Bilateral Cleft Lip Nose Deformity Research Articles

Dynamic Nasolabial Growth After Primary Surgery for Patients With Bilateral Cleft Lip: A Five-Year Follow-Up Study

Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction. The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6months and 5years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05. A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P=.000<.05), but the CL had increased nearly as much (P=.270). For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis.

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

A novel technique using a subcutaneously pedicled islanded prolabial flap for the secondary correction of bilateral cleft lip and nasal deformity.

Context:The bilateral cleft lip and nose deformity frequently requires lip revision surgery at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle.Aims:We have devised a new technique of using prolabial tissue tailored as an island of skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral aesthetic unit in patients with bilateral cleft lip nasal deformity.Settings and Design:This technique was used in 21 patients from March 2012 to August 2015. All patients had undergone primary lip repair at other institutions and required lip revision with simultaneous rhinoplasty.Subjects and Methods:The objective criteria considered in the post-operative evaluation by the authors included improvement of philtral ridge projection, symmetry of philtral column and nasal sill and white roll continuity. The ten individual parameters were given a score from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the total score was rated as 31–40 = excellent, 21–30 = good, 11–20 = fair and 0–10 = Poor. The patients' overall satisfaction was assessed at 6 months postoperatively to record their impression of the aesthetic improvement after our procedure.Results:The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative complications. The authors' assessment judged 15 (71.4%) patients as having an excellent outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective satisfaction with the post-operative appearance of their upper lip and rated their results as improved and overall satisfaction scoring was high.Conclusions:This technique is a new addition to the repertoire of procedures which already exist for the correction of bilateral cleft lip nose deformity. It is safe, reliable and has a good aesthetic outcome with no significant morbidity.

Secondary bilateral cleft lip-nose deformity correction by rhinoplasty with simultaneous Abbe flap.

Aim:The purpose of this article is to review modification and outcome of secondary rhinoplasty along with Abbé flap for correction of secondary bilateral cleft lip deformity.Materials and Methods:A total of thirteen patients of secondary bilateral cleft lip-nose deformity having tight upper lip, lack of acceptable philtral column, Cupid's bow definition, irregular lip scars, and associated nasal deformity were selected. All the patients received Abbé flap and simultaneous nasal correction. All cases were treated during a period of three years. Mean patient age at the time of the operation was 21 years, and ranged from 16 to 27 years. The average follow-up period was three years.Results:Assessment of results was based on comparing preoperative and postoperative clinical photographs done by surgeon and patient relatives and patient satisfaction questionnaires. The columellar lengthening and upper lip vermillion correction achieved was satisfactory. There were no perioperative complications such as airway obstruction, bleeding, infection, wound disruption, or flap necrosis.

Unfavourable results in the repair of the cleft lip

Introduction:Unfavorable results in unilateral and bilateral cleft lip repair are often easy to spot but not always easy to prevent as to treat. We have tried to deal with the more common problems and explain possible causes and the best possible management options from our experience.Unilateral cleft lip repair:Unfavorable results immediately after repair involve Dehiscence and Scaring. Delayed blemishes include vermillion notching, a short lip, deficiency in the height of the lateral vermillion on the cleft side, white roll malalignment, oro-vestibular fistula, the cleft lip nose deformity, a narrow nostril and a “high-riding” nostril. We analyze the causes of these blemishes and outline our views regarding the treatment of these.Bilateral cleft lip:Immediate problems again include dehiscence as also loss of prolabium or premaxilla. Delayed unfavorable results are central vermillion deficiency, a lip that is too tight, bilateral cleft lip nose deformity, problems with the premaxilla and maxillary growth disturbances. Here again we discuss the causation of these problems and our preferred methods of treatment.Conclusion:We have detailed the significant unfavorable results after unilateral and bilateral cleft lip surgery. The methods of treatment advocated have been layer from our own experience.

Three-Dimensional Analyses of Nasal Forms After Secondary Treatment of Bilateral Cleft Lip–Nose Deformity in Comparison to Those of Healthy Young Adults

To 3-dimensionally analyze outcomes after the secondary treatment of bilateral cleft lip-nose deformity at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, Kagoshima, Japan. Ten Japanese male young adults with bilateral cleft lip with or without palate (BCL±P) who had undergone definitive nose correction and were followed up for 1 to 4 years were enrolled in this study. Ten unaffected race- and gender-matched young adults were used as controls. All patients underwent secondary correction of the nose by open rhinoplasty through a bilateral reverse-U incision, columellar strut graft, and medial-upward advancement of the nasolabial components with vestibular expansion by use of a free mucosal graft. In 3 patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotated into the columellar base was added for columella lengthening. Nasal forms were periodically measured by use of a 3-dimensional noncontact laser scanner. The angular and linear measurements and the curvature of the alar groove arch were compared between patients and control subjects. Comparison of the preoperative and postoperative nasal forms showed significant improvements in the nasal dorsum and tip angles, as well as nasal height. The size of the nasal alar grooves was also increased to the same size range as the control subjects. There were persistent differences between postoperative columellar angle and nasal width in patients and those in the control subjects. Our surgical procedures can provide an acceptably protruded nasal form for patients with BCL±P without damaging the upper lip tissue, but further improvement to prevent nasal tip overprojection may be useful.

