Surgical Treatment in Unilateral Cleft Lip–Nose Patients: Long-Term Follow-Up Using a Personal Approach Based on Rose and Spina Techniques

Abstract

A 24-year follow-up with simultaneous treatment of the lip, nose, and palate in the neonatal period is presented. The first author operated on 92 patients in the neonatal period using a personal approach based on the Rose and Spina techniques. Technical details of the primary repair are described. The unilateral cleft lip-nose is operated on through a curved skin incision, with an upper third Z-plasty. Extensive detachment of the musculature is realized without incising the sulcus. Two flaps close the mucosal layer in an S-shaped position. The nose is approached through a precartilaginous incision on the cleft side, and "V-Y" advancement of a mucocartilaginous flap is realized to restore the normal alar cartilage shape and position. The follow-up showed normal development of the ala with position maintenance without nasal stenosis in 95% of the cases. Good lip functional results were seen in 100% of the cases. Minimal skin scar revision procedures were required in 10% of the cases.

Cleft Lip/Nasal Deformities After Plastic Surgery for Unilateral Cleft Lip/Palate: A Prospective Study at a Large Hospital in Vietnam

“…This is also a statement by many surgeons worldwide. 9 , 10 In our study, the lip was too short in 34.8%, equivalent to that reported by Rajanikanth et al, but lower than that reported by Cheema SA and Asim M (63%). 6 , 7 …”

Safety of neonatal cleft lip repair

“…Major advances have subsequently been made in our understanding and practice of neonatal surgery and anaesthesia, and more recent studies [4][5][6][7][8][9][10][11][12] have indicated that repair does not convey a significant additional risk. However, surgical practice does not seem to have changed in response to these reports.…”

“…Several previous advocates of neonatal repair have set exclusion criteria including low birthweight, respiratory problems (apnoeic episodes or dyspnoea), hypoglycaemia, jaundice, convulsions, cardiac murmurs, and multiple congenital abnormalities [5][6][7][8][9][10][11][12]. In contrast, it has been this unit's policy to offer neonatal repair to all babies with a cleft lip deformity.…”

Avaliação nasal pós-cirurgia de alongamento de columela por meio de medidas antropométricas do nariz e análise facial em pacientes com fissura transforame incisivo bilateral (FTIB)

“…O protocolo cirúrgico atual do HRAC para a reabilitação dos pacientes com FTIB começa com a queiloplastia em um único tempo cirúrgico, á partir dos três meses de idade. Exceto em casos de desvios e projeção acentuada da pré-maxila e pró-labio muito deficiente, quando realiza se em dois tempos cirúrgicos utilizando a técnica de Spina (MARTINS;MARTINS, 2003). Quando a fenda é muito ampla é necessário realizar em um terceiro tempo cirúrgico para reparação definitiva do lábio, queiloplastia secundária por volta dos quatro anos de idade.…”