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Updated: Dec 25, 2025

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Change in Incisional Design in Primary Unilateral Cleft Lip Repair Under General Anesthesia.

Tomoko Tsuda1, Lan Lan1, Daichi Morioka2

  • 1Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Kanagawa.

The Journal of Craniofacial Surgery
|March 27, 2020
PubMed
Summary

General anesthesia alters infant nasolabial features, impacting unilateral cleft lip (UCL) surgical planning. Preoperative 3D imaging of awake infants is crucial to prevent secondary deformities.

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Area of Science:

  • Plastic Surgery
  • Craniofacial Surgery
  • Pediatric Surgery

Background:

  • Infants with unilateral cleft lip (UCL) exhibit distinct nasolabial features when awake versus under general anesthesia.
  • These differences can influence the accuracy of cheiloplasty (lip repair) incisional designs.

Purpose of the Study:

  • To investigate how patient position and anesthesia (awake vs. general anesthesia) affect nasolabial features and incisional design for UCL repair.
  • To compare anthropometric measurements of incisional designs between awake and anesthetized states.

Main Methods:

  • Three-dimensional facial images of 20 infants with UCL were analyzed.
  • Two distinct incisional designs were applied to images of awake infants.
  • These designs were anthropometrically compared to designs created from images of the same infants under general anesthesia.

Main Results:

  • General anesthesia significantly increased vermillion height on both medial and lateral cleft sides.
  • The rotation flap incision on the medial lip element shortened under anesthesia, while the lateral advancement flap remained largely unchanged.
  • Philtral ridge lengths on both cleft and non-cleft sides were significantly reduced under anesthesia, though this did not impact lateral flap width calculations.

Conclusions:

  • Anesthesia-induced changes in nasolabial morphology can lead to surgical inaccuracies and secondary cleft lip deformities.
  • Preoperative planning utilizing 3D imaging of awake infants is recommended to mitigate these risks and improve surgical outcomes.