Secondary correction of bilateral cleft lip nose deformity – Clinical and three-dimensional observations on pre- and postoperative outcome

Purpose The purpose of this study was to describe the clinical and three-dimensional (3D) outcomes following secondary correction of bilateral cleft lip and nose by reverse-U incision, nasal tip cartilage graft, and medial-upward advancement of bilateral nasolabial components with vestibular expansion with a free mucosal graft. Patients and methods Secondary correction of the bilateral cleft lip and nose deformity was performed on 11 patients with complete bilateral cleft lip, alveolus and palate (BCLP). In four patients with an extremely short columella, an inferiorly based small pedicle flap from rim skin rotating into the columella base was included to elongate the columella length. Pre- and postoperative nasal forms were recorded using photos and 3D data taken serially. Results The nasal forms and lateral profiles were improved in all patients postoperatively. The pre- and postoperative 3D colour images demonstrated satisfactorily elongated columella length, symmetrically increased nasal tip projection, and enlarged alar groove. No serious complications were observed postoperatively. Conclusions Our secondary correction technique of the bilateral cleft lip and nose will provide successful results producing an adequate nasal tip projection and alar forms without damaging the upper lip tissue in patients with BCLP.

Bilateral cleft lip nasal deformity

Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity.Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention.There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM) too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth.This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it's management both at the time of cleft lip repair and also secondarily, at a later date. It also discusses the practices followed at our centre.

MOC-PS(SM) CME Article: Late Cleft Lip Nasal Deformity

After reading this article, the participant should be able to: 1. Understand the components of unilateral and bilateral secondary or delayed cleft lip nasal deformity. 2. Design and execute the surgical correction more logically. 3. Minimize the risks and better manage complications and suboptimal outcomes. Rhinoplasty remains one of the most challenging plastic surgery procedures, and patients with a cleft lip nose deformity pose an even greater challenge. The biggest enigmas are achievement of caudal nose congruity and creation of symmetric nostrils. This article reviews the factors to consider when assessing a patient for correction of secondary cleft lip nasal abnormalities and the surgical techniques available to correct the deformities. Some of the components of the unilateral cleft lip nose deformity include asymmetric tip, short columella, long lateral crus, flat nostril, wide alar base, caudal positioning of the nostril floor on the cleft side, and a short and deviated columella. The common features of bilateral cleft lip nose deformity include short columella, underprojected tip, flat alae, and wide and often asymmetric and horizontal nostrils. While an endonasal approach can improve these noses, the most success is attained through an open technique. Systematic reorientation of distorted nasal architecture, especially the lower lateral cartilages, and creation of a balanced platform for the lower lateral cartilages constitute some of the cardinal principles for correcting the cleft lip nose deformities. Potential complications and ways to minimize them are discussed.

The Central Lip Flap and Nasal Mucosal Rotation Advancement: Important Aspects of Composite Correction of the Bilateral Cleft Lip Nose Deformity

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.

Assessment of Bilateral Cleft Lip Nose Deformity: A Comparison of Results as Judged by Cleft Surgeons and Laypersons by Lun-Jou Lo, M.D. Fen-Hwa Wong, Ph.D. Samir Mardini, M.D. Yu-Ray Chen, M.D. M. Samuel Noordhoff, M.D.

Received for publication March 18, 2002. Jeffrey L. Marsh, M.D. Cleft Palate and Craniofacial Deformities Institute St. Louis Children's Hospital Washington University Medical Center St. Louis, Mo. 63110[email protected]

Assessment of Bilateral Cleft Lip Nose Deformity: A Comparison of Results as Judged by Cleft Surgeons and Laypersons

Assessment of Bilateral Cleft Lip Nose Deformity: A Comparison of Results as Judged by Cleft Surgeons and Laypersons

Designs for correction and camouflage of bilateral clefts of the lip and palate.

The bilateral cleft anomaly is difficult to correct and camouflage because of the double lack of many important landmarks and the shortness of skin in the midvertical plane. A possible solution in patients who have some columella or in those of races not needing a long columella is the strap flap advancement of the nostril sills and alar bases. In all other cases, the forked flap is the method of choice for adequate correction and camouflage of the bilateral cleft lip-nose deformity.

Bilateral reverse U incisions and separately placed columella relaxation incision for correction of bilateral cleft lip nose deformity

The reverse U incision method has been employed for the correction of the unilateral cleft lip nose deformity for more than twenty years with satisfactory results. It has some columella lengthening effect and thus has proved to be useful for the correction of nasal deformities of bilateral cleft lip. To augment its columella lengthening effect a columella relaxation incision is added to the bilateral reverse U incision for the correction of the bilateral cleft lip nose deformity. This results in a reconstructed columella of satisfactory length and width.

Secondary correction of bilateral cleft lip nose deformity

For correction of the bilateral cleft lip nasal deformity, a modified bilateral reverse U incision is used in combination with a short, forked flap; by using this combination, satisfactory lengthening of the columella, preserving the natural pout of the lip, can be obtained. We have applied this method to 12 cases undergoing secondary repair of bilateral cleft lip in the past 3 years, and the results of this treatment, along with representative photographs of some of our patients, are presented herein.

Use of the Abbé flap in revision of the bilateral cleft lip-nose deformity

Use of the versatile Abbé flap for lip-nose revision of a representative adult with bilateral cleft lip and palate is reported. The deformity is discussed, and the surgical plans are developed and executed. Presented is a technique for reliably securing the lateral orbicularis oris muscle components to the philtrum, which ensures viability of the transposed flap and provides functional continuity across the midline while accentuating the philtral dimple.