Semin Plast Surg 2005; 19(4): 313-328
DOI: 10.1055/s-2005-925904
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Unilateral Cleft Lip-Approach and Technique

Kenneth E. Salyer1 , Shai M. Rozen1 , Edward R. Genecov2 , David G. Genecov1
  • 1International Craniofacial Institute, Cleft Lip and Palate Treatment Center, Dallas, Texas
  • 2Private Practice, Dallas, Texas
Further Information

Publication History

Publication Date:
03 January 2006 (online)

ABSTRACT

This article presents the philosophy, technique, and personal and team approach for treating children with unilateral cleft lip-nose deformities based on the senior author's 36 years of experience. The treatment of unilateral cleft lip almost without exception must involve correction of the nasal deformity. To obtain excellent results, the surgeon must integrate technique, teamwork, and timing based on multidisciplinary protocols developed over the years. Technique must involve broad dissection of the nasal and lip elements off the abnormal skeletal base and delicate but wide dissection of the nasal cartilage to achieve contour and tip projection. The team must include and assimilate surgical, orthodontic, speech, and when necessary orthognathic viewpoints to achieve the optimal result. The final goal is to bring the child to normal facial appearance at conversational distance. It is important to realize that the treatment of the unilateral cleft is rarely one procedure at one time but rather a culmination of several interventions precisely timed in the growing phase of the child from infancy to adulthood.

