29. Examples of Incomplete Clefts of Varying Degrees

29 EXAMPLES OF INCOMPLETE CLEFTS

OF VARYING DEGREES

KEY TO CODE ON CASES NOSE

NASAL FLOOR BD BIRTH DATE

FAMILY HISTORY

FT FIRST TRIMESTER LIP A1VEOLUS OCA OTHER CONGENITAL ANOMALIES

OP OPERATION AD ADHESION

ADV ADVANCEMENT

ROT ROTATION RA ROTATIONADVANCEMENT

HP HARD PALATE

SOFT PALATE

13 BONE GRAFT

BACKCUT

WR WHITE ROLL FLAP

FLAPC COLUMELLA

CLEFT IS INDICATED BY STIPPLING

UBMUCOUS CLEFT OR SUBMUCOUS DIS

BY HORIZONTAL LINES VERMILION NOTCH CASE

WEEKS POSTOPERATIVE

BD OCTOBER 16 1961 OP POSTERIOR VY ROLL DOWN OF FR UNKNOWN VERMILION WITHOUT SKIN INCISIONS FT UNKNOWN OCA INTERNAL STRABISMUS

MINIMAL CLEFT WITH CONGENITAL SCAR CASE

MONTHS MONTHS

BD MAY 15 1968 RA AT MONTHS COMMENT CONGENITAL SCAR WITH VET

FR NO CLEFTS OP ROT WITH BC FOR COL NEAL SHORTNESS OF LIP AND WIDTH OF

FT UNEVENTFUL ADV WITH WR ALAR BASE NASAL FLOOR REQUITED SCAR EXCISION OCA NONE DENUDED FOR INSERTION INTO AND MODERATE ROTATION AND AD

COLUMELLA BASE VANCEMENT TO GIVE NATURAL BALANCE

336 MINIMAL CLEFT WITH CONGENITAL SCAR CASE

BD MARCH21 1964

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT 7½ MONTHS OP ROT WITH BC FOR COL 72 MONTHS ADV WITH WR CLEFT VERMILION

EDGE INTERDIGITATION INTO NON CLEFT AT FREE BORDER

YEATS

COMMENT CONGENITAL SCAT WITH SHORTENING AND VERMILION NOTCH

REQUITED SCAR EXCISION MODERATE

ROTATION AND ADVANCEMENT NASAL

FLOOR WEDGE EXCISION MUSCLE SU AND TURE VERMILION INTETDIGIRATION TO ACHIEVE BALANCE IT4 2Y T5

37 MINOR CLEFT WITH CONGENITAL GROOVE CASE

SEPTEMBER 1964

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AR MONTHS OP ROT WITH FOR COL ADV WITH WR WEDGE FROM

NASAL FLOOR

III IN

141 MONTHS MONTHS

II IN

31 SI II

COMMENT IMPORTANT TO PTESERVE I4 II PHILTRUM DIMPLE AND CLEFT SIDE COL

UMN AS MUCH AS POSSIBLE 3YEARS PENICILLIN

MINOR CLEFT WITH CONGENITAL GROOVE CASE

18 MONTHS

MARCH 1964 AT 18 MONTHS COMMENT AIM TO PRESERVE COLUMN

FH NO CLEFTS OP ROT WITH BC FOR COL ON CLEFT SIDE AS WELL AS NORMAL SIDE FT UNEVENTFUL ADV WITH WR ALAR RIM CXCI AND STILL ROTATE DIMPLE AND BOW OCA NONE SION INTO BALANCED POSITION

HEALING SLIGHT CONTRACTURE

MINOR CLEFT WITH CONGENITAL GROOVE CASE

AR MONTHS COMMENT SCAR BALANCES BD APRIL 1969 OPPOSITE FH NO ANOMALIES OP ROT WITH FOR COL COLUMN MAINTAINING CENTRAL DIM K4I FT MOTHER HAD ADV WITH WR ALAR RIM CXCI PIE SION STREP THROAT TREATED WITH AND MYCIN DRUG OCA NONE MINOR CLEFT CASE

NOVEMBER 1970

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT 32 MONTHS ROT WITH HC ADV WITH MONTHS MONTHS DAYS POSTOPERATIVE WR POSTERIOR MUCOSAL INTERDIG ITATION

COMMENT MORE ROTATION NECESSARY

THAN OBVIOUS AT FIRST GLANCE 10 MONTHS

II 340 MILION

MINOR CLEFT CASE

JULY 29 1963

FT UNEVENTFUL

RA AT MONTHS

OP ROT WITH FAT CAL ADV WITH WR

MONTHS MONTHS REVISIONS AT YEAT EXCESS VET TTIM SMALL SCAT TEVISIAN

MONTHS

COMMENT SCAR EXCISION WITH SLIGHT ROTATION AND ADVANCEMENT PLUS THE WHIRE ROLL ACHIEVED YEARS FLAP BALANCE MINOR CLEFT CASE

