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Facial Cleft and Pierre Robin Sequence

  • Anthony S. de Buys RoessinghEmail author
  • Oumama El Ezzi
  • Georges Herzog
  • Martin Broome
Chapter

Abstract

A typical facial cleft can be labial, labio-maxillary (unilateral or bilateral), labio-maxillary-palatal (unilateral or bilateral), or isolated palatal. We may also find a bilateral labial cleft or a labial cleft with a partial palatal cleft. They correspond to the Tessier 2 classification, and we will not describe the other types of Tessier clefts (1–14) which are much less common (Tessier, J Maxillofac Surg 4:69–92, 1976,[1]). Depending on the type of cleft and the age of the child, feeding, speech, and ear-nose-throat (ENT), dental, orthodontic, esthetic, and also psychological problems will be present (Malek, Classification and anatomo-clinical forms, in: Malek, ed., Lesions, pathophysiology and primary treatment cleft and lip palate, Martin Dunitz, London, 2000, pp. 17–26, [2]).

In developed countries, a multidisciplinary team includes several specialists who will handle the diverse problems of children born with a cleft and follow the child through each developmental stage (Jackson, Cleft lip and palate, in: Mustardé and Jackson, eds., Plastic surgery in infancy and childhood, Longman Group UK Limited, London, 1988, pp. 1–43, [3]). This is why the handling of a cleft starts at the time it is diagnosed, ideally before birth, and ends when the child is fully grown. It also requires the collaboration of obstetricians and geneticians. The concept of the multidisciplinary team is essential for the good and correct follow-up of the child born with a cleft and also of his family. The objective of the group is to bring together specialists in rehabilitation in order to optimize the care and the treatment in all fields: esthetic for the skin and functional for orthodontics, ENT and speech, and psychological. Only a multidisciplinary team can be fully efficient in helping children and their families, by offering optimal care according to priorities and demands. Such a team must include specialists in the medical and paramedical disciplines which might be involved in dealing with the sequelae at any age (Millard, The naming and classifying of clefts, in: Millard, ed., Cleft Craft, the evolution of its surgery, Little, Brown and Company, Boston, MA, 1976, pp. 41–52, [5]).

Progress in surgery and anesthesia over the last 50 years has been tremendous. The risk related to general anesthesia, present especially during the first 6 months of life, has been radically reduced. Major progress in ENT treatment and speech therapy has brought an improvement in the quality of life and a lessening of the long-term sequelae. Modern maxillofacial surgical techniques in orthodontics allow us to envisage solutions in cosmetic and functional rehabilitation.

The sequelae of facial clefts are many and involve many tissues, organs, and systems, from an esthetic point of view, the lip and the nose, and from a functional point of view, feeding at birth and long-term breathing and speaking. The impact on the personality of the child and his psychological well-being must also be taken into account (Stock and Feragen, Psychol Health 31:777–813, 2016, [5]). The heterogeneity within the groups of cleft types, the existence of associated anomalies, the different timing and surgical techniques of primary palatoplasty, the difference in speech therapy follow-up, and the evaluation techniques all complicate the evaluation of these sequelae.

Keywords

Cleft Pierre Robin sequence Syndrome Surgery Team 

Notes

Acknowledgments

The authors are grateful to Annette Wagnière for reviewing the English text.

