Abstract
The Millard method of unilateral cleft lip repair has been associated with a short lip and a flattened nose on the cleft side. The aim of this study was to determine the need for revision surgery following repair of unilateral cleft lip repair at the Komfo Anokye Teaching Hospital. Satisfaction with facial appearance (upper lip, nose and general facial appearance) was assessed quantitatively by means of a Visual Analogue Scale (VAS), where 0 cm indicates totally unsatisfied or "highly unattractive" and 10 cm indicates totally satisfied or "highly attractive". Three assessors--parents, surgeon and lay-person--were purposively selected to score their level of satisfaction with repair of complete and incomplete unilateral cleft lip. The assessors also indicated the need for any revision. The total sample size was 120, of which 40.0% were male and 60.0% were female. There were 79 cases of repaired complete unilateral cleft lip and 41 incomplete unilateral cleft lip. Average scores of satisfaction of parents were 6.6, 6.8 and 7.2 for nose, lip and general facial appearance (GFA) respectively. Satisfaction scores for surgeon were 6.1(nose), 6.0 (lip) and 6.5 (GFA), while those of the lay-assessor were 5.2(nose), 5.4 (lip) and 6.0(GFA). Concerning the need for revision, parents indicated 30.2% as needing revision, surgeon 33%; and lay-assessor 40%. Of the cases that needed revision, 33.3% were complete cleft lip and 0.1% were incomplete cleft lip. Parents were more satisfied with unilateral cleft lip repair using the Millard procedure than either the surgeon or lay assessor. Those who needed revision were mostly children who presented with complete unilateral cleft lip.
Highlights
Cleft lip and palate are the most frequent congenital craniofacial deformities, with a mean prevalence of between 1:500 and 1:700 in Europe.[1]
The aim of this study is to evaluate the need for revision of unilateral cleft lip repair using Millard procedure at Komfo Anokye Teaching Hospital (KATH) in Ghana
In a study to evaluate the aesthetic outcome of cleft lip surgery by the public using the visual analogue scale, the average score for general appearance, was 7.55, the aesthetics of the mouth was 7.40 and the nose was 7.23.4 This study had a similar trend of satisfaction with average scores of general facial appearance (GFA) as 6.6, lip was 6.1 and nose was 6.0
Summary
Cleft lip and palate are the most frequent congenital craniofacial deformities, with a mean prevalence of between 1:500 and 1:700 in Europe.[1] The abnormalities vary greatly in terms of width of the cleft as well as other characteristics. Treatment modalities differ with regard to timing of surgery and the technique of reconstruction.[3]. Treatment of cleft lip and palate should provide both good aesthetic and functional (speech, occlusion) results.[4,5] Successful surgical repair of the unilateral cleft lip is commonly defined as one that results in normal orbicularis oris[6] function and a near perfect symmetry of the lip and nose. Unilateral cleft lip repair may, be associated with a number of complications that could affect the aesthetic outcome
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