REFERENCES

  • 1 Bardach J, Salyer K E. Surgical Techniques in Cleft Lip and Palate. 2nd ed. St. Louis; Mosby Year Book 1991
  • 2 Millard D R. Cleft Craft: The Evolution of its Surgery. Vols 1-3. Boston; Little, Brown 1980
  • 3 Shprintzen R, Bardach J. Cleft Palate Speech Management: A Multidisciplinary Approach. St. Louis; Mosby-Year Book 1995
  • 4 Salyer K E. Early and late treatment of unilateral cleft nasal deformity.  Cleft Palate Craniofac J. 1992;  29 556-569
  • 5 Salyer K E. Primary correction of the unilateral cleft lip-nose: a 15-year experience.  Plast Reconstr Surg. 1986;  77 558-568
  • 6 McComb H. Primary correction of unilateral cleft lip-nasal deformity: a 10-year review.  Plast Reconstr Surg. 1985;  75 791-799
  • 7 Salyer K E. New concepts in primary unilateral cleft lip-nose repair.  Worldplast. 1995;  2 83-97
  • 8 Salyer K E, Genecov E, Genecov D. Unilateral cleft lip-nose repair: a 33-year experience.  J Craniofac Surg. 2003;  14 549-558
  • 9 Noordhoff M S, Chen Y, Chen K, Hong K, Lo L. The surgical technique for the complete unilateral cleft lip-nasal deformity.  Oper Tech Plast Reconstr Surg. 1995;  2 167-174
  • 10 McComb H. Primary repair of unilateral cleft lip nasal deformity.  Oper Tech Plast Reconstr Surg. 1995;  2 200-205
  • 11 Williams A, Sandy J, Thomas S, Sell D, Sterne J. Cleft lip and palate care in the United Kingdom-the Clinical Standards Advisory Group (CSAG) study. Part 1: background and methodology.  Lancet. 1999;  354 1697-1698
  • 12 Randall P. Lip adhesion.  Oper Tech Plast Reconstr Surg. 1995;  2 164-166
  • 13 Pool R. Tissue mobilization with preoperative lip taping.  Oper Tech Plast Reconstr Surg. 1995;  2 155-158
  • 14 Salyer K E, Genecov E. Surgical-orthodontic management of the cleft patient from infancy to adulthood: 25 years experience. Teaching course at the ACPA annual meeting, Toronto, 1994. 
  • 15 Millard D R, Latham R. Improved primary surgical and dental treatment of clefts.  Plast Reconstr Surg. 1990;  86 856-871
  • 16 Millard D R, Latham R, Huifen X, Spiro S, Morovic C. Cleft lip and palate treated by perisurgical orthopedics, gingivoperiosteoplasty, and lip adhesion (POPLA) compared with previous lip adhesion method: a preliminary study of serial dental casts.  Plast Reconstr Surg. 1999;  103 1630-1644
  • 17 Santiago P, Grayson B, Cutting C, Gianoutsos M, Kwon S. Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty.  Cleft Palate Craniofac J. 1998;  35 77-80
  • 18 Henkel K, Gundlach K. What effect does using the Latham devices have on craniofacial growth in uni- and bilateral lip-jaw-palate clefts?.  Mund Kiefer Gesichtschir. 1998;  2 55-57
  • 19 Rintala A, Ranta R. Periosteal flaps and grafts in primary cleft repair: a follow-up study.  Plast Reconstr Surg. 1989;  83 17-24
  • 20 Gordan C B, Reyna Rodriguez X P, Ochoa Lopez E, Puente Sanchez A. Primary distraction cheiloplasty: The BAD DOG procedure four year follow-up. Fourth International Congress of Maxillofacial and Craniofacial Distraction; Monduzzi Editore 2003 Bologna, Italy;
  • 21 Bergland O, Semb G, Abyholm F. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.  Cleft Palate J. 1986;  23 175-205
  • 22 Abyholm F, Bergland O, Semb G. Secondary bone grafting of alveolar clefts.  Scand J Plast Reconstr Surg. 1981;  15 127-140
  • 23 Grayson B H, Cutting C B. Presurgical nasoalveolar orthopedic molding in primary correction nose, lip and alveolus of infants born with unilateral and bilateral clefts.  Cleft Palate Craniofac J. 2001;  38 193-198
  • 24 Shetye P R. Facial growth of adults with unoperated clefts.  Clin Plast Surg. 2004;  31 361-371
  • 25 Buschang P H, Porter C, Genecov E, Salyer K E. Face mask therapy of preadolescents with unilateral cleft lip and palate.  Angle Orthod. 1994;  64 145-150
  • 26 Salyer K E, Bardach J. Salyer & Bardach's Atlas of Craniofacial and Cleft Surgery. Vol 2: Cleft Lip and Palate Surgery Philadelphia; Lippincott-Raven 1999
  • 27 Fara M. The importance of folding down muscle stumps in the operation of unilateral clefts of the lip.  Acta Chir Plast. 1971;  13 162-169
  • 28 Noordhoff M S. Reconstruction of vermilion in unilateral and bilateral cleft lips.  Plast Reconstr Surg. 1984;  73 52-61
  • 29 Mohler L R. Unilateral cleft lip repair.  Plast Reconstr Surg. 1987;  80 511-517
  • 30 Berkowitz S, Mejia M, Bystrik A. A comparison of the effects of the Latham-Millard procedure with those of a conservative treatment approach for dental occlusion and facial aesthetics in unilateral and bilateral complete cleft lip and palate: part I. Dental occlusion.  Plast Reconstr Surg. 2004;  113 1-18
  • 31 Berkeley W. The cleft-lip nose.  Plast Reconstr Surg. 1959;  23 567-575
  • 32 Pigott R. Alar leapfrog: a technique for repositioning the total alar cartilage at primary cleft lip repair.  Clin Plast Surg. 1985;  12 643-658
  • 33 Buschang P, Schroeder J, Genecov E, Salyer K E. Growth status of children treated for unilateral cleft lip and palate.  Plast Reconstr Surg. 1991;  88 413-419
  • 34 Yamada A, Salyer K E. Long-term outcome in unilateral cleft lip and palate: one surgeon's experience. In: Lilja J Transactions of the 9th International Congress on Cleft Palate and Related Craniofacial Anomalies. 2001 793 Elanders Novum, Sweden;

Kenneth E SalyerM.D. 

International Craniofacial Institute, Cleft Lip and Palate Treatment Center

7777 Forest Lane, Suite C-717, Dallas, TX 75230

    >