References

  1. 1.
    Tessier P. Anatomical classification of facial, craniofacial and laterofacial clefts. J Maxillofac Surg. 1976;4:69–92.CrossRefPubMedGoogle Scholar
  2. 2.
    Malek R. Classification and anatomo-clinical forms. In: Malek R, editor. Lesions, pathophysiology and primary treatment cleft and lip palate. London: Martin Dunitz; 2000. p. 17–26.CrossRefGoogle Scholar
  3. 3.
    Jackson IT. Cleft lip and palate. In: Mustardé JC, Jackson IT, editors. Plastic surgery in infancy and childhood. London: Longman Group UK Limited; 1988. p. 1–43.Google Scholar
  4. 4.
    Millard R. The naming and classifying of clefts. In: Millard R, editor. Cleft Craft, the evolution of its surgery. Boston, MA: Little, Brown and Company; 1976. p. 41–52.Google Scholar
  5. 5.
    Stock NM, Feragen KB. Psychological adjustment to cleft lip and/or palate: a narrative review of the literature. Psychol Health. 2016;31:777–813.CrossRefPubMedGoogle Scholar
  6. 6.
    Bezerra JF, Oliveira GH, Soares CD, et al. Genetic and non-genetic factors that increase the risk of non-syndromic cleft lip and/or palate development. Oral Dis. 2015;21(3):393–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Persson C, Elander A, Lohmander-Agerskov A, et al. Speech outcomes in isolated cleft palate: impact of cleft extent and additional malformations. Cleft Palate Craniofac J. 2002;39:397–408.CrossRefPubMedGoogle Scholar
  8. 8.
    Gilboa SM, Broussard CS, Devine OJ, et al. Influencing clinical practice regarding the use of antiepileptic medications during pregnancy: modeling the potential impact on the prevalence of spina bifida and cleft palate in the United States. Am J Med Genet C Semin Med Genet. 2011;157:234–46.CrossRefGoogle Scholar
  9. 9.
    De Roo LA, Wilcox AJ, Lie RT, et al. Maternal alcohol binge-drinking in the first trimester and the risk of orofacial clefts in offspring: a large population-based pooling study. Eur J Epidemiol. 2016;31:1021–34.CrossRefGoogle Scholar
  10. 10.
    Millacura N, Pardo R, Cifuentes L. Effects of folic acid fortification on orofacial clefts prevalence: a meta-analysis. Public Health Nutr. 2017;23:1–9.Google Scholar
  11. 11.
    Mossey PA, Little J, Steegers-Theunissen R, et al. Genetic interactions in nonsyndromic orofacial clefts in Europe-EUROCRAN study. Cleft Palate Craniofac J. 2016;20:39–399.Google Scholar
  12. 12.
    Funato N, Nakamura M. Identification of shared and unique gene families associated with oral clefts. Int J Oral Sci. 2017;9(2):104–9.  https://doi.org/10.1038/ijos.2016.56.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ludwig KU, Ahmed ST, Böhmer AC, et al. Meta-analysis reveals genome-wide significance at 15q13 for nonsyndromic clefting of both the lip and the palate, and functional analyses implicate GREM1 as a plausible causative gene. PLoS Genet. 2016;11:e1005914.CrossRefGoogle Scholar
  14. 14.
    Hagberg C, Larson O, Milerad J. Incidence of cleft lip and palate and risks of additional malformations. Cleft Palate Craniofac J. 1998;35(1):40–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Rey-Bellet C, Hohlfeld J. Prenatal diagnosis of facial clefts: evaluation of a specialised counselling. Swiss Med Wkly. 2004;134:640–4.PubMedGoogle Scholar
  16. 16.
    Herzog G. Psychological impact and antenatal diagnosis on the future parents. In: Herzog G, editor. Smile. Pully: Triton Printers; 2011.Google Scholar
  17. 17.
    Baudon JJ, Renault F, Goutet JM, et al. Motor dysfunction of the upper digestive tract in Pierre Robin sequence as assessed by sucking-swallowing electromyography and esophageal manometry. J Pediatr. 2002;140:6.CrossRefGoogle Scholar
