Challenges in maxillofacial reconstruction on secondary cleft deformities

Abstract

Cleft surgery demands much on the meticulous surgical skills and aesthetic sense in relation to craniofacial growth and functions. With the understanding of genetic interplay and peer review on the surgical outcome, cleft surgeons have made great strides in treatment concept during the past decades. It is inevitable that secondary cleft deformities may rely on the cumulative effects of functional and morphological abnormalities from the stage of primary repair. Problems could range from uncorrected defects, complicated healing from initial repair, to some exaggerated developmental facial disharmonies as the patients attain adolescent or adult age. For this reason, the Cleft Palate Team is posed an immense challenge in treating the residual cleft deformities. Some of the challenges include large oronasal fistula, severe maxillary or midfacial retrusion, and pursuit of aesthetics on lip nose complex correction. These problems demand sophisticated surgical skills and sound understanding of craniofacial bio-physiology. The sequential treatment strategy of secondary cleft reconstruction as practiced in the United Christian Hospital is considered as the foundation in the management of those challenging maxillofacial complexities. The purpose of the present paper is to share our sequential protocol practiced in the United Christian Hospital as a foundation to accomplish those maxillofacial complexities. Treated clinical cases demonstrate the innovative application of distraction osteogenesis on severe cleft skeletal correction, the use of tongue flap for repair of large oronasal defect, and corrective radical rhinoplasty with fascial graft augmentation. The last section of the present report is concentrated on the practical application of Nasal Symmetry Index for assessing result of cleft rhinoplasty.