Bilateral Cleft Lip Deformity Research Articles

Repair of the deformity of bilateral cleft lip with non-elongated cheiloplasty and rectangular mucomuscular complex flaps of double vermilion

Objective To introduce experiences with non-elongated cheiloplasty and rectangular mucomuscular complex flaps of double vermilion for repairing bilateral cleft lips. Methods 29 patients (20 males and 9 females) with bilateral cleft lips underwent operations of non-elongated cheiloplasty and rectangular mucomuscular complex flaps of double vermilion. There were 15 bilateral complete cleft lips, 11 bilateral incomplete cleft lips and 3 bilateral mixed cleft lips. The deformity of white lips was reconstructed with traditional non-elongated cheiloplasty. When repairing the vermilion, the rectangular mucomuscular complex flaps which included mucous membrane of vermilion and part of orbicularis oris in double vermilion were designed, and vermilion of fore lip was incised along boundary of wet lip and dry lip. Then rectangular mucomuscular complex flaps of double vermilion were rotated downward and inward to be sewn with fore lip. At the step, the end of orbicularis otis should be sewn widely and fitly in order to form a normal annular structure. Results The wounds of all the patients were healed at one stage. The height and width of patients' upper lips were proper and the center tubercles of the upper lips were obvious. No whistling deformity appeared. Conclusion The method for repairing bilateral cleft lips is simple and reliable. Less tissues could be excised and the satisfactory form and function of nose and lip could be achieved. It is worthy to be applied in clinical practice. Key words: Bilateral cleft lips; Non-elongated eheiioplasty; Rectangular mucomuscular complex flaps

Correction of the Secondary Bilateral Cleft Lip Deformity Encountered in Guatemala

Correction of the Secondary Bilateral Cleft Lip Deformity Encountered in Guatemala

Correction of the Secondary Bilateral Cleft Lip Deformity Encountered in Guatemala

Correction of the Secondary Bilateral Cleft Lip Deformity Encountered in Guatemala

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: application of occult Abbé flap

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: application of occult Abbé flap

Repair of the Bilateral Cleft Lip Deformity

The bilateral cleft lip is a complex deformity involving discontinuity of the soft tissue layers of the lip and, frequently, the underlying bony structure. Satisfactory repair requires a thorough understanding of the anatomic deformity. The authors' philosophy and timing of the bilateral cleft lip repair are discussed. Details of the surgical technique are outlined.

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited.

The purpose of this retrospective study was to review the method of using the Abbé flap for correction of secondary bilateral cleft lip deformity in selected patients with tight upper lip, short prolabium, lack of acceptable philtral column and Cupid's bow definition, central vermilion deficiency, irregular lip scars, and associated nasal deformity. A total of 39 patients with the bilateral cleft lip nasal deformity received Abbé flap and simultaneous nasal reconstruction during a period of 6 years. Mean patient age at the time of the operation was 19.1 years, and ranged from 6.6 to 38.5 years. The average follow-up period was 1.8 years. Fourteen patients had prior orthognathic operations. The Abbé flap was designed 13 to 14 mm in length and 8 to 9 mm in width and contained full-thickness tissue from the central lower lip, with a slightly narrow reverse-V caudal end. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. Part of the prolabial skin was preserved and mobilized for columellar elongation, if indicated. Open rhinoplasty was carried out with or without cartilage graft for columella and nasal tip reconstruction. Reduction of the alar width and nostrils was achieved by a Z-plasty or excision of scar tissue at the nostril floor. The Abbé flap was then transposed cephalad, insetting into the median defect and sutured in layers. The results demonstrated no flap problems or perioperative complications. Seven patients needed further minor revisions on the nose and/or lip. Laser treatment was used to improve the lip scars in three patients. The patients were satisfied with the final outcome and found the lower lip scars acceptable. In conclusion, the described technique of Abbé flap and simultaneous rhinoplasty is an effective reconstructive method for select patients with bilateral cleft lip and nasal deformity.

Bilateral one-stage rotation advancement technique for Saudi children with isolated bilateral incomplete cleft lip: low revision rate despite multiple imperfections.