  18. 18.
    Myer CM, Reed JM, Cotton RT, et al. Airway management in Pierre Robin sequence. Otolaryngol Head Neck Surg. 1998;118:630–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Müller-Hagedorn S, Buchenau W, Arand J. Treatment of infants with syndromic Robin sequence with modified palatal plates: a minimally invasive treatment option. Head Face Med. 2017;13:4.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Caouette-Laberge L, Bayet C, Larocque Y. The Pierre Robin sequence: review of 125 cases and Evolution of treatment modalities. Plast Reconstr Surg. 1994;93:934–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Taylor MRG. The Pierre Robin Sequence: a concise review for the practicing paediatrician. Pediatr Rev. 2000;22:4.Google Scholar
  22. 22.
    Cohen MM Jr. Robin sequences and complexes: causal heterogeneity and pathogenetic/phenotypic variability. Am J Med Genet. 1999;84:311–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Sher AE. Mechanisms of airway obstruction in Robin sequence implications for treatment. Cleft Palate Craniofac J. 1992;29:224–31.CrossRefPubMedGoogle Scholar
  24. 24.
    Jamshidi N, Macciocca I, Dargaville PA. Isolated Robin sequence associated with a balanced t (2;17) chromosomal translocation. J Med Genet. 2004;41:e12004.CrossRefGoogle Scholar
  25. 25.
    Schaefer RB, Arun KG. Airway management in patients with isolated Pierre Robin Sequence during the first year of life. J Craniofac Surg. 2003;14:462–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Li HY, Lo LJ, Chen KS, et al. Robin Sequence: review of treatment modalities for airway obstruction in 110 cases. Int J Otorhinolaryngol. 2002;65:45–51.CrossRefGoogle Scholar
  27. 27.
    Marcellus L. The infant with Pierre Robin Sequence: review and implications for nursing practice. J Ped Nurs. 2001;16:23–34.CrossRefGoogle Scholar
  28. 28.
    de Buys Roessingh AS, Herzog G, Hohlfeld J. Respiratory distress in Pierre Robin: successful use of pharyngeal tube. J Ped Surg. 2007;42:1495–9.CrossRefGoogle Scholar
  29. 29.
    Yao C-T, Wang J-N, Tai Y-T, et al. Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway. Rescucitation. 2004;61:97–9.CrossRefGoogle Scholar
  30. 30.
    Argamaso RV. Glossopexy for upper airway obstruction in Robin sequence. Cleft Palate Craniofac J. 1992;29:232–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Denny AD, Amm CA, Schaefer RB. Outcomes of tongue-lip adhesion for neonatal respiratory distress caused by Pierre Robin Sequence. J Craniofac Surg. 2004;15:819–23.CrossRefPubMedGoogle Scholar
  32. 32.
    Easter B, Wood C, Eppley BL, et al. Mandibular traction system for adjunctive management of airway insufficiency in infants with Pierre Robin malformation sequence. Am J Occup Ther. 1991;191:941–3.CrossRefGoogle Scholar
  33. 33.
    Vieira TP, Monteiro FP, Sgardioli IC, et al. Clinical features in patients with 22q11.2 deletion syndrome ascertained by palatal abnormalities. Cleft Palate Craniofac J. 2015;52:411–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Veau V. Chirurgie. In: Veau V, editor. Bec-de-lièvre. Paris: Masson et Cie; 1938. p. 95–109.Google Scholar
  35. 35.
    Le Mesurier AB. A method of cutting and suturing the lip in the treatment of complete unilateral clefts. Plast Reconstruct Surg. 1949;4:1.CrossRefGoogle Scholar
  36. 36.
    Tennison CW. The repair of unilateral cleft lip by the strencil method. Plast Reconstruct Surg. 1952;9:115.CrossRefGoogle Scholar
  37. 37.
    Malek R. Surgical repair: other procedures. In: Malek R, editor. Lesions, pathophysiology and primary treatment cleft and lip palate. London: Martin Dunitz; 2000. p. 139–42.CrossRefGoogle Scholar