1960

ER ONLY ONE MALE SIBLING

WITH CONGENITAL LIP SCAR

AND CLEFT

FT UNEVENTFUL OCA NONE

RA AR MONTHS OP STANDARD RA WITHOUT RE

FINEMENTS EXCEPT FOR COL LATERAL

OVERLAP OF VERMILION MUCOSA

II REVISIONS 14 MONTHS POSTOPERATIVE

SLIGHT SCAR EXCISION VERMIL UPPER MONTHS ION TRIM ON CLEFT FREE BORDER

ORIGINAL DEFORMITY AND EARLY RESULT PUBLISHED IN PLAST RECONSTR SURG 3336 1964

COMMENT LATERAL LIP ELEMENT THICKER

AND LONGER VERTICALLY THAN NONCLEFT ELEMENT BY ELEVATION OF ADVANCE

MENT INTO ROTATION GAP THIS DIS CREPANCY WAS BENEFITED LYEAR

342 MINOR CLEFT CASE 10

FEBRUARY 1962

FH NO CLEFTS

FT ONE DAY OF NAUSEA CRAMPS DIARRHEA OCA NONE

RA AR MONTHS OP ROT WITH HC FOR COL ADV WITH WR WEDGE FROM MONTHS NASAL FLOOR TRIMMING OF NORMAL VERMILION FREE BORDER

REVISIONS YEARS LATER REVISION OF VERMILION VERTICAL AND HORIZONTAL

FREE BORDER TRIMMING

MONTH POSTOPERATIVE

COMMENT THIS WAS ALMOST BILATERAL

CLEFT BUT EFFECTIVELY CORRECTED WITH UNILATERAL ROTATIONADVANCEMENT

AND WHITE ROLL FLAP IO YEARS HALFWAY CLEFT CASE 11

BD MAY 29 1957

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT MONTHS

OP EARLY STANDARD RA WITHOUT MONTHS MONTHS YEAT

REFINEMENTS AND WITH INTETDIGITA

NON OF VERMILION AT FREE BORDER

HP SP VY PUSHBATK AT 11 MONTHS

REVISION AT 11 MONTHS CLEFT SIDE VERMILION TRIMMED

COMMENT WELLBALANCED RESULT

EVEN THOUGH WHITE ROLL FLAP NON

BEING USED YET HERE MUSCLE TISSUE

FROM THE CLEFT EDGE WOULD BE USED

TO FILL OUT THE DEPRESSION IN THE

UPPER PORTION OF THE LATERAL LIP ELE

MENT PRIMARILY NOW 15 YEARS

LH 344 II

11 HALFWAY CLEFT CASE 12

MONTHS

10 13 YEARS YEARS YEARS

WHITE ROLL OCTOBER 1959 RA AR MONTHS COMMENT CONTINUITY REFINEMENTS ACHIEVED BY MM SKIN GRAFT FROM MOTHER HAS CLEFT OP RA WITHOUT NO THE ARM AS PRIMARY WHITE ROLL FLAP NOSE DEFORMITY WR FLAP WAS NOT USED IN 1959 PATIENT WITHOUT CLEFT BEING HE HAD CLEFT AR MUCOCUTANE DOES NOT KNOW LIP HALFBROTHER REVISION YEARS ON MATERNAL SIDE OUS WHITE ROLL CREATED BY TINY SKIN

HAS CLEFT LIP GRAFT FROM ARM

WITH NASAL DE AND RESULT FORMITY AND AL ORIGINAL DEFORMITY EARLY AND PALATE VEOLAR DEFECT PUBLISHED IN CLEFT LIP BY FT UNEVENTFUL GRABB ROSENSTEIN AND BZOCH OCA NONE 1971 HALFWAY CLEFT CASE 13

MONTHS 4S MONTHS WEEKS POSTOPERATIVE

BD 1962 AT MONTHS MAY 22 RA COMMENT THE MUSDE DEFICIENCY IN FJ NO CLEFTS ROT WITH HC FOR COL THE OP UPPER PORTION OF THE LATERAL LIP FT UNEVENTFUL ADV WITH NOSTRIL WR FLOOR ELEMENT IS NOT EVIDENT IN EARLY OCA NONE EXCISION ALAR RIM EXCI WEDGE POSTOPERATIVE PHOTO MUSCLE FLAP SION FROM MEDIAL ELEMENT WOULD HE IN

SERTED INTO THIS DEFICIENCY DURING THE PRIMARY PROCEDURE IF DONE TO DAY

23 WAY CLEFT CASE 14

CI IL

4MONRHS 4MONTHS LYEAR

APRIL 30 1968 RA AT 4I MONTHS COMMENT UPPER PORTION OF LATERAL NO ROT WITH HC FH CLEFTS OP FOR COL LIP ELEMENT THIN AND DEFICIENT IN FT MEDICATION ADV WITH TO WR MUSCLE MUSCLE FLAP FROM EDGE OF

