A Comparative Study of Facial Growth Following Cleft Lip Repair with or without Soft-Tissue Undermining

Despite timely repair of cleft lip, secondary deformities such as vermilion notching or “whistle deformity” often require further surgical treatment. The use of dermis-fat graft for soft tissue augmentation of the upper lip is an established technique. We propose an innovation on this technique, by which the dermis-fat graft can be placed reliably and with minimal dissection by use of a soft red rubber sheath to protect the Keith needle while delivering the graft through the submucosal pocket in the dry vermilion, thereby avoiding the needle inadvertently catching soft tissue inside the pocket. We recommend using an 8F red rubber catheter, cutting the catheter to be just shorter than a 2.5-inch Keith needle. This provides a sheath through which the Keith needle can be passed within the submucosal vermilion tunnel. We believe this to be much more reliable for vermilion augmentation than other techniques, including fat injection, and makes graft inset more predictable, faster, and simpler.

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Effect of Lip Closure on Facial Growth in the Surgically Induced Cleft Rabbit

Otolaryngology ◽

10.1177/019459987808600526 ◽

1978 ◽

Vol 86 (5) ◽

pp. ORL-786-ORL-803 ◽

Cited By ~ 8

Author(s):

Karl J. Eisbach ◽

Janusz Bardach

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Control Level ◽

Facial Growth ◽

Skull Measurements ◽

Cleft Palate Repair ◽

Cleft Lip Repair ◽

Palate Repair ◽

Maxillary Growth ◽

Repair Group

This project was designed to determine whether cleft lip repair has an influence on facial growth. To study this, 62 rabbits were divided into four groups: control, control without repair, Millard-type repair, and Bardach-type repair. Surgical clefts of the lip, alveolus, and the palate were created in 6-week-old rabbits. Periodic measurements were made of the pressure exerted by the lip on the maxillary alveolus. The animals were killed 20 weeks postoperatively. The skulls were processed and measurements were taken from the skulls. The pressure measurements showed a definite increase in lip pressure on the maxillary alveolus for the lip repair group. This pressure was high soon after surgery, rapidly returned toward the control level, but never reached it. Skull measurements indicate an inhibition in anterior maxillary growth for the “control without repair” group. This inhibition was even more profound in the two lip repair groups. No significant differences were found in maxillary width or mandibular length. When correlations were made to see if increased lip pressure resulted in decreased anterior maxillary growth, a significant correlation was found for both lip repair groups. This means that as the pressure of the lip repair increased, it resulted in a decrease in anterior maxillary growth. The data reported here indicates that cleft lip surgery must be considered as having a definite influence on anterior maxillary growth inhibition observed in the cleft lip and palate population. Further studies are indicated to determine the role of cleft palate repair on facial growth.

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Fetal cleft lip repair in rabbits: Postnatal facial growth after repair

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(91)90342-j ◽

1991 ◽

Vol 49 (6) ◽

pp. 603-611 ◽

Cited By ~ 21

Author(s):

Thomas B. Dodson ◽

Brian Schmidt ◽

Michael T. Longaker ◽

Leonard B. Kaban

Keyword(s):

Cleft Lip ◽

Facial Growth ◽

Cleft Lip Repair

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