  38. 38.
    Skoog T. Cleft lip. In: Skoog T, editor. Plastic surgery. Stuttgart: Georg Thieme; 1974. p. 94–123.Google Scholar
  39. 39.
    Meyer R. Residual deformities of the columella. In: Meyer R, editor. Secondary rhinoplasty. Berlin: Springer; 2002. p. 247–71.CrossRefGoogle Scholar
  40. 40.
    Malek R. Primary treatment. In: Malek R, editor. Lesions, pathophysiology and primary treatment cleft and lip palate. London: Martin Dunitz; 2000. p. 51–89.CrossRefGoogle Scholar
  41. 41.
    Malek R. First stage: early primary veloplasty. In: Malek R, editor. Lesions, pathophysiology and primary treatment cleft and lip palate. London: Martin Dunitz; 2000. p. 139–42.CrossRefGoogle Scholar
  42. 42.
    Morris HL, Bardach J, Ardinger H, et al. Multidisciplinary treatment results for patients with isolated cleft palate. Plast Reconstr Surg. 1993;92:842–51.CrossRefPubMedGoogle Scholar
  43. 43.
    Furlow LT Jr. Cleft palate repair by double opposing Z-plasty. J Plast Reconstr Surg. 1986;78:724.CrossRefGoogle Scholar
  44. 44.
    Neimann GS, Duncan DS. Perceptions of social and vocational acceptable of adults with facial disfigurement and velopharyngeal insufficiency. Presented at the American Cleft Palate-Craniofacial Association Annual Meeting, New York, 1986.Google Scholar
  45. 45.
    Goudy S, Lott D, Canady J, Smith RJ. Conductive hearing loss and otopathology in cleft palate patients. Otorhinolaryngol Head Neck Surg. 2006;6:946–8.CrossRefGoogle Scholar
  46. 46.
    Flynn T, Möller C, Jönsson R, et al. The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts. Int J Pediatr Otorhinolaryngol. 2009;73:1141–446.CrossRefGoogle Scholar
  47. 47.
    Doyle WJ, Reilly JS, Jardini L, et al. Effect of palatoplasty on the function of the eustachian tube in children with cleft palate. Cleft Palate J. 1986;23:63–8.PubMedGoogle Scholar
  48. 48.
    Valtonen H, Dietz A, Qvarnberg Y. Long-term clinical audiologic and radiologic outcomes in palate cleft children treated with early tympanostomy for otitis media with effusion: a controlled prospective study. Laryngoscope. 2005;115:1512–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Grant HR, Quiney RE, Mercer DM, et al. Cleft palate and glue ear. Arch Dis Child. 1998;63:176–9.CrossRefGoogle Scholar
  50. 50.
    Sheean P, Miller I, Sheehan JN, et al. Incidence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaryngol. 2003;67:785–93.CrossRefGoogle Scholar
  51. 51.
    Watters GWR, Jones JE, Freeland AP. The predictive values of tympanometry in the diagnosis of middle ear effusion. Clin Otolaryngol. 1997;22:343–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Kay DL, Nelson M, Rosenfeld RM, et al. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg. 2001;124:374–80.CrossRefPubMedGoogle Scholar
  53. 53.
    Shapiro S. Otology findings of an Inuit population of cleft palate children. J Otolaryngol. 1998;17:101–2.Google Scholar
  54. 54.
    Shaw R, Richardson D, McMahon S. Conservative management of otitis media in cleft palate. J Craniomaxillofac Surg. 2001;31:316–20.CrossRefGoogle Scholar
  55. 55.
    El Ezzi O, Herzog G, Broome M, et al. Grommets and speech at three and six years in children born with total cleft or cleft palate. Int J Pediatr Otorhinolaryngol. 2015;79:2243–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Stewart KJ, Ahmad T, Razzell RE, et al. Altered speech following adenoidectomy: a 20 year experience. Br J Plast Surg. 2002;55:469–73.CrossRefPubMedGoogle Scholar
  57. 57.
    McWilliams BJ, Morris HL, Shelton RJ. Cleft palate speech. BC Decker: Philadelphia, PA; 1990.Google Scholar
  58. 58.
