Reconstruction of Major Dehiscence After Bilateral Cleft Lip Repair

Abstract

Repair of complete bilateral cleft lip with protruding premaxilla is challenging, and postoperative dehiscence was common. Re-repair is usually suggested for the dehisced lip, but other methods might be needed in unique situations. Evaluation was performed to check the presence of prolabial skin, wound scarring, and the position of premaxilla. Reconstruction plan was made to restore the anatomical components as possible and to repair under minimal tension. Two patients with major dehiscence were reported. In the first case, separation from the columella base and tissue destruction in central lip were noted. Repeated complete dehiscence on one side was reported in the second case before he was referred to our center. The premaxilla was protruding in both cases. Abbe flap was performed as delayed procedure in the first case. Reposition of the premaxilla in conjunction with lip repair was required in the second case. In both cases, adequate muscle approximation plus subcutaneous retention sutures were used to cope with the tension, and satisfactory healing was achieved. It is concluded that additional methods could be required for the reconstruction of major dehiscence after bilateral cleft lip repair. Careful planning and surgical execution ensured successful outcome.

Presurgical Orthopedic Treatment of a 3-Year-Old Child with Unoperated Complete Bilateral Cleft Lip and Palate and Protruding Premaxilla

“…There were no significant surgical complications. The repaired lip did not dehisce, 28 the scars were considered acceptable, 29 there were no premaxillary or vomerine fractures, and the premaxillary segment remained vital and without vascular compromise. 30 Other potential complications related to surgical palatal repair in persons with BCCLP were avoided: necrosis, infection, and fistulas in palatal repair.…”

An Intraoperative Rescue Procedure for the Protruding Premaxilla in the Repair of Complete Bilateral Cleft Lip: Rapid Premaxillary Molding

“…We do not consider surgical adhesion or premaxillary setback in the primary reconstruction. When the tissue tension was significantly high in the presence of premaxillary protrusion, the postoperative dehiscence of the lip repair was reported from 24% to 45% with other complications (Deleyiannis, 2009; Narayanan and Adenwalla, 2013; Lim et al, 2018). Based on our experience, the intraoperative RPM is a reliable and useful adjunct procedure, as there was no dehiscence or other complications in our patients.…”

“…Early intervention during the first year of life, including lip adhesion (Innis, 1961; Bishara and Olin, 1972; Seibert, 1983; Millard and Latham, 1990; Berkowitz et al, 2004; Nemes et al, 2013), nasoalveolar molding (Grayson and Cutting, 2001; Lee et al, 2008; Garfinkle et al, 2011; Grayson and Garfinkle, 2014; Broder et al, 2016; Maillard et al, 2017), or even surgical premaxillary setback (Cronin, 1957; Niranjane et al, 2014) has been described as the treatment of protruding premaxilla. However, these procedures are not always successful (Maillard et al, 2017) and there are possible complications such as dehiscence (Lim et al, 2018), heavy scars on the lip tissue (Bardach and Salyer, 1991, Witt and Hardesty, 1993; Winters and Hurwitz, 1995), or unfavorable maxillary growth (Bishara and Olin, 1972; Koh et al, 2013).…”

A Commentary on an Intraoperative Rescue Procedure for the Protruding Premaxilla in the Repair of Complete Bilateral Cleft Lip: Rapid Premaxillary Molding

“…Long-term follow-up of this group of patients in underserved areas and providing ideal continuity of care have been challenging. In short-term follow-up, however, these patients had successful lip repair without dehiscence or any other complications (Lim et al, 2018).…”