Abstract: 14.10 Complete Cleft Lip And Palate: How To Restore Function, Symmetry And Lack Of Bone In One Surgical Procedure

Abstract

INTRODUCTION: Complete clefts lip and palate represent a long journey for patients, families and the cleft team. We have to face a lack of function, symmetry and shape. There are involved soft tissue, muscles, cartilages, bone and all of them are displaced, distorted or missed. In more than 40 years of experience in our department we developed a strong surgical protocol that has a its center the cheilo-rhyno-plasty and periosteoplasty procedure. Within 3 hours procedure we try to restore every single part involved in order to achieve better results and less need of further procedures. MATERIALS AND METHODS: We performed a modified Tennison technique for UCLP and the Mulliken one on BCLP; we used to perform some principles from the early treatment of the nose by Mulliken and, furthermore, we introduced a carefully excision of a semilunar skin flap at the base of the displaced alar cartilage in order to improve the symmetry of the nose. Moreover, in order to restore the lack of maxillary bone, we performed a periosteoplasty described by Massei. The average age was 2,5-3 months. Photographs are taken pre, post operation and at each follow ups. RESULTS: We performed the procedures on UCLP cases and on BCLP ones, from January 2010 to December 2014. We achieved satisfied results in symmetry, muscular reconstruction, correct philtrum shape, length and position and, moreover, a proper shape and structure for the nasal pyramid. Periosteoplasty procedure has decreased the need of bone graft in the 70% of cases. Main complications are: 0,1% of post operative bleeding, 15% of skeletal class III malocclusion. CONCLUSIONS: We do believe that an earlier surgical approach represent the best way to achieve better aesthetic results and less need of further operation. Periosteoplasty procedure is our milestone to decrease the need of bone graft.