Bilateral complete cleft lip and nasal deformity: an anthropometric analysis of staged to synchronous repair

This is a retrospective accounting of a personal evolution from staged to synchronous surgical correction of bilateral complete cleft lip and nasal deformity. Technical development can be separated into three phases: (1) two-stage lip/nasal repair with a banked forked flap and subsequent intranasal transposition of the times (n = 15), (2) two-stage lip/nasal repair and later transection of the banked times (n = 5), and (3) one-stage lip/nasal repair without a forked flap (n = 12) and with closure of alveolar cleft (n = 6 of 12). The premaxillary orthopedic program employed a removable jackscrew device in phases 1 and 2; the Georgiade-Latham pin-retained appliance was used in phase 3. Anatomic outcome was documented by anthropometry: Eight nasolabial measures were compared with normative age-matched data. Mean age at postoperative evaluation: phase 1, 8.1 years; phase 2, 4.6 years; and phase 3, 2.5 years. Nasal height, nasal protrusion, and columellar length were generally within 1 SD of normal growth curves in all three phases. Interalar measures were wide in phases 1 and 2 (1 to 2 SD) and closer to 1 SD of the mean in phase 3. Total lip height tended to be long in phases 1 and 2 and was shortened purposely in phase 3 (1 to 2 SD). Vermilion-mucosa accounted for the long lip in the earlier phases. Cutaneous lip length was 1 to 2 SD or more below normal in all phases.(ABSTRACT TRUNCATED AT 250 WORDS)