Correction of the Vestibular Web during Primary Repair of Unilateral Cleft Lip

Patel, Kamlesh B.; Mulliken, John B.

doi:10.1097/prs.0000000000000549

Cited by 20 publications

(14 citation statements)

References 33 publications

(47 reference statements)

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“…For manipulation of the nasal cartilage, a marginal incision was made on the cleft side to identify the lower lateral cartilage. The cartilage was then mobilized, and overlying fibro-fatty tissue was removed to facilitate cartilage elevation as previously described by Patel and Mulliken 41 (Fig. 3 ).…”

Section: Methodsmentioning

confidence: 99%

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Hammoudeh

Imahiyerobo

Fan

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:The optimal timing for cleft lip repair has yet to be established. Advances in neonatal anesthesia, along with a growing body of literature, suggesting benefits of earlier cleft lip and nasal repair, have set the stage for a reexamination of current practices.Methods:In this prospective study, cleft lip and nasal repair occurred on average at 34.8 days (13–69 days). Nasal correction was achieved primarily through molding the nasal cartilage without the placement of nasal sutures at the time of repair. A standardized anesthetic protocol aimed at limiting neurotoxicity was utilized in all cases. Anesthetic and postoperative complications were assessed. A 3-dimensional nasal analysis compared pre- and postoperative nasal symmetry for unilateral clefts. Surveys assessed familial response to repair.Results:Thirty-two patients were included (27 unilateral and 5 bilateral clefts). In this study, the overall complication rate was 3.1%. Anthropometric measurements taken from 3-dimensional-image models showed statistically significant improvement in ratios of nostril height (preoperative mean, 0.59; postoperative mean, 0.80), nasal base width (preoperative mean, 1.96; postoperative mean, 1.12), columella length (preoperative mean, 0.62; postoperative mean, 0.89; and columella angle (preoperative mean, 30.73; postoperative mean, 9.1). Survey data indicated that families uniformly preferred earlier repair.Conclusions:We present evidence that early cleft lip and nasal repair can be performed safely and is effective at improving nasal symmetry without the placement of any nasal sutures. Utilization of this protocol has the potential to be a paradigm shift in the treatment of cleft lip and nasal deformity.

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Section: Methodsmentioning

confidence: 99%

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Hammoudeh

Imahiyerobo

Fan

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…[ 1 2 3 4 5 6 7 ] The nose tissues should be preserved and not resected as recently proposed by Patel and Mulliken. [ 16 ] (c) The necessity of pre-surgical management lacks scientific support and should be considered as an alternative strategy.…”

Section: Discussionmentioning

confidence: 99%

Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty: An anthropometric study

Rossell-Perry

2017

Indian J Plast Surg

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Background:Secondary nose deformity after unilateral cleft lip repair is a common problem. Loss of tip projection on the cleft side of unilateral cleft lip nasal deformity can be difficult to correct due to lack of adequate support. The purpose of this study is to evaluate the surgical outcome after using V-Y-Z plasty to address unilateral cleft lip nasal deformities.Methods:A cross-sectional study of one surgeon's outcome of 58 performed primary complete unilateral cleft lip nasal deformity repairs. All these patients met the study criterion of having anthropometric measurements at the cleft and non-cleft side of the nose performed at least 1 year postoperatively.Results:Since 2012, 32 consecutive patients have undergone primary anatomical repair of the cleft nasal deformity in patients with a complete unilateral cleft. We have not found statistically significant differences between the cleft and non-cleft nostril dome height and columella length measured at least 1 year postoperatively.Conclusions:The findings suggest that the V-Y-Z plasty is a good alternative to create a more symmetric nasal tip in patients with primary unilateral cleft lip nasal deformity. Additional studies are required to evaluate functional and long-term outcomes after primary rhinoplasty in patients with unilateral cleft lip.

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“…2,9,10 Primary nasal repair was done at the time of lip repair using a semi-open approach, with placement of domal and intercartilaginous sutures under direct vision as previously described. 11 Centralization of the anterior caudal margin of the septum and release of the tail of the cleft side lateral crus in a V-Y fashion was performed before approximation of the domes. [12][13][14]…”

Section: Methodsmentioning

confidence: 99%

Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height

Chiang¹,

Zubovic²,

Skolnick³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry. Methods: Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut “poker incision” to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry. Results: Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], P = 0.56), demonstrating satisfactory upper lip symmetry. Conclusions: Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry.

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Correction of the Vestibular Web during Primary Repair of Unilateral Cleft Lip

Abstract: The vestibular web seen after repair of a cleft lip has bony, cartilaginous, and soft-tissue elements and can be prevented during primary correction of the cleft nasal deformity.

Cited by 20 publications

References 33 publications

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol

Primary unilateral cleft lip nasal deformity repair using V-Y-Z plasty: An anthropometric study

Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height

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