Reply: Modified Unilateral Incomplete Cleft Lip Repair with Primary Nasal Overcorrection: A Muscle-Driven Technique

Objective: Few studies have focused on perioperative management of cleft lip repair. We sought to evaluate the available data on this topic to create evidence-based clinical guidelines. Design: Systematic review, meta-analysis. Methods: A PubMed search was performed focusing on perioperative management of cleft lip repair. Studies were included if they included comparative data. A systematic review and meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Main Outcome Measures: Systematic review of literature regarding wound closure, postoperative arm restraints, perioperative antibiotics, outpatient or ambulatory surgery, or feeding restrictions postoperatively. Results: Twenty-three articles met inclusion criteria after initial screening of 3103 articles. This included 8 articles on wound closure, 2 on postoperative restraints, one on perioperative antibiotics, 6 on outpatient surgery, and 6 on postoperative feeding. Meta-analysis could be performed on dehiscence rates with postoperative feeding regimen and readmission rates after outpatient versus inpatient lip repair. There were few studies with low risk of bias. Outpatient cleft lip repair does not increase readmission (odds ratio [OR]: 0.92, 95% CI: 0.28-3.07). Allowing postoperative breastfeeding or bottle-feeding does not increase dehiscence (OR: 0.61, 95% CI: 0.19-1.95). There was no evidence of publication bias. Conclusion: Within the limitations of available data, there is no evidence of a clearly superior closure material. The evidence does not support use of postoperative arm restraints. The evidence does not support the use of preoperative nasal swabs for antibiotic guidance. With careful patient selection, outpatient cleft lip repair appears safe. The evidence supports immediate breastfeeding or bottle-feeding after cleft lip repair.

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Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620982801 ◽

2021 ◽

pp. 105566562098280

Author(s):

Robin A. Tan ◽

Frans J. Mulder ◽

Roderic M. F. Schwirtz ◽

David G. M. Mosmuller ◽

Henrica C. W. De Vet ◽

...

Keyword(s):

Analysis Of Variance ◽

Online Survey ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Old Patients ◽

Rank Score ◽

Cleft Lip Repair ◽

Typical Appearance ◽

Unilateral Cleft Lip Repair ◽

Insight Into

Objective: To gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople. Design: An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis. Setting: Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA. Patients: Photographs of 6- to 18-year-old patients with repaired UCLP. Results: “Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant ( P = 0.89). Conclusions: Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.

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Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620982757 ◽

2021 ◽

pp. 105566562098275

Author(s):

Robertus Arian Datusanantyo ◽

Magda Rosalina Hutagalung ◽

Sitti Rizaliyana ◽

Djohansjah Marzoeki

Keyword(s):

Cleft Lip ◽

Outcome Measure ◽

Cleft Lip And Palate ◽

Inclusion Criteria ◽

Initial Size ◽

Tertiary Center ◽

Observational Cohort ◽

Cleft Lip Repair ◽

Unilateral Cleft Lip Repair ◽

Junior Residents

Objective: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. Design: Observational cohort study. Setting: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. Patients, Participants: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. Interventions: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. Main Outcome Measure(s): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. Results: While nasal width and philtral height ratios decreased significantly ( P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged ( P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly ( P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged ( P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. Conclusion: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

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120: Is Restricted Breast and Bottle-Feeding Necessary Following Cleft Lip Repair?

Paediatrics & Child Health ◽

10.1093/pch/19.6.e35-118 ◽

2014 ◽

Vol 19 (6) ◽

pp. e77-e77

Author(s):

M Dhaiban ◽

S Younas ◽

JA Channa ◽

N Akhtar

Keyword(s):

Cleft Lip ◽

Bottle Feeding ◽

Cleft Lip Repair

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The Contour Lines of the Upper Lip and a Revised Method of Cleft Lip Repair

Annals of Plastic Surgery ◽

10.1097/00000637-199109000-00008 ◽

1991 ◽

Vol 27 (3) ◽

pp. 238-252 ◽

Cited By ~ 22

Author(s):

Takuya Onizuka ◽

Masaharu Ichinose ◽

Yoshiaki Hosaka ◽

Yoshihiro Usui ◽

Takao Jinnai

Keyword(s):

Cleft Lip ◽

Upper Lip ◽

Contour Lines ◽

Cleft Lip Repair

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The modified Z-plasty for unilateral cleft lip repair

British Journal of Plastic Surgery ◽

10.1016/0007-1226(93)90199-l ◽

1993 ◽

Vol 46 (8) ◽

pp. 676-680 ◽

Cited By ~ 10

Author(s):

D.B. Fernandes ◽

D.A. Hudson

Keyword(s):

Cleft Lip ◽

Cleft Lip Repair ◽

Unilateral Cleft Lip Repair

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TGF-beta-3 Promotes Scarless Repair of Cleft Lip in Mouse Fetuses

Journal of Dental Research ◽

10.1177/154405910208101007 ◽

2002 ◽

Vol 81 (10) ◽

pp. 688-694 ◽

Cited By ~ 24

Author(s):

K. Kohama ◽

K. Nonaka ◽

R. Hosokawa ◽

L. Shum ◽

M. Ohishi

Keyword(s):

Cell Proliferation ◽

Cyclin D1 ◽

Cleft Lip ◽

Ex Vivo ◽

Fetal Surgery ◽

Mesenchymal Cell ◽

Tenascin C ◽

Cleft Lip Repair ◽

Mouse Fetuses ◽

Mesenchymal Transformation

TGF-β3 mediates epithelial-mesenchymal transformation during normal fusion of lip and palate, but how TGF-β3 functions during cleft lip repair remains unexplored. We hypothesize that TGF-β3 promotes fetal cleft lip repair and fusion by increasing the availability of mesenchymal cells. In this investigation, we demonstrated that cleft lips in mouse fetuses were repaired by fetal surgery, producing scarless fusion. At the site of the operation, we first observed an infusion of platelets expressing TGF-β3, followed by increased expression of cyclin D1 and tenascin-C, and coupled with increased mesenchymal cell proliferation. In an ex vivo serumless culture system, cleft lip explants fused in the presence of exogenous TGF-β3. Cultured lips also showed up-regulation in cyclin D1 and tenascin-C expression. These findings suggest that microsurgical repair of cleft lip in the fetus that produced scarless fusion is mediated by TGF-β3 regulation of mesenchymal cell proliferation and migration at the site of repair.

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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 ◽

Rotation Advancement

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.

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