The Correction of a Secondary Bilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

Objective: To assess the aesthetic and functional long-term results of surgical and orthodontic treatment of patients with bilateral cleft lip, palate, and alveolus. Design: Long-term follow-up study. Setting: Teaching hospital in Austria. Patients: Twenty adult patients who had been operated on as children for bilateral cleft lip, palate, and alveolus. Interventions: Lateral cephalometric and model analysis. The sum of all mesiodistal tooth diameters in the maxilla and mandible were compared with standard Bolton tracings. Main outcome measures: Aesthetic and functional results. Results (model analysis): The upper arch was too wide in 12 patients and the mandibular arch was too wide in 4 patients. In 11 patients, the lateral teeth were crowded, and all had a persistent transverse space deficit and a reduction in sagittal measurements. Fifteen patients had alveolar midline displacement of the maxilla as well as of the mandible. Results (lateral cephalometric measurements): The lateral cephalograms showed a mean sella-nasion-A point angle of 77° and a maxillary baseline-nasion-sella line angle of 9°, indicating a tendency toward maxillary retrognathia. An anterior facial height index of 42% (compared with the standard 58%) indicated a slight reduction in midface height with consequent increase in the height of the lower face. Conclusion: There is specific growth impairment of the midface in adults who were treated as children for bilateral clefts of lip, palate, and alveolus. An optimal result can be achieved only by additional orthognathic surgery (Le Fort II osteotomy).

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Long-term results of the two-stage palatoplasty/Hotz’ plate approach for complete bilateral cleft lip, alveolus and palate patients

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/s1010-5182(03)00023-4 ◽

2003 ◽

Vol 31 (4) ◽

pp. 215-227 ◽

Cited By ~ 17

Author(s):

Alcibiades E Silvera Q ◽

Kazuhiro Ishii ◽

Toru Arai ◽

Shuichi Morita ◽

Kazuhiro Ono ◽

...

Keyword(s):

Cleft Lip ◽

Long Term Results ◽

Two Stage ◽

Bilateral Cleft Lip

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

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3181af15c5 ◽

2009 ◽

Vol 20 (5) ◽

pp. 1455-1461 ◽

Cited By ~ 8

Author(s):

Seok-Kwun Kim ◽

Myung-Hoon Kim ◽

Yong-Seok Kwon ◽

Keun-Cheol Lee

Keyword(s):

Cleft Lip ◽

Long Term Results ◽

Bilateral Cleft Lip ◽

Cleft Lip Repair

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Repairing the Cleft Lip Nasal Deformity

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2000_037_0234_rtclnd_2.3.co_2 ◽

2000 ◽

Vol 37 (3) ◽

pp. 234-242 ◽

Cited By ~ 4

Author(s):

Jorge I. De La Torre ◽

Pamela M. Gallagher ◽

Barry K. Douglas ◽

Mayer Tenenhaus

Keyword(s):

Cleft Lip ◽

Primary Repair ◽

Surgical Revision ◽

Long Term Results ◽

Nasal Deformity ◽

Nasal Defect ◽

Early Primary ◽

Cleft Lip Nose

Objective The repair of the cleft lip nose and nasal deformity remains a challenging endeavor for reconstructive surgeons. Psychosocially, this complex, multifaceted deformity significantly stigmatizes the patient. Numerous techniques have been advocated by multiple authors for the treatment and reconstruction of these deformities, usually requiring serial staged reconstructions. Method Described is our technique for early primary repair of the cleft lip nasal deformity. The use of multiple suspension sutures to repair the nasal defect facilitates the repair of even very wide cleft lips. Conclusions These maneuvers provide an aesthetic and functional repair of the nasal defect in conjunction with the lip repair. Long-term results have minimized the need for surgical revision.

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Repair of bilateral cleft lip and its variants

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699380 ◽

2009 ◽

Vol 42 (S 01) ◽

pp. S79-S90

Author(s):

John B. Mulliken

Keyword(s):

Primary Closure ◽

Cleft Lip ◽

Three Dimensional ◽

Nasal Deformity ◽

Dimensional Changes ◽

Bilateral Cleft Lip ◽

Long Term Follow Up ◽

Technical Modifications

ABSTRACTThe surgeon who lifts a scalpel to repair a bilateral cleft lip and nasal deformity is accountable for: 1) precise craftsmanship based on three-dimensional features and four-dimensional changes; 2) periodic assessment throughout the child's growth; and 3) technical modifications during primary closure based on knowledge gained from long-term follow-up evaluation. These children should not have to endure the stares prompted by nasolabial stigmata that result from outdated concepts and technical misadventures. The principles for repair of bilateral complete cleft lip have evolved to such a level that the child's appearance should be equivalent to, or surpass, that of a unilateral complete cleft lip. These same principles also apply to the repair of the variants of bilateral cleft lip, although strategies and execution differ slightly.

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