Repair of Bilateral Cleft Lip: Review, Revisions, and Reflections

Abstract

Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.

Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya

“…A good proportion of our patients were operated on after their first year of life. Most centers in the developed countries operate cleft lip at around four months of age, using the rule of ten as a general guiding principle [5,12]. This is, however, not the case in the developing countries like ours.…”

“…It, however, to minimally addresses the nasal deformity and therefore for patients with severe nasal deformity would always result in suboptimal results. Mulliken type of repair best addresses the nasal deformity in bilateral cleft lip [5]. It encompasses greater dissection of the nose with removal of the fibrofatty tissues between the lower cartilages.…”

“…However, this is not necessarily true. Many authors have reported very satisfactory results with bilateral cleft lip surgeries [4,5].…”

Patterns of Secondary Deformities After Bilateral Cleft Lip Repair in A Cohort of Patients

“…It is for the same reason that secondary revision is more frequently necessary in bilateral cleft lip repairs. 7 Finding may be attributed to the fact that as compared to unilateral clefts, bilateral cleft lips have double the amount of soft tissue defect. Similarly suture lines are not only double, as compared to the unilateral cases, but may have more complex repair as well, which makes the symmetry and uniform distribution of vector forces on repaired segments more difficult.…”

Managing labio-maxillarypalatal clefts: the Nancy protocol

“…We prefer to use the Millard cheiloplasty technique 5 as modified by Mulliken [9][10][11] , which facilitates lengthening the columella when indicated ( fig. 12 a and b).…”