Treatment of Complete Bilateral Cleft Lip-Nasal Deformity

Abstract

The modern technique of presurgical orthopedics and nasoalveolar molding produces a better skeletal foundation and nasal shape for the repair of the bilateral cleft lip-nasal deformity. The general principles are as follows: (1) preserve the presurgical columellar length; (2) keep the width of the central lip segment narrow without compromising the blood supply; (3) advance the columella prolabium complex superiorly to allow reconstruction of the orbicularis oris muscle behind the prolabium; (4) release the alar cartilage attachment from the pyriform rim and provide additional coverage of this soft tissue deficiency with the use of inferior turbinate flaps; (5) release and reposition the lower lateral cartilage; (6) adequately dissect above the maxillary periosteum; (7) reconstruct the nasal floor by local mucosal flaps; (8) reconstruct the prolabial buccal sulcus with tissue from the prolabium; (9) reconstruct the orbicularis muscle sphincter and attach it to the anterior nasal spine; (10) reconstruct a new Cupid's bow, central vermilion, and lip tubercle with tissue from the lateral lips; (11) balance the height of both lateral lips without any incision around the ala; and (12) maintain the presurgical nasolabial angle. The residual nasal deformity remains a problem that needs further improvement. The long-term result in Chang Gung Craniofacial Center suggests overcorrection of columella height before, during, and after lip repair.

Wnt signaling in orofacial clefts: crosstalk, pathogenesis and models

“…To date, the most prevalent treatment for orofacial clefts is surgical repair coupled with nasoalveolar molding to direct postnatal tissue growth and subsequent orthodontic treatment (Chen et al, 2005). Protocols and procedures have varied widely, not only in developing areas of the world, but within developed countries as well (Mossey et al, 2009).…”

Initial experiences with NAM‐assisted primary repair of the BCLP deformity

“…Grayson et al commence nasal stenting when the alveolar cleft width is less than 6 mm. Suri suggests that the optimal time for addition of nasal stents is when more than two‐third of the alveolar cleft width reduces and a return of incisive papilla to facial midline is evidenced . Though the alveolar cleft width reduced significantly during treatment, cleft width at the stage of commencing the nasal stenting in the BCLP infant was more than the 6 mm suggested.…”

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

“…Patients with incomplete clefts and other craniofacial anomalies were Indian J Plast Surg:2020;53:371-376 excluded from this study. All infants who had arrived at the center before 6 weeks of age were treated with Eric Liou's technique of NAM 13 for an average of 4 months. The patients were called every 2 weeks to make adjustments to the device.…”