21 PREVENT MIS MEDIAL ELEMENT WOULD HAVE FILLED

III CARRIAGE OUR THE CONTOUR OCA NONE

II HALFWAY CLEFT CASE 15

NOVEMBER 20 1964

FH NO CLEFTS FT UNEVENTFUL

OP ROT WITH FOR COL ADV WITH WR POSTETIOR MEDIAL

MUCOSAL FLAP TO CLEFT SIDE

REVISIONS YEAR LATER ELLIPTICAL EXCISION FROM FREE BORDER OF CLEFT

VY ADVANCEMENT OF ALAR BASE

COMMENT MUCOCURANEOUS RIDGE ON

THE LATERAL LIP ELEMENT FLATTENED OUR

TOO SOON IN THE ORIGINAL DEFORMITY

SO THAT GETTING STRONG RIDGE IN CONTINUITY ACROSS THE CLEFT WAS DIFFI CULT OF AT THE STELIN TWINS AND CLEFTS TWINS TWINNING RATE 133 1921 FOGH ANDERSEN 1962 INTERNATIONAL CLEFT PALATE CONGRESS IN AND FRENKEL IN 1970 REPORTED SIAI IF ANY TRAIT IS SOLELY GENETICALLY DETER IN HE 100 TWINS WITH MIRROR UNILATERAL BE SIMI 1973 COPENHAGEN REPORTED IMAGE MINED THERE SHOULD 100 PERCENT OF TWINS IN CLEFTS INCLUD THERE HAVE BEEN NO CONCER THIS PAIRS OVER 5000 REPORTS LARIRY IN MONOZYGOTIC TWINS DEGREE OF IDENTICAL ING 17 PAIRS OF MONOZYGORIC TWINS TREATMENT CONCORDANT OF CNNCORDANCE HOWEVER IS NOR FOUND HAVE HAD AMONG THESE WERE TWO PAIRS OF IDENTICAL BUT AS PAIR AS PATIENTS AS POINTED OUR BY FOGH ANDERSEN IN CONCORDANT TWINS ONE THEY ARE FOR YOUR STUDY ACCORDIN DIFFERENCE IN MONOZYGORIC PAIR 1942 ANY PHYSICAL MONOZY HAD UNILATERAL LEFT COMPLETE CLP THE COHN CONDRON ONCE MEDICAL DIRECT TWINS MAY BE ATTRIBUTED TO EXOG GONE THE OF MIAMI MAILMAN OTHER PAIR HAD UNILATERAL LEFT INCOMPLETE UNIVERSITY CT ENOUS FACTORS INFLUENCING THE AFFECTED WITH FOR CHILD THERE IS CL THERE WAS ALSO PAIR SYMMET DEVELOPMENT TWIN OR TO AN ARREST OF MANIFESTATION IN RICAL OR MIRROR TYPE RIGHT AND LEFT COM WHELMING EVIDENCE THAT THESE BOYS THE APPARENTLY NORMAL TWIN TWINS WITH PLERE CL MONOZYGOTIC SINGLE PLA MENRAKOS METRAKOS AND BAXTER IN 1958 IN MONOCHORIONIC STATE AND COM REPORTED PAIR OF MONOZYGORIC TWINS ONE IN 1972 FOR ENGLAND AND WALES BLAKE AMNION SHARING MOST COMMON WITH CL AND THE OTHER NORMAL NOR REFUTE RECORDED FOR THE YEAR 1968 819272 LIVE GROUP ANTIGENS BIAS RAMSEY AND WYNNWILLIAMS IN 1960 RE MIXED CULTURES WAR BIRTHS 8697 TWIN PREGNANCIES TWINNING LYMPHOCYTE PORTED PAIR OF MONOZYGONIC TWINS ONE AND SIMILA DERN OF WITH CLEFTS HE EXTRA HAVING REMARKABLY WITH LEFT UNILATERAL AND THE OTHER RATE 194 1175 CLP AND COUNTS NUMBER OF MONO GLYPHICS RIDGE WITH BILATERAL CLP IN 1966 BOOCHAI POLARED EXPECTED OF TWINS REPORTED TWO PAIRS OF MONOZYGOTIC TWINS ZYGORIC TWINS 2609 30 PERCENT DIAMOND FLAPS FOR TWIN TUHERCIES NUMBEROF ONE PAIR HAD CLP AND NORMAL MATE BEING MONOZYGOTIC EXPECTED EACH IDENTICAL TWIN WITH HIS SYMMEL WHILE HAD THE OTHER PAIR RIGHT CLP 8697 CLEFTS IN TWINS 25 ONE CONCORDANT CLEFT NOT ONLY HAD ROTA AND THE OPPOSITE TWIN HAD LEFT MICRO 697 ADVANCEMENT BUT RECEIVED BLAKE AND WREAKES FORM CL IN 1972 THIRD OF THIS SHOULD BE MONOZYGOTIC DIAMONDSHAPED POSTERIOR MUCOSAL FIVE OF TWINS REPORTED PAIRS MONOZYGOTIC TWINS WITH CLEFTS IF 30 TO 40 PERCENT OF POSITION FLAP TO BOLSTER HIS ONE HAD CLEFTS OF PAIR UNEQUAL DEGREE MONOZYGOTIC TWINS WITH CLEFTS ARE CON RUBERELE WHILE THE OTHER FOUR PAIRS HAD ONE CLEFT CORDANT 1967 THERE FOGHANDERSEN NO MATTER HOW CAREFULLY NATURE AND ONE NORMAL EACH FOGHANDERSEN IN SHOULD HAVE BEEN THREE CONCORDANT MONO TO DUPLICATE OR HOW DILIGENTLY THE SUR OF OF 1971 PUBLISHED AN ACCOUNT PAIR TWINS IN ENGLAND AND WALES IN ZYGORIC ATTEMPTS TO ASSIST HER IDENTICAL MONOZYGOTIC TWINS ONE WITH UNILATERAL 1968 DUCNION DOES NOT OCCUR NOR ONLY HA AND THE OTHER WITH BILATERAL CLP CLP IN THE USA WITH 4000000 YEARLY TWIN DIFFERENCE IN VISUAL ACUITY REQU AND CITED IT AS ANOTHER TO EXAMPLE SUPPORT BIRTH RATE AND 47500 TWIN LIVE BIRTHS GLASSES BUT THE TWO LIPS SHOWSLIGHT HIS THAT CP IS DISTINCT THEORY GENETICALLY THE CLEFT RATE OF 1750 ONE 86 USING ARIONS IN THEIR HEALING GROWTH AND NOTED FROM CLP HE CAN THE NUMBER OF TWINS WITH EXTRAPOLATE OPMENR THEY ARE BOTH HOWEVER 47500 TWIN STUDIES IN DENMARK AND OTHER COUNTRIES ADJUSTED LITTLE GENTLEMEN CLEFTS 128 THAT IS 128 ARE THE SAME NO SINGLE EXAMPLE OF ONE TWIN 750 AND THE OTHER CP HAS PARTNER HAVING CLP TWINS WOULD BE BORN WITH CLEFTS YEARLY BEEN DESCRIBED YEN ONETHIRD OF THEM OR 42 WOULD BE MONO AROUND 14 OF THESE WOULD BE CON SINCE THEN HE HAS HAD FURTHER CONFIR ZYGONIC CORDANT HOW MANY OF THE 14 WOULD BE MATION WITH ANOTHER PAIR OF MONOZYGONIC CONCORDANT IS UNCERTAIN TWINS ONE UNILATERAL AND ONE BILATERAL SYMMETRICALLY THERE YEN IT SEEMS QUITE UNUSUAL THAT ARE AND ALSO PAIR WITH AN ISOLATED CLEFT PALATE THREE OF IDENTICAL CONCORD IN ONE AND BIFID UVULA IN THE OTHER ONLY EXAMPLES NR CLEFT IN TWINS RE IN 1922 DAVIS NOTED CASE OF LIPS MONOZYGONIC PORTED IN THE WORLD LITERATURE TWINS REPORTED BY SHEARER IN WHICH THERE WERE DAVIS 1922 FOGHANDERSEN 1942 1973 WHAT IS MORE DAVIS IN 1922 WROTE MANY BOY AND GIRL ONE OF WHOM HAD CLEFT OF OF HIS FRIENDS IN LARGE CLEFT SURGERY CLINICS THE SOFT PALATE THE OTHER CLEFT OF THE HARD LIKE BLAIR IVY FEDERSPIEL GILMER AND PALATE AND SINGLE HARELIP NEW AND ASKED IF THEY HAD ANY SUCH CASES DID NOT TWO INSTANCES OF IDENTICAL CONCORDANCE ZN THEY II EXACT MIRROR IMAGE COMPLETE UNILATERAL MONOZYGOTIC TWINS CLEFT LIPS HAVE BEEN REPORTED SHEARER IN 1942 IN DENMARK FOGHANDERSEN RE CLEFTS 26 PORTED OUT OF TOTAL OF 867

