millards rotational advancement flap and. In twentytwo 10yearold uclap patients, who had the lip repaired using the tennisonrandall technique and did not undergo further revisional surgery, differences were determined between landmarks, surface areas of the upper lip vermilion and nostrils and virtual volumes of midface, nose and upper lip for cleft and noncleft sides, separately, after having established. Triangular cleft repair vanderbilt university medical center. Many papers have described surgery for congenital and acquired clefts. Tennison was inspired by lemesurier, but moved the zplasty to the cleft side cupids bow peak. The tennisonrandall technique then creates a too long lip on the affected side, since you bring in a triangle of extra tissue. For this reason, the internal bevel incision should be made as close to the tooth as possible i. Tennison z plasty tennison 1952 frustrated by straightline scar contraction in blacks zplasty technique which preserves the cupids bow and places it in normal position he inserted a wedge from the lateral lip into the lower portion of the medial lip, and achieved good results and called it stencil method came to be known as the tennison triangular flap technique. After suturing was complete, the skin wound was dressed with sofratulle gauze, over which dry gauze was placed, and plaster was ap. In 1966, thomas cronin from houston described elevation of the lateral triangular flap 1 mm above the mucocutaneous border to facilitate vermilion alignment. Child with an upper gi alteration 2 study guide by nd1993 includes 75 questions covering vocabulary, terms and more. 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. The geometry of thetriangular flap was described by randall, who popularized this method of liprepair. Triangular flap technique group t figure 1 millards rotational advancement flap technique group m figure 2 and was performed for 30 patients each.
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. Cleft lip operation tennisonrandall vs millard lip surgery. The second most commonly used method of lip repair uses the interdigitation of triangular flaps tennison and randall. Cleft lip and palate surger dental implant courses.
Child with an upper gi alteration 2 flashcards quizlet. Others have, on the other hand, adopted tennison randall technique in their cleft lip repair because of its geometrical predictability and reliability, consistency in decreasing vertical lip contraction, and its application in wide cleft. Unilateral cheiloplasty iowa head and neck protocols. This technique is based on careful measurements of specific landmarks. Quizlet flashcards, activities and games help you improve your grades. Karapandzic flap was used in one of the electrical burn patient due to the involvement of the oral commissure. Part 2 primary and secondary surgical surgical treatment.
The noordhoff technique utilizes a lateral lip triangular flap to reconstruct the dry. This incision opens to achieve the desired height of the medial lip. Randalls modification randall 1959 modified by reducing the size of the inferior. Physical assessment of the infant with cleft lip andor palate. Once the basic principles of cleft lip repair are fully understood the operation is fairly. The flap technique for pocket therapy pocket dentistry. Tennisonrandalls triangular technique is the most widely used triangular technique due to its geometrical predictability and reliability and its consistency. This point is chosen to create a symmetric cupids bow. Techniques of repair ul cleft lip millards rotational advancement modifications of millards technique. Technical strategies triangular with ala nasi tan repair of. 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. Jun 22, 2008 the tennison randall procedure is known as a geometrical design requiring exact presurgical measurements. The gingivolabial sulcus incision was made and simonarts band transected with needle point cautery and the premaxillary flap was raised to release the tissue.
Basic steps of triangular flap technique sorry for the low light subscribers, please turn up brightness on your device. The popularity of the triangular flap technique tennison randall dimin. The geometry of the triangular flap was described by. The rotation advancement technique of millard has the greatest number of followers and is recognized as a simple method once experience is obtained 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. Others have, on the other hand, adopted tennisonrandall technique in their cleft lip repair because of its geometrical predictability and reliability, consistency in decreasing vertical lip. These two points mark the base of the columella and the alar base. Tennisonrandall triangular flap repair it utilizes the interdigitation of triangular flaps geometric design.
Twentysix patients received the tennisonrandall technique and 74. This technique 5 matches a downward rotation flap on the medial lip with an advancement flap on the lateral lip. Nov 22, 2017 basic steps of triangular flap technique sorry for the low light subscribers, please turn up brightness on your device. Triangular with ala nasi tan repair of unilateral cleft li. Two points of closure along the nostril floor are designed so that. A comparative study of immediate wound healing complications.
Nasolabial symmetry following tennisonrandall lip repair. In addition, some operations specifically designed for congenital clefts require more complicated techniques. Jun 04, 2019 tennison introduced the triangular flap technique of unilateral cleft lip repair, which preserved the cupids bow in 1952. It involves the raising of a triangular flap at the cleft side lateral lip segment, which is moved into an artificial defect that is created in the medial lip segment after. The most important side of being learn easily of tennison randall technique is because of being geometrical. The tan repair lengthens the vertical lip using a triangular flap, resulting in a. This has proven extremely difficult to correct secondarily. Repair of the unilateral cleft lip advanced considerably during the past century 7, 8, with two methods being popular among clinicians. This surgical technique is applicable for all complete or incomplete unilateral cleft lips. The inclusion criteria were a non syndromic patients. The method of triangular repair most often described is p. 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. The triangular flap technique, originally presented in 1952 by tennison 1952 and modified in 1959 by randall 1959, is based on a geometric design and requires a high degree of precision in marking the incisions. Open rhinoplasty for correction of the secondary nasal.