    Borel-Maisonny S. L’insuffisance vélaire, point de vue de l’orthophoniste. Reeduc Orthophon. 1975;13:61–81.Google Scholar
  59. 59.
    Shprintzen RJ. Evaluation of velopharyngeal insufficieny. Otolaryngol Clin North Am. 1989;22:519–36.PubMedGoogle Scholar
  60. 60.
    Trichet C, de Buys Roessingh AS, Herzog G. Fentes labio-palatines: guidance orthophonique au sein de l’équipe pluridisciplinaire. Archives de Pédiatrie. 2010;17:790–9.CrossRefGoogle Scholar
  61. 61.
    Marsh JL, Wray RC. Speech prosthesis versus pharyngeal flap: a randomized evaluation of the management of VP incompetency. Plast Reconstr Surg. 1980;65:592–4.CrossRefPubMedGoogle Scholar
  62. 62.
    Shprintzen RJ, Lewin M, Croft C. A comprehensive study of pharyngeal flap surgery: tailor made flaps. Cleft Palate J. 1979;16:46–55.PubMedGoogle Scholar
  63. 63.
    Herzog G. Dental sequelae—orthodontics. In: Herzog G, editor. Smile. Pully: Triton Printers; 2011.Google Scholar
  64. 64.
    Broome M, Herzog G, Hohlfeld J. Influence of the primary cleft palate closure on the future need for orthognathic surgery in unilateral cleft lip and palate patients. J Craniofac Surg. 2010;21:1615–8.CrossRefPubMedGoogle Scholar
  65. 65.
    Long RE, Semb G, Shaw WC. Orthodontic treatment of the patient with complete clefts of lip, alveolus and palate: lessons of the past 60 years. Cleft Palate Craniofac J. 2000;37:533.CrossRefGoogle Scholar
  66. 66.
    Rygh P, Tindlund R. In: Turvey TA, Vig KWL, Fonesca RJ, editors. Facial clefts and craniofacial synostosis. Principles and management. Philadelphia, PA: WB Saunders; 1995.Google Scholar
  67. 67.
    Scolozzi P, Verdeja R, Herzog G, et al. Maxillary expansion using transpalatal distraction in patients with unilateral cleft lip and palate. Plast Reconstruct Surg. 2007;119:2200–5.CrossRefGoogle Scholar
  68. 68.
    Daskalogiannakis J, Ross RB. Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J. 1997;34(5):455–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Herzog G. Feeding the baby. In: Herzog G, editor. Smile. Pully: Triton Printers; 2011.Google Scholar
  70. 70.
    Bishara SE, Jakobsen JR, Krause JC, et al. Cephalometric comparisons of individuals from India and Mexico with unoperated cleft lip and palate. Cleft Palate J. 1986;23:116–25.PubMedGoogle Scholar
  71. 71.
    Shetye PR. Facial growth of adults with unoperated clefts. Clin Plast Surg. 2004;31:361–71.CrossRefPubMedGoogle Scholar
  72. 72.
    Capelozza Filho L, Normando AD, da Silva Filho OG. Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP. Cleft Palate Craniofac J. 1996;33:51–6.CrossRefPubMedGoogle Scholar
  73. 73.
    Liao YF, Mars M. Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2005;42:594–600.CrossRefPubMedGoogle Scholar
  74. 74.
    Good PM, Mulliken JB, Padwa BL. Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate. Cleft Palate Craniofac J. 2007;44:396–401.CrossRefPubMedGoogle Scholar
  75. 75.
    Daskalogiannakis J, Mehta M. The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate. Cleft Palate Craniofac J. 2009;46:498–502.CrossRefPubMedGoogle Scholar
  76. 76.
    Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987;24:5–77.PubMedGoogle Scholar
  77. 77.
    Chigurupati R. Orthognathic surgery for secondary cleft and craniofacial deformities. Oral Maxillofac Surg Clin North Am. 2005;17:503–17.CrossRefPubMedGoogle Scholar
  78. 78.
    Posnick JC, Witzel MAS, Dagys AP. Management of jaw deformities in the cleft patient. In: Bardach J, Morris HL, editors. Multidisciplinary management of cleft lip and palate. Philadelphia, PA: WB Saunders; 1990.Google Scholar
  79. 79.
