PDF herunterladen
Semin Plast Surg 2012; 26(04): 156-163
DOI: 10.1055/s-0033-1333885
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contemporary Concepts for the Bilateral Cleft Lip and Nasal Repair

Rohit K. Khosla
1   Division of Plastic & Reconstructive Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford University, Stanford, California
,
Jyoti McGregor
2   Pediatric Plastic & Craniofacial Surgery, Health Sciences Centre, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
,
Patrick K. Kelley
3   Division of Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
,
Joseph S. Gruss
4   Division of Plastic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
13. Februar 2013 (online)

    Lizenzen und Reprints

Abstract

The bilateral cleft lip and nasal deformity presents a complex challenge for repair. Surgical techniques continue to evolve and are focused on primary anatomic realignment of the tissues. This can be accomplished in a single-stage or two-stage repair early in infancy to provide a foundation for future growth of the lip and nasal tissue. Most cleft surgeons currently perform a single-stage repair for simplifying patient care. Certain institutions utilize presurgical orthopedics for alignment of the maxillary segments and nasal shaping. Methods for the bilateral cleft lip repair are combined with various open and closed rhinoplasty techniques to achieve improved correction of the primary nasal deformity. There is recent focus on shaping the nose for columellar and tip support, as well as alar contour and alar base position. The authors will present a new technique for closure of the nasal floor to prevent the alveolar cleft fistula. Although the alveolar fistula is closed, alveolar bone grafting is still required at the usual time in dental development to fuse the maxilla. It is paramount to try and minimize the stigmata of secondary deformities that historically have been characteristic of the repaired bilateral cleft lip. A properly planned and executed repair reduces the number of revisions and can spare a child from living with secondary deformities.

Keywords

bilateral cleft lip - bilateral cleft lip and palate - cleft nasal deformity - primary bilateral cleft lip repair - primary cleft rhinoplasty
 

  • References

  • 1 Schendel SA, Pearl RM, De Armond SJ. Pathophysiology of cleft lip muscles following the initial surgical repair. Plast Reconstr Surg 1991; 88 (2) 197-200
    PubMedGoogle Scholar
  • 2 Millard DR. Bilateral cleft lip and a primary forked flap: a preliminary report. Plast Reconstr Surg 1967; 39 (1) 59-65
    PubMedGoogle Scholar
  • 3 Millard Jr DR. Closure of bilateral cleft lip and elongation of columella by two operations in infancy. Plast Reconstr Surg 1971; 47 (4) 324-331
    PubMedGoogle Scholar
  • 4 Manchester WM. The repair of bilateral cleft lip and palate. Br J Surg 1965; 52 (11) 878-882
    CrossrefPubMedGoogle Scholar
  • 5 Byrd HS, Ha RY, Khosla RK, Gosman AA. Bilateral cleft lip and nasal repair. Plast Reconstr Surg 2008; 122 (4) 1181-1190
    PubMedGoogle Scholar
  • 6 Trott JA, Mohan NA. A preliminary report on one stage open tip rhinoplasty at the time of lip repair in bilateral cleft lip and palate: the Alor Setar experience. Br J Plast Surg 1993; 46 (3) 215-222
    CrossrefPubMedGoogle Scholar
  • 7 Grayson BH, Cutting CB, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg 1993; 92 (7) 1422-1423
    PubMedGoogle Scholar
  • 8 Cutting C, Grayson B, Brecht L, Santiago P, Wood R, Kwon S. Presurgical columellar elongation and primary retrograde nasal reconstruction in one-stage bilateral cleft lip and nose repair. Plast Reconstr Surg 1998; 101 (3) 630-639
    CrossrefPubMedGoogle Scholar
  • 9 Mulliken JB. Primary repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg 2001; 108 (1) 181-194 , 195–196
    PubMedGoogle Scholar
  • 10 Mulliken JB, Wu JK, Padwa BL. Repair of bilateral cleft lip: review, revisions, and reflections. J Craniofac Surg 2003; 14 (5) 609-620
    CrossrefPubMedGoogle Scholar
  • 11 McComb H. Primary repair of the bilateral cleft lip nose: a 15-year review and a new treatment plan. Plast Reconstr Surg 1990; 86 (5) 882-889 , discussion 890–893
    PubMedGoogle Scholar
  • 12 Georgiade NG, Latham RA. Maxillary arch alignment in the bilateral cleft lip and palate infant, using pinned coaxial screw appliance. Plast Reconstr Surg 1975; 56 (1) 52-60
    CrossrefPubMedGoogle Scholar
  • 13 Georgiade NG, Mason R, Riefkohl R, Georgiade G, Barwick W. Preoperative positioning of the protruding premaxilla in the bilateral cleft lip patient. Plast Reconstr Surg 1989; 83 (1) 32-40
    PubMedGoogle Scholar
  • 14 Millard Jr DR, Latham RA. Improved primary surgical and dental treatment of clefts. Plast Reconstr Surg 1990; 86 (5) 856-871
    CrossrefPubMedGoogle Scholar
  • 15 Mulliken JB, Pensler JM, Kozakewich HP. The anatomy of Cupid's bow in normal and cleft lip. Plast Reconstr Surg 1993; 92 (3) 395-403 , discussion 404
    PubMedGoogle Scholar
  • 16 Kelley PK, Harshbarger R, Da Silveira A, Gruss J. Use of the extended lateral nasal lining flap improves primary cleft lip results and eliminates long term nasal lining deficiency. Paper presented at: American Cleft Palate-Craniofacial Association Annual Meeting; April 5–9, 2011; San Juan, Puerto Rico
    PubMedGoogle Scholar
  • 17 Tajima S, Maruyama M. Reverse-U incision for secondary repair of cleft lip nose. Plast Reconstr Surg 1977; 60 (2) 256-261
    CrossrefPubMedGoogle Scholar
  • 18 Tajima S. Follow-up results of the unilateral primary cleft lip operation with special reference to primary nasal correction by the author's method. Facial Plast Surg 1990; 7 (2) 97-104
    Artikel in Thieme ConnectPubMedGoogle Scholar