Presurgical Unilateral Cleft Lip Anthropometrics: Implications for the Choice of Repair Technique

Abstract

The lateral lip is frequently short in both vertical and transverse dimensions. These findings warrant consideration for the use of repairs other than rotation advancement (and its variations) in the setting of lateral lip deficiency.

Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation

“…29,40 The former 21 can incorporate deficient tissues into the repair, 41 and the latter 29,40 can sacrifice lateral lip length. 19 Although measured ch-cphi increases with time following rotation advancement, 29,40 preservation of lateral lip length may be important to avoid the accordion effect of tissue advancement that reduces the natural fullness of the lip. Third, in contrast to rotationadvancement, the alar base is incorporated into the design of the lip repair.…”

“…19 When the lateral lip is short (i.e., complete clefts), the components need to fit into a smaller space and angles between incisions are made more acute (Fig. 1, below, left).…”

Cleft Lip, Cleft Palate, and Velopharyngeal Insufficiency

“…2,3 The transverse length of the lateral lip element (Noordhoff's point to the commissure) is almost always shorter than that of the noncleft side (Cupid's bow to the commissure). Lateral lip element hypoplasia, defined as combined height and transverse length deficiency, is present in 63 percent of patients with unilateral cleft.…”

“…Lateral lip element hypoplasia, defined as combined height and transverse length deficiency, is present in 63 percent of patients with unilateral cleft. 3 The orbicularis oris muscle is misdirected by the cleft. 4,5 On the cleft side, the lower bundle of the pars superficialis changes direction as it approaches the cleft to run almost vertically to find insertion to the cleft side nostril and periosteum of the piriform aperture.…”

Commentary on Anthropometric Effect of Mucoperiosteal Nostril Floor Reconstruction in Complete Cleft Lip

“…5,6 Limitations using modifications of Millard technique to address unilateral complete cleft lip with short lateral segment have been described by Fisher. 7 We have published a technique to correct lateral lip deficiencies (more than 6 mm in comparison with noncleft side) developed by us after long time using Millard modifications with limited results.…”