348 FL IIALFWAY CLEFTS CASE 16 17

MONTHS

MONTHS 43 YEARS

POSTERIOR MUCOSAL BD OCTOBER 1969 RA AR MONTHS FLAP FROM CLEFT ELEMENT CUR 1ST MUCOSA OF CLEFT AS TO CREATE RUBERCIE TWIN OP EDGE CUR AS OF PH CLEFTS CUPIDS BOW ALAR RIM EXCI NO FLAP TO LINE ALVEOLUS ROT WITH FT SION UNEVENTFUL BC FOR COL ADV WITH WR OCA NONE

MONTHS 16 MONTHS

OCTOBER 51969 COMMENT MONOZYGORIC TWINS WITH TWIN 2ND TWIN DIAMOND POSTERIOR MUCOSAL

PH NO CLEFTS FLAPS

OCA NONE HALFWAY CLEFT CASE 18

AUGUST 1960 FH NO CLEFTS

FT THTEATENED MISCATTIAGE AT

OCA NONE

RA AT MONTHS OP STANDARD RA WITHOUT REFINE FOR COL MENTS EXCEPT NO WR FLAP

UNFORTUNATELY MONTHS

TUBER REVISIONS AT YEARS VY CLE ALAR RIM EXCISION AR 10

YEARS DOUB1EBR VEST SCAR EX CISION

COMMENT MY COVER PUZZLE BOY 12 YEARS

350 FIALFWAY CLEFT CASE 19

OCTOBER 71963 FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT 2½ MONTHS OP ROT WITH FOR COL ADV WITH WR ALAT RIM CXCI

HP AT MONTHS VOMER FLAP DO SURE OF HP AT SP 18 MONTHS ISLAND FLAP PUSHBACK MONTHS 212 MONTHS REVISIONS AR MONTHS TRIM MING OF VERMILION FREE BORDER ALAR BASE ON NORMAL SIDE RE DUCED ALAR RIM EXCISION

COMMENT MORE OF CLEFT THAN VISI

BLE BUT CORRECTABLE WITH ROTATION AND ADVANCEMENT YEARS HALFWAY CLEFT CASE 20

BD NOVEMBER 28 1963 FH NO KNOWN ANOMALIES BUT

MOTHER ADOPTED FT UNEVENTFUL OCA HEMANGIOMA OF CHE

RA AT MONTHS MONTHS 32 MONTHS YEAR OP ROT WITH BC FOR COL ADV WITH WR POSTERIOR MU

COSAL INRERDIGIRARION

ILI

COMMENT BALANCED UP AND NOSE WITH CONTINUOUS MUCOCURANEOUS WHITE ROLL RIDGE 9YEARS

352 MRCX

IV ALFWAY CLEFT CASE 21

MONTHS

YEATS YEARS YEARS

COMMENT BY KEEPING THE SLIGHTLY BD NOVEMBER 1968 RA AT MONTHS ROTATION AND ROT WITH BC FOR COL WIDE NASAL FLOOR INTACT FH NO CLEFTS OP WITHOUT POSTERIOR MU ADVANCEMENT WAS POSSIBLE FT UNEVENTFUL ADV WITH WR NOSTRIL TOO MUCH BUT NASAL FLOOR REDUCING THE CLEFT OCA NONE COSAL INRETDIGITATION RIM EXCISION PRIMARILY WHEN SEEN AT AGE LI LEFT INTACT ALAR HEALED LACERATION OF HER RIGHT COM