The author is unaware of any article published in the English literature during the past 25 years that addresses specifically the results of surgery in isolated bilateral incomplete cleft lip deformity. The current study presents the outcome and investigates the surgical revision rate in 10 consecutive Saudi children with this deformity. Surgery was performed by the same surgeon using the bilateral one-stage rotation advancement technique. No primary nasal correction was performed in any of the patients. There were no immediate postoperative complications. Only one patient was offered a revision, but the parents refused and stated that they were happy with the result. No secondary lip or nasal correction was suggested or planned for any of the other patients. A panel of 10 medical students was asked to assess the surgical results using a 10-point scale. The one patient who was offered a revision obtained the lowest grade (mean score, 7.5 points). The remaining patients had a mean score that ranged between 7.9 points and 9.3 points. It appears that the multiple imperfections and asymmetries observed in the postoperative photographs were not thought to be severe enough to warrant surgical revision.

Reconstruction of the superior labial sulcus in secondary bilateral cleft lip deformities: an inverted U-shaped flap.

A shallow buccal sulcus deformity following bilateral cleft lip repair is not rare. A variety of techniques are described for the secondary reconstruction of a deficient sulcus. Most of these are associated with a variable amount of contraction with subsequent obliteration of the sulcus. In this article, an inverted U-shaped flap is described for the secondary reconstruction of the deficient sublabial sulcus. In these patients, mobility of the upper lip was severely restricted, so orthodontic treatment was not possible. This technique was used in nine patients whose primary cleft lip repairs were performed in different institutions. The amount of re-adhesion or contraction was negligible, because a bare surface was not left behind and skin or mucosal grafts were not used. By advancing the lateral segments of the lip medially, projection of the upper lip was increased. The procedure resulted in adequate upper lip mobility for all patients, and sufficient sulcus was maintained during 1 to 6 years of follow-up. The patients experienced no difficulty with orthodontic appliances after this reconstruction.

Secondary correction of bilateral cleft lip deformity with simultaneous Abbé flap and nasal repair

For secondary repair of a bilateral cleft lip deformity with a short columella and defective upper lip, simultaneous correction of the lip and nose is ideal. We perform a nasal repair through a bilateral reverse-U incision and columella elongation using the upper lip. An Abbé flap is then transferred to the upper lip defect. This procedure enables total reconstruction of characteristic bilateral cleft lip deformities in one stage. We have applied this method to 15 patients (9 males and 6 females) with an average age of 18.7 years. Although some patients need jaw surgery, all have been satisfied with the results.

Secondary correction of the bilateral cleft lip nose by excision of the columellar forked flap and nasal remodelling with reverse-U flaps: a preliminary report

Although the forked flap procedure has been widely used as a technique to lengthen the columella in the bilateral cleft lip deformity, often the results are unfavourable. We describe a technique to achieve a more natural shape, in which the unsatisfactory forked flap is excised and the columella is reconstructed by mobilization and rotation of nasal skin, combined with bilateral reverse-U flaps. Five consecutive patients who underwent this secondary correction procedure are presented.

Use of levator labii superioris muscle flap in the muscle repair of cleft lips

In order to facilitate and improve muscle repair in wide cleft lips, a levator labii superioris muscle flap has been used to augment the orbicularis oris muscle. The neurovascular pedicle of this muscle flap can be preserved to eliminate the possibility of ischemic muscle fibrosis and atrophy. Eleven patients between the ages of 4 months and 24 years having wide cleft lips underwent this procedure. Seven had a unilateral and 4 had a bilateral cleft lip deformity. In one patient who had a bilateral complete cleft lip, the levator labii superioris muscle was directly approximated to the contralateral muscle. In the other three patients with bilateral cleft lips, the levator labii superioris muscle flaps were approximated to the contralateral orbicularis oris muscles. In all 7 of the unilateral cases, the levator labii superioris muscle flaps were used to obtain a tension free closure and for filling out the defect below the nostril sill. None of the patients had wound infection, wound dehiscence or scar widening. The functional loss resulting from the transposition of the flap is compensated for by the remaining synergistic muscle, the zygomaticus minor. This method of muscle repair seems to be completely benign, and the muscle flap dissection can be performed easily and safely.