    de Buys Roessingh AS, Dolci M, Zbinden-Trichet C, et al. Success and failure for children born with facial cleft in Africa: a 15-year follow-up. World J Surg. 2012;36:1963–9.CrossRefPubMedGoogle Scholar
  80. 80.
    de Buys Roessingh AS, Cherpillod J, Herzog G, et al. Speech prognosis and need of pharyngeal flap for non syndromic vs syndromic Pierre Robin Sequence. J Ped Surg. 2008;43:668–74.CrossRefGoogle Scholar
  81. 81.
    de Buys Roessingh AS, Cherpillod J, Trichet C, Hohlfeld J. A comparison of the effect of a cranial-based pharyngeal flap on the speech of children born with a total cleft, an isolated cleft palate or a short palate. J Oral Maxillofac Surg. 2006;64:1736–42.CrossRefPubMedGoogle Scholar
  82. 82.
    Leuchter I, Schweizer V, Hohlfeld J, et al. Treatment of velopharyngeal insufficiency by autologous fat injection. Eur Arch Otorhinolaryngol. 2010;267:977–83.CrossRefPubMedGoogle Scholar
  83. 83.
    Brothers DB, Dalston RW, Peterson HD, et al. Comparison of the Furlow double-opposing Z-platoplasty with the Wardill-Kilner procedure for isolated clefts of the soft palate. Plast Reconstr Surg. 1995;95:969–77.CrossRefPubMedGoogle Scholar
  84. 84.
    Karling J, Henningsson G, Larson O, et al. Comparison between two types of pharyngeal flap with regard to configuration at rest and function and speech outcome. Cleft Palate Craniofac J. 1999;36:154–65.CrossRefPubMedGoogle Scholar
  85. 85.
    Karling J, Henningsson G, Larson O, et al. Adaptation of pharyngeal wall adduction after pharyngeal flap surgery. Cleft Palate Craniofac J. 1999;36:166–72.CrossRefPubMedGoogle Scholar
  86. 86.
    Barone CM, Shprintzen RJ, Strauch BS, et al. Pharyngeal flap revision: flap elevation from a sacred posterior pharynx. Plast Reconstr Surg. 1994;93:279–84.CrossRefPubMedGoogle Scholar
  87. 87.
    Becker M, Svenson H, Sarnäs KV, et al. Wardill procedures for primary palate repair in patients with isolated cleft palate-speech results. Scand J Plast Reconstr Surg Hand Surg. 2000;34:27–32.CrossRefPubMedGoogle Scholar
  88. 88.
    Argamaso RV, Shprintzen RJ, Strauch B, et al. The role of lateral pharyngeal wall movement in flap surgery. Plast Reconstr Surg. 1980;66:214–8.CrossRefPubMedGoogle Scholar
  89. 89.
    Witt PD, Myckatyn T, Marsh JL. Salvaging the failed pharyngoplasty: intervention outcome. Cleft Palate Craniofac J. 1998;35:447–53.CrossRefPubMedGoogle Scholar
  90. 90.
    Ahl R, Harding-Bell A, Wharton L, et al. The buccinator mucomuscular flap: an in-depth analysis and evaluation of its role in the management of velopharyngeal dysfunction. Cleft Palate Craniofac J. 2016;53:177–84.CrossRefGoogle Scholar
  91. 91.
    Schönborn. zit n.Sanvenero-Rosselli, 1865.Google Scholar
  92. 92.
    Sanvenero-Rosselli G. Die Gaumenplastik unter Verwendung von Pharynxlappen Langenbecks. Arch Klein Chir. 1960;56:295.Google Scholar
  93. 93.
    Fischer-Brandies E, Nejedlo I. A modification of the Sanvenero-Rosselli velopharyngoplasty. J Craniomaxillofac Surg. 1991;21:19–21.CrossRefGoogle Scholar
  94. 94.
    Barot LR, Cohen MA, Larossa D. Surgical indications and techniques for posterior pharyngeal flap revision. Ann Plast Surg. 1986;16:527–31.CrossRefPubMedGoogle Scholar
  95. 95.
    Meyer R. Residual deformities of the ala. In: Meyer R, editor. Secondary rhinoplasty. Berlin: Springer; 2002. p. 295–309.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anthony S. de Buys Roessingh
    • 1
    Email author
  • Oumama El Ezzi
    • 1
  • Georges Herzog
    • 1
  • Martin Broome
    • 1
  1. 1.Multidisciplinary Cleft TeamUniversity Hospital Center of the Canton of Vaud (CHUV)LausanneSwitzerland

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