MUCOSAL FREE MISSURE WAS MORE NOTICEABLE THAN REVISIONS AR YEARS RESIDUAL EFFECTS OF THE CLEFT AND BORDERTRIM ALAR BASE WEDGE EXCI ANY IRS SION WHITE ROLL TEVISION SURGERY HALFWAY CLEFT CASE 22

MONTHS MONTHS YEAR HEALTHY

HARD SCAR AT WEEKS AT MONTHS BD FEBRUARY 1965 RA 1ST ATTEMPT AT MONTHS FH NO CLEFTS CARDIAC ARREST COMPLETED AT SOFT WELLHEALED FT UNEVENTFUL MONTHS OCA NONE OP ROT WITH BC FOR COL ADV WITH WR WEDGE FROM COMMENT HAPPY ENDING AFTER

NASAL FLOOR HAZARDOUS BEGINNING

HALFWAY CLEFT CASE 23

MONTHS

THE DIFFERENCE IN THE BD OCTOBER 20 1971 RA AT MONTHS COMMENT OF THE OF THE BOW ON FR NO CLEFTS OP ROT WITH BC FOR COL HEIGHTS PEAKS NONCLEFT ELEMENT IS FT UNEVENTFUL ADV WITH WR ALAR BASE SU THE MM ONEHALF THE VERTICAL OC NONE TURED TO SEPTUM WITH NYLON POS EQUAL TO LENGTH OF THE THIS TENOR MUCOSAL INRERDIGITANION UPPER LIP 12 MM THE THAT LIMIT OF ALAN RIM EXCISION MUCOSASCRAP EXPLODES THEORY IS ALL TO ALVEOLUS TO MM RANDALL CRAMER II THE LENGTHENING THAT ROTATION CAN

ACHIEVE WITHOUT CROSSING INTO THE

NORMAL SIDE HALFWAY CLEFT CASE 24

BD AUGUST 27 1971 FII NO CLEFTS FT UNEVENTFUL GCA NONE

RA AT4MONTHS WITH BC FOT COL OP ROT ADV WITH WR ALAR BASE DE

NUDED AND SUTURED TO SEPTUM

ALAR RIM DENUDED AND TRANSPOSED

AS FLAP

SP CLOSURE OF SOFT PALATE AND VPMER TO BOTH SIDES OF MUCOPERI

OSREUM OF HARD PAHRE NO LENGTH MONTHS MONTHS EZUNG

REVISION FULLTHICKNESS HORIZONTAL

OF LIP ALONG NASAL JOIN TO

SHORTEN CLEFT SIDE SLIGHTLY RARE

MONTHS POSTOPERATIVE

NASAL FLOOR DENUDED AS TIP FALAR BASE WHICH WAS ADVANCED AND SUTURED TO THE SEP DENUDED AJAR RIM FLAP TRANS PTSED INTO THE NASAL TIP CREASE

YEAR 17

HALFWAY CLEFT CASE 25

MARCH 27 1972

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT MONTHS MONTHS MONTHS MONTHS POSTOPERATIVE OP MUCOSAL EDGES OF CLEFT USED

