Long-Term Results in the Bilateral Cleft Lip Repair by Mulliken's Method

Abstract

By performing Mulliken's method, we can achieve natural lip and nasal shape, harmonious Cupid's bow, appropriate nasal projection, and natural philtrum.

Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

“…This is exemplified by what Aufricht said in 1955: “please do not touch the nasal tip until the child is at least a teenager” [17]. This dictum has been clinically challenged over time by the benefits of rhinoplasty performed at infancy, including improvement of nasal symmetry, balance, and aesthetics, and by attenuation of the patient/parental psychosocial burden [7,8,9,10,11,12,13,14,15,16,21,22,23,24,25,26,27]. However, a recent survey demonstrated that one-half of cleft surgeons continue to deny these potential benefits to their patients [20], mainly because of the hypothetical disturbance in nasal growth, which remains an open question in cleft care [17,18,19].…”

“…Most previous studies attempting to clarify this issue have limited nasal measurements to childhood and teenage years [17,18,19,21,23,24,25,27]. Furthermore, investigations reporting nasal growth data at maturity have included only a limited number of patients and the measurements have solely been based on the subjective opinion of the treating surgeon or two-dimensional photogrammetry of a single parameter (columellar–labial angle) [22,26].…”

“…Despite the benefits of primary rhinoplasty for nasal reconstruction [7,8,9,10,11,12,13,14,15,16,21,22,23,24,25,26,27,39], some patients may require additional nasal surgical intervention at preschool age (intermediate rhinoplasty) to address a residual tip-related deformity, as this is the most critical period of psychosocial development [40,52,53,54]. If nasal growth disturbance after primary rhinoplasty is secondary to development of heavy scar tissue, as theorized in traditional teaching, patients with two rhinoplasties within the first 6 years of life would have an even greater nasal growth restriction when they reached maturity.…”

“…On the other hand, opponents have based their opinions mainly on the traditional teaching that “primary rhinoplasty may potentially interfere with nasal growth” [17,18,19,20]. Studies showing the absence of nasal growth interference had methodological limitations (e.g., mixed sample sizes, age groups, and/or methods used for nasal measurements) that hindered universal acceptance of primary rhinoplasty within cleft centers worldwide [21,22,23,24,25,26,27]. It is therefore essential that further outcome analyses are conducted by implementing a well-delineated methodology based on accurate quantitative evaluation of nasal dimensions and comparisons between treated patients and normal subjects.…”

Postoperative lip and nose forms following primary bilateral cleft lip repair selecting one/two stage surgery in comparison to those of healthy children

“…However, with excessive elevation of the nasal tip in the cephalic direction, the nasolabial angle may be too large. Mulliken [19], Kohout et al [20], and Kim et al [21] mentioned greater nasolabial angles, and these obtuse angles were improved over time and the nasal tip was blunted in their methods. When considering Asians, who have a smaller columella-labial angle than Caucasians, overprojection of the nasal tip may be a problem.…”