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Published on: June 20, 2018
Nasolabial Revisions in Unilateral Incomplete Cleft Lip: One Surgeon's 28-Year Experience
Stephan P K Tan1, Ingrid M Ganske1, John B Mulliken1
1From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School.
Background:
Repair of unilateral incomplete cleft lip is the surgeon's opportunity to achieve a superior result with few revisions.
Methods:
This study is a retrospective review of consecutive patients with unilateral incomplete cleft lip, defined as a defect extending 30 to 90 percent of cutaneous labial height, treated between 1985 and 2013 by one surgeon. Rates and types of revisions were collected, and photographs of patients who did not have a revision were reviewed to determine whether a revision was needed.
Results:
One hundred thirty-six patients met inclusion criteria. Fifty-seven percent needed revision of the mucosal free margin; less than 10 percent needed other minor labial revisions. Fifteen percent required a nasal revision, most commonly reelevation of the lower lateral cartilage. Over time, the only statistically significant change in frequency was increased revisions of the free border.
Conclusions:
Nasal revision rates are low in unilateral incomplete cleft lip compared to complete forms in previously published data by the senior author (J.B.M.). In contrast, labial revisions of the free margin are more common. The reason is that the surgeon became more cognizant of vermilion-mucosal deficiency on the noncleft side and more likely to offer a submucosal flap or dermis-fat graft to level the lip for normal upper incisor show.
Clinical Question/Level Of Evidence:
Therapeutic, IV.