TO LINE SULCUS ROT WITH BC

FOR COL ADV WITH WR MEDIAL

MUSCLE EDGE FLAP TRANSPOSED UNDER

DEFICIENT RIP OF ADVANCEMENT FLAP PROLENE KEY SUTURE WEDGE FROM

NASAL FLOOR ALAR RIM EXCISION

COMMENT THIS IS THE INCOMPLETE

CLEFT USED FOR DEMONSTRATION IN

CHAPTER 27 IYEAR

FJ II

356 HALFWAY CLEFT SUBMUCOUS CLEFT ON THE OTHER HALF CASE 26

BD MAY 24 1972

FH NO CLEFTS

FT SPOTTING DURING EARLY WEEKS OCA NONE

AT MONTHS ROT WITH HC MEDIAL MONTHS OP EDGE MUSCLE FLAP INTO POCKET IN LATERAL FLAP GROOVE ADV WITH WR FLAP

NASAL FLOOR AND ALAR BASE INTACT AND ROTATED CLOCKWISE

MONTHS POSTOPERATIVE

COMMENT MEDIAL MUSCLE FLAP INTO

POCKET UNDER GROOVE TO FILL OUT

DEFICIENT TIP OF LATERAL FLAP SUE CESSFUL INNOVATION 17 MONTHS

57 23 WAY CLEFT CASE 27

BD JULY 13 1957

FR NO CLEFTS FT UNEVENTFUL OCA NONE

RA AR MONTH

OP STANDARD RA WITHOUT TE

FINEMENTS ALAR RIM EXCISION

CLEFT VERMILION INRERDIGIRARION AT

EDGE POSTERIORLY

REVISIONS AR YEARS WHITE ROLL

FLAP TRANSPOSED ACROSS SCAR AT MUCO CUTANEOUS REVISION OF JUNCTION MONTH MONTH FREE BORDER VERMILION

COMMENT THIS WAS BEFORE WHITE ROLL

FLAPS WERE BEING DONE PRIMARILY YEARS

II 358 23 WAY CLEFT CASE 28

WEEKS 22 MONTHS

YEARS

BD JANUARY 25 1958 RA AT WEEKS QMMENT THE DEFICIENCY OF MUSCLE FH NO CLEFTS STANDARD OP RA WITHOUT RE IN THE UPPER PORTION OF RHE LATERAL UNEVENTFUL FINEMENTS ALAR RIM EXCISION ADVANCEMENT FLAP NEEDS MUSCLE OCA NONE EDGE FLAP FOR EXTRA CONTOUR REVISIONS AT 10 MONTHS ALAR RIM

EXCISION CLEFT VERMILION EXCESS EXCISED AT YEARS SAME PROCEDURES

ORIGINAL DEFORMITY AND EARLY RESULT PUBLISHED IN FA MED ASSOC 52625 1965

359 23 WAY CLEFT CASE 29

BD FEBRUARY 21 1958

FH 3RD COUSIN WITH CLEFT LIP

AND PALATE FT UNEVENTFUL OCA NONE

RA AT 2½ MONTHS 2½ MONTHS 2½ MONTHS YEARS OP STANDARD RA WITHOUT RE

FINEMENTS EXCEPT FOR COL CLEFT

VERMILION OVERLAP TO NONCLEFR SIDE

REVISIONS AR YEARS REVISION OF VER MILION AT 14 YEARS VY VERMILION RUBERCIE TRIMMING EXCESS CLEFT VET MILION FREE BORDER ALAR RIM EXCISION

AND CHIN IMPLANT

ORIGINAL DEFORMITY AND EARLY RESULTS PUBLISHED IN PLAST RECCMSTR SURG 25595 1960 AND FA MED ASSOC 52625 1965

COMMENT IF SHE LOOKS THIS NICE AT

14 YEARS SHE WILL BE BEAUTIFUL AT 18 14 YEARS

360 23 WAY CLEFT CASE 30

BD OCTOBER 1958

NO CLEFTS

FT MOTHER HAD LEG INFECTION FIRST MONTH

AT MONTHS

OP STANDARD RA WITHOUT REFINE CLEFT MONTHS MONTHS MENTS MUCOSA INTETDIGIRA TION BEHIND FREE BORDER

ALAR RIM EXCISION

ORIGINAL DEFORMITY AND EARLY RESULT

PUBLISHED IN PLAST RECONSTR SURG 33 35 1964

MONTHS POSTOPERATIVE

COMMENT WHEN PATIENT WAS RE

CALLED AT AGE 13 MOTHER INFORMED ME THAT HER DAUGHTER DID NOT KNOW

SHE HAD HAD CLEFT LIP 13 YEARS

361 23 WAY CLEFT CASE 31

BD OCTOBER 71958 FH PATERNAL COUSIN BILATERAL

CLEFT LIP AND PALATE FT UNEVENTFUL OCA NONE

AT WEEKS

OP STANDARD RA WITHOUT REFINE MENTS

ISLAND FLAP PUSHBACK AT YEATS

RESISION AT YEARS VY ROLLDOWN

ON CLEFT SIDE VERMILION WEEKS

WEEK POSTOPERATIVE

SPA

COMMENT THIS CASE DID PRETTY WELL

WITHOUT WHITE ROLL FLAP YEARS

362 IL 23 WAY CLEFT CASE 32

JULY 21 1959 FATHER 42 MOTHER 34

NO CLEFTS FT UNEVENTFUL OCA NONE

RA AR MONTHS OP RA WITHOUT REFINEMENTS

CLEFT VERMILION OVERLAP TO MEDIAL CLERILCNR

COMMENT LACK OF REFINEMENTS IN

THIS EARLY CASE SHOWS LACK OF FINESSE

THE VERMILION FLAP FROM CLEFT SIDE

OVERLAPPING THE NONCLEFT SIDE RENDS

TO AN GIVE ASYMMETRY REQUIRING SECONDARY REVISION THIS IS REASON FOR SUBSEQUENT CHANGE TO STRAIGHT CLOSURE AT THIS POINT 23 WAY CLEFT CASE 33

