Primary unilateral cleft lip repair

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Abstract

The unilateral cleft lip is a complex deformity. Surgical correction has evolved from a straight repair through triangular and quadrilateral repairs to the Rotation Advancement Technique of Millard. The latter is the technique followed at our centre for all unilateral cleft lip patients. We operate on these at five to six months of age, do not use pre-surgical orthodontics, and follow a protocol to produce a notch-free vermillion. This is easy to follow even for trainees. We also perform closed alar dissection and extensive primary septoplasty in all these patients. This has improved the overall result and has no long-term deleterious effect on the growth of the nose or of the maxilla. Other refinements have been used for prevention of a high-riding nostril, and correction of the vestibular web.

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Most cited references 40

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Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study.

Betty Chien-Jung Pai, Ellen Wen-Ching Ko, Chiung-Shing Huang … (2005)

To assess nostril symmetry and alveolar cleft width in infants with unilateral cleft lip and palate following presurgical nasoalveolar molding (NAM). Fifty-seven newborn patients underwent presurgical nasoalveolar molding. Magnified basal view facial photos were taken at four different times: initial visit (T1), before cheiloplasty (T2), 1 month after cheiloplasty (T3), and 1 year of age (T4). Direct measurements from the photos included: (1) nostril width on the affected and nonaffected side; (2) nostril height on the affected and nonaffected side; (3) columella-nasal base angle; and (4) width of the alveolar cleft. Nostril width and height data were used to calculate a ratio of affected to nonaffected side. Effects of nasal symmetry after presurgical nasoalveolar molding were compared between the affected and nonaffected side. The nostril width ratio was 1.7, 1.2, 1.0, and 1.2 for T1 to T4. The nostril height ratio was 0.5, 0.8, 1.0, and 0.9 for T1 to T4. The angle of the columella was 53.3 degrees , 69.9 degrees , 91.2 degrees , and 86.9 degrees for T1 to T4. The average alveolar cleft width was 8.2 mm at T1 and closed down to 2.4 mm before cheiloplasty (T2) in cases with complete cleft. Infants with presurgical nasoalveolar molding improved symmetry of the nose in width, height, and columella angle, as compared to their presurgical status. There was some relapse of nostril shape in width (10%), height (20%), and angle of columella (4.7%) at 1 year of age.

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Primary correction of the unilateral cleft lip nose: a 15-year experience.

Kenneth Salyer (1986)

This paper reviews a 15-year personal experience based on 400 unilateral cleft nasal deformities that were reconstructed using a method that repositions the alar cartilage by freeing it from the skin and lining and shifts it to a new position. The rotation-advancement lip procedure facilitates the exposure and approach to the nasal reconstruction. The nasal soft tissues are transected from the skeletal base, reshaped, repositioned, and secured by using temporary stent sutures that readapt the alar cartilage, skin, and lining. The nasal floor is closed and the ala base is positioned to match the normal side. Good subsequent growth with maintenance of the reconstruction has been noted in this series. The repair does not directly expose or suture the alar cartilage. Improvement in the cleft nasal deformity is noted in 80 percent of the cases. Twenty percent require additional techniques to achieve the desired symmetry. This method has been used by the author as his primary unilateral cleft nasal repair and has been taught to residents and fellows under his direction with good results. This technique eliminates the severe cleft nasal deformity seen in many secondary cases.

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A triangular flap operation for the primary repair of unilateral clefts of the lip.

Stephen K. Randall (1959)

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Plast Surg

Journal ID (publisher-id): IJPS

Title: Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India

Publisher: Medknow Publications (India )

ISSN (Print): 0970-0358

ISSN (Electronic): 1998-376X

Publication date (Print): October 2009

Volume: 42

Issue: Suppl

Pages: S62-S70

Affiliations

Department of Plastic Surgery, Burns, Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies, Jubilee Mission Medical College & Research Institute, Trichur-680 005, Kerala, India

Author notes

Address for Corrsepondence: Dr. H.S. Adenwalla, Charles Pinto Centre for Cleft Lip and Palate, Jubilee Mission Hospital, Trichur, India. E-mail: charlespinto@ 123456sify.com

Article

Publisher ID: IJPS-42-62

DOI: 10.4103/0970-0358.57189

PMC ID: 2825078

PubMed ID: 19884683

SO-VID: 30535da2-3ecc-4c63-92eb-89a464348e3a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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