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      A comprehensive review of surgical techniques in unilateral cleft lip repair

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          Abstract

          Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures.

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          Presurgical nasoalveolar molding in infants with cleft lip and palate.

          B Grayson, Araceli Santiago, C Cutting … (1999)
          Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. In this paper, we present a paradigm shift from the traditional methods of presurgical infant orthopedics. Some of the problems that the traditional approach failed to address include the deformity of the nasal cartilages in unilateral as well as bilateral clefts of the lip and palate and the deficiency of columella tissue in infants with bilateral clefts. The nasoalveolar molding (NAM) technique we describe uses acrylic nasal stents attached to the vestibular shield of an oral molding plate to mold the nasal alar cartilages into normal form and position during the neonatal period. This technique takes advantage of the malleability of immature cartilage and its ability to maintain a permanent correction of its form. In addition, we demonstrate the ability to nonsurgically construct the columella through the application of tissue expansion principles. This construction is performed by gradual elongation of the nasal stents and the application of tissue-expanding elastic forces that are applied to the prolabium. Use of the NAM technique has eliminated surgical columella reconstruction and the resultant scar tissue from the standard of care in this cleft palate center.
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            Unilateral cleft lip repair: an anatomical subunit approximation technique.

            M. Fisher (2005)
            A technique of unilateral cleft lip repair is described. The repair draws from a variety of previously described repairs and adheres to a concept of anatomical subunits of the lip. Cases from within the spectrum of the deformity have been chosen from a series of 144 consecutive cases to demonstrate the applicability of the technique in all forms of unilateral cleft lip. Incisions cross the lip perpendicular to the cutaneous roll at the cleft side peak of Cupid's bow of the medial lip and at the base of the philtral column of the lateral lip. Above this level, incisions ascend the lip to allow for approximation along a line symmetrical with the non-cleft-side philtral column. Incisions then ascend superolaterally bordering the lip columellar crease to the point of closure in the nostril sill. A Rose-Thompson lengthening effect occurs just above the level of the cutaneous roll. If necessary, a small triangle positioned just above the cutaneous roll is often used. Any central vermilion deficiency is augmented by a laterally based triangular vermilion flap from the lateral lip element. Since January of 2000, this technique has been used in 144 consecutive unilateral cleft lip repairs. The inferior triangle is small (average, 1.24 mm; range, 0 to 2 mm). The technique can be applied to all degrees of unilateral cleft lip. A technique of unilateral cleft lip repair is described. The repair allows for a repair line that ascends the lip at the seams of anatomical subunits.
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              The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study.

              Kaixian Chen, David Huang, I. Subramanian … (2004)
              The purpose of this study was to assess the progressive changes of nasal symmetry, growth, and relapse after presurgical nasoalveolar molding and primary cheiloplasty in unilateral complete cleft lip/palate infants. Twenty-five consecutive complete unilateral cleft lip/palate infants were included. All the infants underwent nasoalveolar molding before primary cheiloplasty. Standard 1:1 ratio basilar photographs were taken before and after nasoalveolar molding, 1 week after cheiloplasty, and yearly for 3 years. Linear measurements were made directly on the photographs. The results of this study revealed that the nasal asymmetry was significantly improved after nasoalveolar molding and was further corrected to symmetry after primary cheiloplasty. After the primary cheiloplasty, the nasal asymmetry significantly relapsed in the first year postoperatively and then remained stable and well afterward. The relapse was the result of a significant differential growth between the cleft and noncleft sides in the first year postoperatively. To compensate for relapse and differential growth, the authors recommend (1) narrowing down the alveolar cleft as well as possible by nasoalveolar molding, (2) overcorrecting the nasal vertical dimension surgically, and (3) maintaining the surgical results using a nasal conformer.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Craniofac Surg
                Journal ID (iso-abbrev): Arch Craniofac Surg
                Journal ID (publisher-id): ACFS
                Title: Archives of Craniofacial Surgery
                Publisher: Korean Cleft Palate-Craniofacial Association
                ISSN (Print): 2287-1152
                ISSN (Electronic): 2287-5603
                Publication date (Print): June 2023
                Publication date (Electronic): 20 June 2023
                Volume: 24
                Issue: 3
                Pages: 91-104
                Affiliations
                Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
                Author notes
                Correspondence: Tae-Suk Oh Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail: tasuko@ 123456amc.seoul.kr
                Author information
                http://orcid.org/0000-0001-8174-8915
                http://orcid.org/0000-0002-6705-6274
                Article
                Publisher ID: acfs-2023-00268
                DOI: 10.7181/acfs.2023.00268
                PMC ID: 10365900
                PubMed ID: 37415466
                SO-VID: 9cbefd53-67ab-4e57-8cd6-fc3ef6582f63
                Copyright © Copyright © 2023 Korean Cleft Palate-Craniofacial Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 May 2023
                Date revision received : 30 May 2023
                Date accepted : 15 June 2023
                Categories
                Subject: Review Article

                Keywords: cheiloplasty,cleft lip,congenital
                Data availability:
                Keywords: cheiloplasty, cleft lip, congenital

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