BD JULY 16 1961 FH FATHER HAD LEFT UNILATERAL

CLEFT LIP AND PALATE FT UNEVENTFUL OCA NONE

RA AR 22 MONTHS MONTHS OP1 ROT WITH HC 2CFORCOL INCREASE MUCOSAL FLAP FROM CLEFT TO MIDRUHERCLE ALAR CRESCENT EXCI

SLON

REVISIONS AT 10 MONTHS POSTOPER

ATIVE DIAMOND EXCISION AT

MUCOCUTANEOUS JUNCTION TRIM

EXCISION OF CLEFT SIDE VERMILION

NOSTRIL SILL EXCISIONREVISION AT

YEARS AGAIN EXCISION AT MUCO CUTANEOUS JUNCTION ALAR RIM EXCISION NORMAL NOSTRIL REDUCED

WITH ALAR EXCISION

OMMEVT MUCOCUTANEOUS JUNCTION

AT SCAR NORCAMOUFLAGED BY WHITE ROLL

FLAP PRIMARILY SO NEVER NATURAL DIAMOND EXCISION IN THIS AREA WAS NOR EFFECTIVE 9½ YEARS

364

IR 23 WAY CLEFT CASE 34

JULY 24 1961

FT UNEVENTFUL OCA NONE

AT MONTHS

OP ROT WITH BC FOT COL

ADV WITH WR WITH VETMILION MONTHS MONTHS THEN DID NONCLEFT MUCOSA TO CLEFT

SIDE AT FREE BOTDET

HP VOMET FLAP AT 11 MONTHS

SP ISLAND FLAP PUSHBACK AT 15 MONTHS

REVISIONS AT 11 YEATS NORMAL ALAR BASE REDUCED DEPRESSED SCAR EXCISED VY MIDLINE TUBERCLE NORMAL VERMILION REDUCED

6YEARS

COMMENT GREATER LIP AND DISTORTIONDEFICIEOF THAN

IN MOST INCOMPLETE CLEFTS EASILY IT CORRECTED WITH THE ROTATIONAD VANCEMENT ACTION 11 YEARS 23 WAY CLEFT CASE 35

MONTHS

MONTHS COMMENT OF BILATERAL BD FEBRUARY 15 1963 RA AT 312 SUGGESTION NECESSITATED MUCOSAL FTEE EH MATERNAL UNCLE HAD OP ROT WITH BC FOR COL CLEFT ADV WITH BORDER REVISION AS SECONDARY CLEFT PALATE WT PRO FT UNEVENTFUL CEDURE OCA NONE REVISIONS AT YEAR VERMILION TRIM ALAR RIM EXCISION

23 WAY CLEFT CASE 36

MONTHS YEARS

BAND BD FEBRUARY 1968 AT MONTHS COMMENT USE OF SIMONARTS AS WITH BC FOR COL THE OF THE ADVANCE FH NO CLEFTS OP ROT LEADING POINT UNEVENTFUL ADV WITH WR MENT FLAP CA NONE AND PUSHBACK WITH ISLAND L4MONTHS LI FLAP AT

366 23 WAY CLEFT CASE 37

BD JULY 23 1964 FR NO CLEFTS FT UNEVENTFUL OCA NONE

AT MONTHS

OP ROT WITH BC FOT COL ADV WITH WT

MONTHS

WEEKS POSTOPETATIVE 4½ YEATS

COMMENT AT LEAST THE ROTATION SCAR

DOES NOT SEEM TO LIMIT HIS LIP AC NON YEATS

Y367 23 WAY CLEFT CASE 38

BD DECEMBER 11966

ER NO CLEFTS FT UNEVENTFUL OCA NONE

EX1 AR MONTHS OP ROT WITH HC FOR COL ADV WITH WR POSTERIOR MU

COSAL FLAP TO CLEFT SIDE ALAR RIM EXCISION

HP AND SP AT YEAR PUSHBACK

WITH ISLAND FLAP

REVISIONS AR REARS HORIZONTAL 22 MONTHS FULLTHICKNESS LIP EXCISION TO

SHORTEN CLEFT SIDE DENUDED ALAR

BASE ADVANCED TO SEPTUM TO REDUCE FLARE ALAR RIM EXCISION 15

COMMENT THIS IS RARE EXAMPLE OF

SLIGHTLY TOO MUCH ROTATION WHICH

REQUIRED FULLTHICKNESS HORIZONTAL

ELLIPTICAL EXCISION OF LIP AT ITS JOIN

ALONG THE ALAR BASE AND NOSTRIL SILL

ON THE CLEFT SIDE TO LIFT THE BOW TO NEAR SYMMETRY YEARS

368 23 WAY CLEFT CASE 39

BD JANUARY 18 1968

EH NO CLEFTS FT UNEVENTFUL NONE

RA AT MONTHS OP ROT WITH BC FOR COL NASAL FLOOR EXCISION ADV WITH WR ALAR RIM EXCISION MONTHS

REVISIE9N AT YEARS VY TUBERCIE VERMILION DENUDE ALAR BASE AND ADVANCE TO SEPTUM NORMAL ALAR BASE REDUCTION

CIRMMINT ROTATION WAS NOT CARRIED

INTO THE NORMAL SIDE BUT LIP SLIGHTLY

LONG VERTICALLY WHICH SUGGESTS THIS

IS NATURAL FOR THIS PATIENT YEARS

369 23 WAY CLEFT CASE 40

BD MAY 11 1970 FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT MONTHS OP ROT WITH BC FOT COL MONTHS MONTHS 12 MONTHS ADV WITH WT WEDGE FROM

