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Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or
Shunsuke Yuzuriha1, Albert K Oh, John B Mulliken
1Boston, Mass. From the Department of Plastic Surgery, Children's Hospital and Harvard Medical School.
Plastic and Reconstructive Surgery
|October 31, 2008
Summary
Asymmetrical bilateral cleft lip repair strategies vary based on the severity of the lesser lip defect. Minor-form defects require synchronous repair, while microform/mini-microform defects are typically repaired later for optimal symmetry.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Asymmetrical bilateral cleft lip involves a complete or incomplete cleft lip with a contralateral lesser form of incomplete cleft lip.
- This condition presents as an asymmetrical bilateral malformation requiring specific surgical considerations.
Purpose of the Study:
- To investigate and define operative strategies for repairing asymmetrical bilateral cleft lip based on the characteristics of the lesser cleft.
- To analyze the outcomes and revision rates associated with different surgical approaches.
Main Methods:
- A retrospective review of a cleft lip registry identified patients with asymmetrical bilateral cleft lip.
- Surgical repair methods were documented, and outcomes were assessed through photographic review and revision recording.
Main Results:
- Of 309 bilateral cleft lip patients, 72 (23%) had asymmetrical cleft lip, with 40 having contralateral minor-form, microform, or mini-microform defects.
- Surgical approaches varied: synchronous bilateral repair for minor-form defects, delayed repair (double unilimb Z-plasty) for microform defects, and vertical lenticular excision for mini-microform defects.
- Revision rates correlated with preoperative asymmetry, with common revisions including median tubercle augmentation and alar base repositioning.
Conclusions:
- The surgical strategy for asymmetrical bilateral cleft lip repair is dictated by the severity of the vermilion-cutaneous dysjunction on the lesser side.
- Synchronous bilateral nasolabial repair is recommended for contralateral minor-form defects.
- Correction of contralateral microform or mini-microform defects is generally deferred to achieve better symmetry postoperatively.
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