Repair of the Unilateral Cleft Lip/Nose Deformity

Abstract

Successful surgical repair of the unilateral cleft lip and nose deformity, defined as normal orbicularis oris function and near-perfect symmetry of the repaired lip and nose, demands that the surgeon possess complete understanding of the embryology and anatomy of the midfacial defects. The surgical approach to repair of the unilateral cleft lip/nose should place great emphasis on achieving symmetry, not only with the lip segments but also perhaps even more importantly with the nasal tip. The reconstruction should recreate an intact fully functional orbicularis oris muscle across the cleft and camouflage the scar optimally. We have found that modification of the Millard rotation-advancement flap technique, with particular attention to the primary nasal repair, provides the best outcomes. In patients who have undergone primary repair of the lip and/or nose deformity, secondary rhinoplasty is generally required, regardless of the technique used at the primary repair. The degree of nasal deformity, however, is less severe following primary repair of the asymmetric nasal tip. We have found that the sliding flap cheliorhinoplasty, Wang's modification of the Vissarionov technique, provides excellent results for most secondary cleft rhinoplasties.

6-0 nylon versus 6-0 vicryl rapide in chieloplasty

“…[12] The type of suture material used in cleft lip surgery has been a long-standing debate among surgeons. Some prefer nonabsorbable suture material because of its easy handling and a minimal inflammatory response[3] while the others prefer absorbable sutures so as to preclude the need of additional procedures sedation or general anesthetic and distressing the child.…”

Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate

“…A variety of surgical approaches to treat aspects of this deformity have been described 1,2,7,18,29,31 . These may involve primary correction of the unilateral cleft-lip nasal deformity at the time of primary lip repair 12,18,23 or correction in secondary cases later on in life 9 .…”

Aspects épidémiologiques, cliniques et thérapeutiques des fentes unilatérales du palais primaire : présentation de 98 observations

“…Les critères d'évaluation étant très hétérogènes, il est difficile de comparer les résultats. Les séquelles naso-labiales sont encore fréquentes [16]. Elles sont essentiellement liées au type anatomo-clinique de la fente et elles s'observent surtout lorsque la ptose du cartilage alaire est sévère.…”