NOSTTILFLOOT CTESCENT FTOM ALAT

HP AND SP AT 11 MONTHS PUSH

BACK IT

REVISIONS AT 1J MONTHS MUCOSA

FREE BORDER TTIM ALAR RIM FLAP TO COLUMELLA

COMMENT ROTATION DID NOT HUG COLUMELLA BASE QUITE ENOUGH SO THE

UPPER PART OF THE SCAR OF UNION IS

NOT QUITE CLOSE ENOUGH TO THE NOS

TRIL SILL PRETTY GOOD PRIMARY NASAL CORRECTION WITH ONLY COLUMELLA

LENGTHENING ALAR BASE POSITIONING AND ALAR RIM REVISIONING

FL II

370 34 WAY CLEFT CASE 41

MARCH 91960

COUSIN WITH CLEFT LIP WHO

DID NOT LIVE UNEVENTFUL OCA NONE

AT 32 MONTHS OP RA WITHOUT TEFINEMENTS EX FOR COL NO WT MNNRH CEPT FLAP

REVISIONS AT YEATS ALAT BASE

DEEPITHELIALIZED AND ADVANCED NORMAL ALAR BASE REDUCED

ZPLASRY OF VESTIBULE OPENED

MUCOCUTANEOUS FLAP

ACROSS CLEFT AT 13 YEATS ALAR LIFT

THROUGH HIGH ALAR MARGIN INCISION ANTERIOR SEPTUM FREED AT SPINE SCOTED ON LEFT SIDE AND MOVED TO

IT LIP MUSCLE APPROXIMA

TION WHITE TOLL INRERDIGIRARION

VY LIP MUCOSAL TOLLDOWN

COMMENT SEVERE INCOMPLETE CLEFT

WHICH STILL REQUIRES MINOR LIP AND NOSE REVISIONS 13 YEARS 34 WAY CLEFT CASE 42

MONTHS MONTHS

VESTIBULE INCLUDED IN ADV 12 YEARS FLAP YEARS CLEFT VERMILION OVERLAPPING INTER MARCH POINT OF LATERAL ADVANCE BD 21 1960 DIGIRATION ON NONCLEFT SIDE COMMENT

FH NO CLEFTS MENT FLAP HAD TO BE TAKEN FROM UP UNEVENTFUL REVISIONS AR SCAR MAKE IN THE NASAL VESTIBULE FT YEARS TO OCA NONE WHITE ROLL AT MUCOCURANEOUS JUNC TION ALAR BASE TRANSPOSED INTO NASAL FLOOR NORMAL ALAR BASE

REDUCED ALAR RIM CRESCENT EXCI SION

372 NH 34 WAY CLEFT CASE 43

JANUARY 17 1962

FH NO CLEFTS FT UNEVENTFUL OCA NONE

RA AT MONTHS

OP ROT WITH BC FOR COL ADV WITH WR ALAR RIM EXCI MONTHS MONTHS SION CONTRACRURE AT WEEKS

HP VOMER FLAP AT 10 MONTHS PUSHBACK WITH SP ISLAND FLAP AT 13 MONTHS

REVISIONS SLIGHT VERMILION TRIM AT

MONTHS POSTOPERATIVE

AND ORIGINAL DEFORMITY EARLY RESULT

PUBLISHED IN PART RECONSTR SURG

WEELTS POSTOPERATIVE

COMMENT ANOTHER EVIDENCE OF EARLY CONTRACTURE AT WEEKS THAT

SMOOTHED OUT IN SEVERAL MONTHS

THIS IS ONE OF THE FIRST WHITE ROLL

FLAPS 10 YEARS

373 34 WAY CLEFT CASE 44

BD AUGUST 12 1968

FH FATHERS PATERNAL GRAND MOTHER HAD CLP FT UNEVENTFUL OCA NONE

RA AT MONTHS ROT WITH BC FOR COL ADV

WITH WR POSTERIOR MUCOSAL FLAP

TO CLEFT SIDE SP AND SP PUSHBACK WITH ISLAND

FLAP AT YEAR

REVISIONS AT YEARS REDUCTION WEEKS OF CLEFT SIDE VERMILION REVISION

OF LATERAL LIP MUSCLE BULGE WITH OF THE FILLING OUT UPPER GROOVE ALAR RIM DENUDED AND TRANSPOSED

AS FLAP INTO THE WEAK AREA OF THE

NASAL RIP

COMMENT THE REPEATED NEED FOR LATERAL GROOVE BOLSTERING AND REVI SION OF CLEFT SIDE VERMILION CAUSED

CHANGE FROM POSTERIOR MUCOSAL FLAPS

TO MUSCLE EDGE FLAPS IN THE PRIMARY

SURGERY YEARS

III

IF 45 WAY CLEFT CASE 45

WEEKS MONTHS

11 YEARS 13 YEARS

MARCH 1959 SP CLOSED WITH WARDILL VY HAM COMMENT ONE OF THE EARLY CASES NO CLEFTS ULAR FRACTURE AND OSREOR LIMBERG COMPLICATED BY GROOVE OF MUSCLE FT UNEVENTFUL OMY DEFICIENCY IN THE LATERAL ELEMENT OCA NUNC AT RIB BONE BG 9½ YEARS SPLIT NO REFINEMENTS EXTENSIONS OR GRAFTS ACROSS AND IN CLEFT MODERN ADJUNCTS WERE USED AND AT WEEKS THE ROTATION SCAR IS LITTLE TOO OP RA WITHOUT RE REVISIONS AT MONTHS ALAR RIM OBLIQUE FOR NORMAL PHILTRUM LINE FINEMENTS CLEFT VET EXCISION FREE BORDER REVISION NO PRIMARY NASAL RIP CORRECTION MILION NONCLEFT SCAR OVERLAP LIP EXCISION AR YEARS LIP NECESSITATES REVISION AT 16 YEARS SIDE NONCLEFT MUCOSA SCAR REVISION VERMILION TRIM POSTERIOR TO TRANSPOSED MUCOCURANEOUS JUNCTION FLAP CLEFT SIDE NORMAL ALAR BASE REDUCED

375