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Updated: May 24, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Single-stage repair of asymmetrical bilateral cleft lip with contralateral lesser form defects
Michael Bezuhly1, David M Fisher
1Halifax, Nova Scotia, and Toronto, Ontario, Canada From the IWK Health Center, Division of Plastic and Reconstructive Surgery, Dalhousie University, and the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto.
Background:
Complete or incomplete cleft lip may include a contralateral lesser form of incomplete cleft lip to give rise to an asymmetrical bilateral cleft lip deformity. The principle of simultaneous bilateral cleft repair remains an area of contention with regard to asymmetrical cases, including a lesser form deformity.
Methods:
The cleft lip database of the senior author (D.M.F.) was searched for patients with complete or incomplete bilateral cleft lip with a contralateral lesser form defect. Results were assessed by reviewing photographs and recording revisions.
Results:
Of 111 patients with bilateral cleft lip, 35 (32 percent) had asymmetrical cleft lip, with 13 patients having contralateral lesser form defects. All infants with complete cleft lip-cleft palate underwent presurgical orthodontics. All patients subsequently went on to single-stage bilateral cleft lip repair. Seven revisions were performed in the symmetrical complete bilateral cleft lip group; no revisions were performed in the asymmetrical bilateral cleft lip group.
Conclusions:
The authors recommend a single-stage operation for repair of the bilateral cleft lip irrespective of the extent: complete, incomplete, lesser form, symmetrical, or asymmetrical. This approach provides the best opportunity to achieve symmetry of the Cupid's bow and of the resultant scar, and provides the ideal opportunity for reconstruction of the prolabial deficiencies of the cutaneous roll, vermilion, and median tubercle.
Clinical Question/Level Of Evidence:
Therapeutic, IV.
