Cleft Lip Repair

Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.

Use of the Modified Unilateral Cleft Lip Repair Technique to Establish a Cupid’s Bow With a Natural Structure

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620962364 ◽

2020 ◽

pp. 105566562096236

Author(s):

Tatsuya Ishigaki ◽

Akikazu Udagawa

Keyword(s):

Surgical Technique ◽

Cleft Lip ◽

Surgical Techniques ◽

Lateral Side ◽

Natural Structure ◽

Repair Technique ◽

Triangular Flap ◽

Cleft Lip Repair ◽

Projection Point

Introduction: There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique. Methods: We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows: we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow. Results: We could preserve the shape and symmetry of the peak of the Cupid’s bow. Conclusion: To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.

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

ISRN Plastic Surgery ◽

10.5402/2013/268094 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

F. W. Nangole ◽

S. O. Khainga

Keyword(s):

Surgical Technique ◽

Complication Rate ◽

Cleft Lip ◽

Surgical Techniques ◽

Complication Rates ◽

Outreach Programs ◽

Bilateral Cleft Lip ◽

The Mean ◽

One Year ◽

Cleft Surgery

This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series.

White Roll Vermilion turn down flap in primary unilateral cleft lip repair: A novel approach

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.163057 ◽

2015 ◽

Vol 48 (02) ◽

pp. 178-184

Author(s):

R. K. Mishra ◽

Amit Agarwal

Keyword(s):

Learning Curve ◽

Cleft Lip ◽

Surgical Techniques ◽

High Light ◽

Scar Contracture ◽

Novel Approach ◽

Cleft Lip Repair ◽

Motivating Factor ◽

ABSTRACT Aim: Numerous modifications of Millard′s technique of rotation - advancement repair have been described in literature. This article envisions a new modification in Millard’s technique of primary unilateral chieloplasty. Material and Methods: Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard’s repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion. Result: With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid’s bow with no vermilion notching of the lips. Conclusion: WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.

Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v4i1.221 ◽

2018 ◽

Vol 4 (1) ◽

pp. 95-100

Author(s):

Prasetyanugraheni Kreshanti ◽

Muhammad Irsyad Kiat

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Techniques ◽

Modified Technique ◽

Nasal Vestibule ◽

Base Position ◽

Alar Base ◽

Cleft Lip Repair ◽

Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques. Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients. Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio. Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.

A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.197226 ◽

2016 ◽

Vol 49 (03) ◽

pp. 340-349 ◽

Cited By ~ 5

Author(s):

Percy Rossell-Perry

Keyword(s):

Surgical Outcomes ◽

Cleft Lip ◽

Surgical Techniques ◽

Anthropometric Measurements ◽

Study Objective ◽

Scar Assessment ◽

Retrospective Audit ◽

Cleft Lip Repair ◽

ABSTRACT Background: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. Materials and Methods: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. Results: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. Conclusions: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.

Harvey Cushing's Contributions to Plastic Surgery: Bilateral Cleft Lip Repair

The Cleft Palate-Craniofacial Journal ◽

10.1597/12-249 ◽

2014 ◽

Vol 51 (1) ◽

pp. 105-109

Author(s):

Josher Molendijk ◽

Courtney Pendleton ◽

Martin Rachwalski ◽

Alfredo Quinones-Hinojosa ◽

Amir H. Dorafshar

Keyword(s):

Plastic Surgery ◽

Cleft Lip ◽

Bilateral Cleft Lip ◽

Cleft Lip Repair

Early and Late Treatment of Unilateral Cleft Nasal Deformity

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1992_029_0556_ealtou_2.3.co_2 ◽

1992 ◽

Vol 29 (6) ◽

pp. 556-570 ◽

Cited By ~ 15

Author(s):

Kenneth E. Salyer

Keyword(s):

Surgical Technique ◽

Cleft Lip ◽

Surgical Techniques ◽

Multidisciplinary Management ◽

Nasal Deformity ◽

Late Treatment ◽

Cleft Lip Repair ◽

Time Correction ◽

Cleft Nasal Deformity ◽

Corrective Procedures

Surgical techniques have been developed to correct nasal deformity associated with unilateral cleft lip, alveolus, and palate. This deformity can be significantly corrected during the primary cleft lip repair, as performed by the technique described by the author. Secondary corrective procedures focus mostly on skeletal support and lining distortions as well as on rearrangements of lower lateral cartilages. At the final stage, esthetic appearance can be significantly improved by contour remodeling with the addition of cartilage and/or bony implants. Choice of surgical technique depends upon the severity of the deformity and the experience and proficiency of the surgeon. At the present time, correction of the nasal deformity associated with a unilateral cleft is an integral part of primary cleft lip repair and part of multidisciplinary management of cleft deformities.

Cleft Lip Repair: Technical Refinements for the Wide Cleft

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0030-1254377 ◽

2010 ◽

Vol 3 (2) ◽

pp. 81-86 ◽

Cited By ~ 10

Author(s):

Eric Meyer ◽

Alan Seyfer

Keyword(s):

Congenital Malformations ◽

Cleft Lip ◽

Common Type ◽

Upper Lip ◽

Vast Array ◽

Triangular Flap ◽

Aesthetic Results ◽

Cleft Lip Repair ◽

Clefts of the lip and palate are among the most common congenital malformations. A unilateral deformity is the most common type of cleft, but even within this subgroup there is a great deal of variety due to the accompanying severe distortion of the upper lip, cheek, nose, and maxilla. To repair such a variety of clefts with good aesthetic results, several general incisional approaches should be mastered along with a variety of subtle techniques that improve the end product. The most common repair utilized in America is the Millard rotation-advancement technique. This is partly due to the perceived superiority in results compared with other repairs and the ease with which this repair can be taught to residents. This repair places the scar along an artificial philtral column and is often quite sufficient in small clefts. Unfortunately, adoption of this “one size fits all” approach can limit the arsenal of the surgeon facing the vast array of differing cleft lip deformities. For example, the modified triangular flap, or Tennison-Randall repair, can be of value when presented with the wider unilateral cleft lip. In an effort to not only demonstrate that excellent results can be achieved when incisional patterns (Millard and Tennison) are used appropriately (small versus large clefts), we compared the results of two types of repairs, performed by a single surgeon over a period of 30 years. In addition, a variety of subtle techniques are reviewed to assist in obtaining excellent aesthetic results for any size repair.