Lip adhesion revisited: A technical note with review of literature

Abstract

Context (Background):Lip adhesion is a direct edge approximation without changing lip landmarks or disturbing tissue required for definitive closure. This converts a complete cleft into an incomplete cleft, facilitating and enhancing subsequent definitive lip and nose repair.Aim:The study aims to describe our technique of lip adhesion and its morbidity, and discuss the rationale for its use.Settings and Design:Retrospective follow-up study of complete clefts operated upon in the Bruges Cleft and Craniofacial Centre, at the supra regional teaching hospital AZ St. Jan, Bruges, between June 1, 1991 and May 1, 2009.Methods and Material:The group comprised 33 unilateral and 24 bilateral lip adhesion procedures. The medical files were reviewed for changes in surgical technique, morbidity, and complications and their treatment.Results:The lip adhesion procedure was performed at the age of two to eight weeks postnatal, and definitive lip closure, at the age of four to six months. In all cases, segment repositioning was further controlled by a palatal guidance plate. Wound dehiscence occurred in eight patients (14.0%), and three patients (5.3%) required reoperation.Conclusions:Although complications occurred, the beneficial effects of lip adhesion in combination with a guidance plate outweighed the risks for anatomical reconstruction of a platform for definitive lip and nose repair. Modifications are suggested to reduce these complications.

Does Initial Cleft Lip Width Predict Final Aesthetic Outcome?

“…16 In addition, reported rates of dehiscence can be as high as 24% in bilateral cases and 8% in unilateral cases. 17,18 Fortunately, no patients in our study experienced any of these complications; however, the complication risk profile is not inconsequential, and should be carefully weighed against the potential benefit on a case-bycase basis. We believe that the procedure should only be offered to patients with very wide clefts to limit the amount of soft tissue undermining, as undermining may potentially negatively impact maxillary growth.…”

“… 16 In addition, reported rates of dehiscence can be as high as 24% in bilateral cases and 8% in unilateral cases. 17 , 18…”

William H. G. Logan and His Bow

“…Proponents of Logan bow cite reduced incisional tension, protection of the upper lip from direct trauma while allowing easy access for wound care, and the ability to maintain dressings in place as reasons for using the device, but offer little to no objective evidence. 10 - 13 Some authors have reported using the device after cleft lip adhesion 14 while others have described preoperative use of Logan bow in hopes of reducing lip tension at the time of definitive cheiloplasty. 15 There are no formal reports of complications or adverse events associated with the use of Logan bow, although Logan himself noted irritation of the cheek skin as a potential problem.…”