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Repair of Asymmetric Bilateral Cleft lip: 1 Stage or 2 Stage
Xinran Zhao1, Yilai Wu1, Guomin Wang1
1Department of Oral & Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Oral Diseases Clinical Research Center, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, China.
Objective:
To verify the advantages and indications of 1-stage and 2-stage repair for asymmetric bilateral cleft lip (BCL).
Design:
Retrospective study.
Setting:
From January 2004 to December 2016 in our department.
Patients:
Patients with BCL.
Main Outcome Measure(S):
Over 6 months after the operation, the surgery outcomes were evaluated and graded by 2 experienced surgeons.
Results:
The result of surgery was evaluated using the scoring method of Mortier et al and Anastassov and Chipkov. Among 133 patients with asymmetric BCL, 61 (45.9%) had 1-stage repair and 72 (54.1%) had 2-stage repair. Sixty-eight (51.1%) patients had complete-incomplete cleft lip (CL), and those who underwent 1-stage repair showed a trend of better outcome (P = .028). Fifty (37.6%) patients with incomplete-microform CL showed no significant difference between the outcomes of 2 surgery plans (P = .253). In 15 (11.3%) patients with complete-microform CL, only one had 1-stage repair with a score of 8.5. The other 14 patients with 2-stage repair were scored 3.68 ± 1.28. Two-stage repair was preferable when the deformity degree was very different on 2 sides, as it could reduce unnecessary scar tissue and extend the nasal columella. One-stage repair could help to achieve the anatomical reduction of the orbicularis oris and a better contour of the vermilion tubercle.
Conclusion:
One-stage repair is recommended for patients with complete-incomplete CL and incomplete-microform CL. Two-stage repair for patients with complete-microform CL is preferred in our center, but more studies are required to support this conclusion.