A method for secondary repair of bilateral cleft lip deformity with closure of orbicularis oris muscle

INTERNATIONAL ABSTRACTS OF PLASTIC AND RECONSTRUCTIVE SURGERY: CONGENITAL ANOMALIES: Cleft Lip and Palate: PDF Only

Combined nose and lip repair for postoperative deformity of bilateral cleft lip

Combined nose and lip repair for postoperative deformity of bilateral cleft lip

Cleft Craft: The Evolution of Its Surgery, vol 2: Bilateral and Rare Deformities

This scholarly book is the second of three volumes on cleft lip, cleft palate, and associated deformities, written by one of the leading authorities in plastic and reconstructive surgery today. In a text filled with abundant illustrations—sketches, portraits, and colored plates—Millard describes the many procedures developed during the past 150 years or more in the repair of the bilateral cleft lip deformity. Special chapters are devoted to bilateral cleft embryology, cleft anatomy, what to do or not to do about the projecting premaxillary segment, the optimum time for bilateral cleft lip surgery, the surgical evolution of repair of bilateral cleft lips, and the treatment of secondary bilateral deformities such as skin scars, muscle discrepancies, and philtrum deformities. In these chapters Millard provides a one-man symposium based on more than three decades of personal experience in treating these deformities. A special section deals with the rare deformities that have not often

A method of reconstruction of the sublabial sulcus and the vermilion tubercle in the secondary repair of the bilateral cleft lip deformity

A method of reconstruction of the sublabial sulcus and the vermilion tubercle in the secondary repair of the bilateral cleft lip deformity

A method of reconstruction of the sublabial sulcus and the vermilion tubercle in the secondary repair of the bilateral cleft lip deformity

A method of reconstruction of the sublabial sulcus and the vermilion tubercle in the secondary repair of the bilateral cleft lip deformity

Secondary repair of bilateral cleft lip deformities: A two-stage approach

A two-stage procedure using previously described principles has been designed to achieve muscle-to-muscle union, narrowing of the philtrum and lengthening of the columella. In addition fuistulas may be corrected simultaneously.

Secondary correction of bilateral cleft lip deformities with Millard's midline muscular closure: R. M. ONeal, D. M. Greer, Jr., and G. L. Nobel. Plast. Reconstr. Surg. 54:45–51 (July) 1974

Secondary correction of bilateral cleft lip deformities with Millard's midline muscular closure: R. M. ONeal, D. M. Greer, Jr., and G. L. Nobel. Plast. Reconstr. Surg. 54:45–51 (July) 1974

Secondary correction of bilateral cleft lip deformities with Millard's midline muscular closure.

Secondary correction of bilateral cleft lip deformities with Millard's midline muscular closure.

Revision of Bilateral Celft Lip Deformity Using Abbe Flap


 
 
 
 Background: Most primary repair of bilateral complete cleft lip does not show satisfying result due to several deformities caused by inappropriate use of the hypoplastic prolabial tissue, failure to advance the lateral lip elements to the midline for primary repair of the orbicularis, and scarring. The Abbe flap is the accepted procedure for the correction of severe secondary deformity of a bilateral cleft lip. By introducing an adequate amount of lip tissue, it relieves the tightness of the upper lip and also corrects the depressions of the tip of the nose. Symmetry between the two lip is also achieved
 Patient and Method: Three patients with tight lip deformity underwent this procedure. The Abbe flap, which was taken from the central portion of the lower lip vermilion, was designed to repair the vermilion tubercle and the Cupid’s bow. A tiny portion of skin was included to facilitate closure of the donor site. The pedicle was divided 3 weeks after operation.
 Results: Each patients showed a more natural contour of the vermilion tubercle and the Cupid’s bow. The scarring of the donor site was inconspicuous. Summary: The Abbe flap can be considered as a choice for revision of bilateral cleft lip deformity. The disadvantages of this flap include patient’s discomfort and the need for multiple procedures.