ABSTRACT
The modern technique of presurgical orthopedics and nasoalveolar molding produces
a better skeletal foundation and nasal shape for the repair of the bilateral cleft
lip-nasal deformity. The general principles are as follows: (1) preserve the presurgical
columellar length; (2) keep the width of the central lip segment narrow without compromising
the blood supply; (3) advance the columella prolabium complex superiorly to allow
reconstruction of the orbicularis oris muscle behind the prolabium; (4) release the
alar cartilage attachment from the pyriform rim and provide additional coverage of
this soft tissue deficiency with the use of inferior turbinate flaps; (5) release
and reposition the lower lateral cartilage; (6) adequately dissect above the maxillary
periosteum; (7) reconstruct the nasal floor by local mucosal flaps; (8) reconstruct
the prolabial buccal sulcus with tissue from the prolabium; (9) reconstruct the orbicularis
muscle sphincter and attach it to the anterior nasal spine; (10) reconstruct a new
Cupid's bow, central vermilion, and lip tubercle with tissue from the lateral lips;
(11) balance the height of both lateral lips without any incision around the ala;
and (12) maintain the presurgical nasolabial angle. The residual nasal deformity remains
a problem that needs further improvement. The long-term result in Chang Gung Craniofacial
Center suggests overcorrection of columella height before, during, and after lip repair.
KEYWORDS
Bilateral cleft lip - nasoalveolar molding - long-term result
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Philip Kuo-Ting ChenM.D.
Craniofacial Center, Chang Gung Memorial Hospital
5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan