The following video demonstrates the author’s method for repairing wide unilateral complete cleft lip and cleft nasal deformities. Details of surgical markings as well as nuances of technique are demonstrated. Video documentation of immediate results as well as progress of healing over the following year are included.
Primary repair of unilateral cleft lip with primary rhinoplasty.
Repair of lip defects and associated congenital cleft nasal deformity
Surgery should be delayed or staged if there are significant medical comorbidities
Standard soft tissue instrumentation and simple towels and drapes. An oral RAE tube should be used for intubation.
The author does not perform any further imaging or work up beyond what was deemed medically appropriate for evaluating this child in infancy after the diagnosis of cleft lip was made. If syndromic features are present, and echocardiogram may be prudent.
An understanding of the aberrant muscular attachments and cartilaginous positioning will improve the surgeon's understanding of the primary unilateral cleft lip and nose deformity and therefore the optimal steps to correct these problems.
The surgery depicted demonstrates a reliable technique for addressing even the widest and most severe unilateral cleft lip and nose deformities in a single stage. Depending on the extent of lip / nose deformity one or more of the components of this technique can be "dialed back" and not used. Performing primary rhinoplasty and vestibular mucosal augmentation at the time of lip repair increases surgical time. Depending on the extent of primary nasal deformity and caudal septal deviation, soft tissue excess within the nasal vestibule on the cleft side may occur. This can cause nasal obstruction during the first years of life until the child grows or revision is deemed necessary.
Bleeding, infection, breakdown of flap, soft tissue nasal stenosis, hypertrophic scarring, need for additional procedures
Mohler LR. Unilateral cleft lip repair. Plast Reconstr Surg 1987, 80(4):511-516 Fisher D.M. Unilateral cleft lip repair: an anatomical subunit approximation technique. Plast Reconstr Surg 2005; 116(1): 61-71. Tse R. Unilateral Cleft Lip: Principles and Practice of Surgical Management. Semin Plast Surg. 2012 Nov; 26(4): 145–155.
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