Different modalities for the management of bilateral cleft lip

Abstract

Objectives The aim of this randomized prospective trial was to evaluate the different modalities for the management of bilateral cleft lip including primary and secondary deformities. Background Cleft lip repair will remain the aim of cleft surgeons. The complexity of deformity and the delicate interrelation between muscular arrangement and external lip features require a comprehensive approach for proper management. This study describes technical refinements in the skin design and modifications in the muscle repair in bilateral cleft lip. Materials and methods From January 2012 to April 2014, 16 patients with bilateral cleft lip deformities received surgical treatment in the form of either (group A, n = 10 patients) closure of the primary cleft according to the type and amount of protrusion of the premaxilla or (group B, n = 6 patients) repair of secondary deformities according the presentation. Demographic data, operative time, post, hospital stay, duration of incapacity for work, postoperative complications (infection, wound dehiscence, hypertrophic scar), symmetry, vermillion red alignment, quality of the scar, and patient satisfaction were recorded. Results The overall results were very satisfactory in function and appearance, without major complications. The lip adhesion procedure was performed at the age of 2-8 weeks postnatally, definitive lip closure at the age of 3-6 months (primary repair 10 cases), and secondary repair at the age of 2 years until adulthood (secondary repair six cases). Wound dehiscence occurred in two cases that healed spontaneously without intervention. Conclusion This method of comprehensive primary muscle, soft tissue, and skin reconstruction in bilateral cleft lip addresses the major sites of distortion in the lip, sulcus, and nasal floor, producing a full central segment, prominent philtral ridges, adequate white roll, and thick vermilion with a seam-like median tubercle in addition to a deep gingivo-labial sulcus and alar base symmetry. Nasal deformity postponed with secondary repair.