Bilateral Cleft Lip Repair

Contributors: Larry Hartzell

Repair of the bilateral cleft lip deformity can be challenging to the cleft and craniofacial surgeon.  The goals of an acceptable repair must include precise continuity of the cupid’s bow, maximizing philtral length, and establishing a mucosa lined sulcus.  We present an example of a repair of the bilateral incomplete lip as described by Millard.

DOI: http://dx.doi.org/10.17797/qefi9lqbam

Bilateral cheiloplasty
Bilateral cleft lip
Medically unfit for general anesthesia. Poor nutrition for compromised healing.
General plastics set up including calipers, straight beaver blade, and skin hooks
Pre-operative photos, Hemoglobin and hematocrit, preoperative parental counseling
External landmarks of the upper lip: Cupids bow, philtrum, philtral dimple, cutaneous white roll, wet and dry vermillion, nasal base.
This repair provides the option of banking redundant skin at the bilateral nasal base as "fork flaps" which may be used later on if collumellar lengthening is anticipated to be necessary. This technique also provides the "E-flap" which gives fullness to the tubercle of the upper lip.
Bleeding, infection, poor wound healing, unacceptable scarring.
1. Noordhoff, MS. (1986) Bilateral cleft lip reconstruction. Plastic and Reconstructive Surgery. Jul;78(1):45-54. 2. Oh, SJ. (2008) Reconstruction of bilateral cleft lip and nose deformity. Journal of Craniofacial Surgery. Sep;19(5):1353-8.

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