Does a Premaxillary Setback and Lip Adhesion Have a Negative Impact on Lip Outcome in Bilateral Cleft Patients?

Background: The purpose of this study was to evaluate the surgical outcome after using primary surgery to address bilateral cleft lip nose and palate deformities. In addition, the authors performed a systematic review to evaluate the effects of the nasoalveolar molding on non-syndromic bilateral cleft lip and palate. Methods: A prospective cohort study on a surgeon’s surgical outcome of 25 consecutively performed primary bilateral cleft lip nasal deformity repairs was conducted and a systematic review of the literature for studies published until December 2019 was done to evaluate the effect of presurgical NAM on nasolabial aesthetics and alveolar gap. Results: Since 2014, 25 consecutive patients with complete bilateral cleft have undergone primary anatomical repair of the cleft nasal deformity using primary cheilorhinoplasty. The average columella length was 4.3 ± 1.3 mm. The average ratio of the columella height to nasal height was 0.48 mm 1 year postoperatively and 0.52 mm 5 years postoperatively. Statistically significant differences have been observed between the pre and postoperative alveolar and palatal gaps after using primary cheiloplasty or bilateral lip adhesion. After systematic literature searching, 14 identified studies were qualified for the final analysis, which included 433 patients. The overall study quality according to Oxford CEBM and GRADE scale was low. Conclusions: The results of this study suggest that the proposed primary cheilorhinoplasty is a good alternative to improve nose appearance and alveolar gap in patients with primary bilateral cleft lip nose and palate deformity. Based on the available scientific evidence, definitive conclusions about the effectiveness of presurgical Naso Alveolar Molding on nasolabial aesthetics cannot be drawn. Quality of the included articles were too low to make a conclusion.

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“…Severe bilateral cleft lip and palate has been defined as a bilateral cleft lip with alveolar gap wider than 1 cm (in 1 or 2 sides). 13 …”

Section: Methodsmentioning

confidence: 99%

Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review

Rossell-Perry

Olivencia-Flores

Delgado-Jimenez

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…These reports discussed that lip adhesion creates unnecessary scarring from an additional procedure and causes abnormal tethering in the lip and nose elements 15,18,19,21,35 . However, a number of reports state that scarring from lip adhesion does not interfere with the appearance of the lip following lip repair, 10,36 and we also report that during the procedure, with meticulous dissection and without involving essential anatomical landmark, the scarring would not interfere with lip repair. Furthermore, by performing lip adhesion, not only the cleft width is reduced, but also the severe malposition of the maxillary segments can be corrected, thereby allowing inexperienced practitioners to perform lip repair more easily.…”

Section: Discussionmentioning

confidence: 58%

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients

Lee

Bae

Seo

2021

Journal of Craniofacial Surgery

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Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and noncleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 AE 0.15, and the lateral lip height ratio was 0.91 AE 0.09 (P < 0.001). No significant differences were observed in lip width and vermilion height between the cleft and non-cleft sides of the upper lip of 6-year-olds; the alar base width ratio was 1.22 AE 0.16, medial lip height ratio was 1.11 AE 0.11, and lateral lip height ratio was 0.89 AE 0.09 (P < 0.05). There were no significant differences in the alar projection and nasal dome height on the cleft side of the nose; the nostril height and width ratios were 0.82 AE 0.11 and 1.31 AE 0.21 (P < 0.001), respectively. These consecutively performed lip adhesions for patients with wide unilateral complete cleft lip resulted in excellent long-term results. Therefore, lip adhesion for wide unilateral complete cleft lip is a reasonable alternative to presurgical molding.

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“…The projection of the premaxilla was measured from the alveolar arch of the lateral segment to the premaxillary arch on CT images. It has been reported that patients with bilateral cleft lip with a protruding premaxilla of more than 10 mm achieved noninferior lip symmetry after premaxillary setback with vomerine ostectomy as patients with less severe original deformities 12) .…”

Section: Discussionmentioning

confidence: 99%

Surgical Premaxillary Setback with Vomerine Ostectomy for Complicated Bilateral Cleft Lip

Oda

Ojima

Ayabe

et al. 2024

JPRS

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Important factors that affect the initial repair of complete bilateral cleft lip (CBCL) include not only the width of the cleft but also the distance between the premaxilla and alveolar bone. We report a case of a patient with CBCL in whom favorable morphological and aesthetical results were achieved by surgical premaxillary setback. The patient was a 5-month-old boy with CBCL, who had a severely protruding premaxilla. Despite repeated lip adhesion before lip closure surgery, wound dehiscence occurred, and therefore, we performed premaxillary setback with vomerine ostectomy. The bone was removed posterior to the vomero-premaxillary suture, and the premaxilla was indirectly stabilized by bilateral mucosal bridging. The procedure for the vomer worked well, and his premaxilla was moved back enough to undergo surgery. The premaxillary setback is thought to be a reasonable option to treat CBCL in patients with a protruding premaxilla. The subsequent long-term follow-up of the midfacial development of these patients is necessary.

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Does a Premaxillary Setback and Lip Adhesion Have a Negative Impact on Lip Outcome in Bilateral Cleft Patients?

Abstract: Bilateral cleft patients with a protruded and deviated premaxilla over 10 mm discrepancy of the lateral maxillary achieved noninferior lip symmetry 1 year postoperatively compared with patients with less severe original deformity.

Cited by 7 publications

References 23 publications

Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review

Surgical Nasoalveolar Molding: A Rational Treatment for Bilateral Cleft Lip Nose and Systematic Review

Results of Lip Adhesion in Wide Unilateral Complete Cleft Lip Patients

Surgical Premaxillary Setback with Vomerine Ostectomy for Complicated Bilateral Cleft Lip

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