The cleft lip appeared completely and incompletely in 11 and 21 patients, respectively. Surgical techniques for treatment of unilateral cleft lip intechopen. For example, the modified triangular flap, or tennisonrandall repair, can be of value. 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. Triangular flap repair of the congenital earlobe cleft. Standardized steps or criteria for designing a triangular flap do not always fit for all types of cleft lip repair. 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. 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.
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. The tennisonrandall procedure is known as a geometrical design requiring exact presurgical measurements. The popularity of the triangular flap technique tennisonrandall dimin ished in the 1970 to 1980s with the gaining popularity of the millard proce dure. Cleft lip surgery a practical guide the cleft surgery organisation. Surgical outcome and complications following cleft lip and. The techniques described for the repair of acquired clefts are not always appropriate for congenital clefts. On the other hand, our method also presents an excellent approximation of both the deep and. The technique plans for a diagonal incision directly above the raised lateral peak into the philtrum.
Nov 20, 2017 this incision opens to achieve the desired height of the medial lip. The geometry of the triangular flap was described by randall, who popularized this method of lip repair. A schematic representation of the incisions for a tennison. The noordhoff technique utilizes a lateral lip triangular flap to reconstruct the dry vermilion. This triangular flap approach became known as the tennison randall repair. Millard ii skoogs technique mohlers technique tennisonrandall triangular flap delaires functional lip closure afroze technique bl cleft lip straight line closure columella lengthening. Lemesurier 2 the pinch technique in blepharoplasty is most commonly used with which technique a. In an effort to not only demonstrate that excellent results can be achieved when incisional patterns millard and tennison are used appropriately small versus large clefts, we compared the results of two types of repairs, performed by a single surgeon over a period of 30 years. Unilateral cleft lip repair modified millards technique dr. However the triangular flap again gained popularity with widespread practice in many highly regarded institutions. This repair technique is conceptually similar to the rotation advancement repair. We applied the tan technique to 32 consecutive 19 male and female patients with unilateral cleft.
Tennisonrandall procedure and the millard procedure. For example, the modified triangular flap, or tennisonrandall repair, can be of value when presented with the wider unilateral cleft lip. The triangular flap operation sustained a long period of popularity with many variations. The rotation advancement technique of millard has the greatest number of followers and is recognized as a simple method once experience is obtained however, a number of surgeons prefer a triangular technique, since it seems simpler to lay out and perform and is. Tennison randall procedure and the millard procedure. In 1959, randall modified the tennison method by reducing the size of the inferior. For example, the lemesurier 7 quadrangular flap, and the tennison 8randall 9 triangular flap. The marcks zplasty modification of the tennison triangular flap cleft lip repair results in excellent preservation of the cupids bow, but in more severe clefts this technique is stigmatized by a characteristic vshaped nasal rim deformity. The tennison triangular flap technique described by randall demonstrates that the medial lip element contains the essential landmarks for cupids bow.
Dec 08, 2008 the tennison triangular flap technique described by randall demonstrates that the medial lip element contains the essential landmarks for cupids bow. 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. Flap and tennisonrandall flap techniques for surgical. It involves the raising of a triangular flap at the cleft side lateral lip segment, which is moved into an artificial. A retrospective evaluation of the aesthetics of the. Pdf comparison between millards rotational advancement flap. A distinct advantage of this technique is that the scar of the suture line recreates the natural philtral column. This triangular flap approach became known as the tennisonrandall repair. Millard rotationadvancement repair and tennison randall triangular flap technique. Tennison introduced the triangular flap technique of unilateral cleft liprepair, which preserved the cupids bow in 1952. The first dorsal metacarpal artery fdma flap or kite flap or fouchers flap is an island pedicle flap proximally based on the first dorsal metacarpal artery and veins william c pederson, 2011. A versatile technique to reconstruct the thumb mahesh prabhu1, rajesh powar 1 and sanjitsingh r sulhyan research paper background. Surgical techniques for treatment of unilateral cleft lip. Triangular with ala nasi tan repair of unilateral cleft.
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. 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. Randall built on tennisons design by adding key anatomic landmarks and geometric techniques to seek mathematic symmetry at closure. Tennison randall flap technique or triangular flap technique for. Though he called it a stencil method, it came to be known as the tennison triangular flap technique. Elevation of the mucosasubmucosa from the orbicularis oris muscle was performed on the lateral cleft flap first using 3397 scissors. The method is a modification of that of millard and involves a small triangular flap on the end of the vermilion ridge. There is no agreement on the ideal timing and the technique of repair among established and experienced cleft surgeons. The length of the noncleft side of the lip is our goal.