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EDITORIAL
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 3

Unfavorable outcome of unilateral cleft lip repair


Director and Consultant Maxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India

Date of Web Publication12-Jul-2016

Correspondence Address:
S M Balaji
Director and Consultant Maxillofacial Surgeon, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu
India
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DOI: 10.4103/2231-0746.186145

PMID: 27563597

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How to cite this article:
Balaji S M. Unfavorable outcome of unilateral cleft lip repair. Ann Maxillofac Surg 2016;6:3

How to cite this URL:
Balaji S M. Unfavorable outcome of unilateral cleft lip repair. Ann Maxillofac Surg [serial online] 2016 [cited 2020 Jul 13];6:3. Available from: http://www.amsjournal.com/text.asp?2016/6/1/3/186145










Unilateral cleft lip is one of the most common congenital deformities encountered in maxillofacial practice. With the evolution of the advanced understanding of locoregional anatomy and mechanism behind cleft lips, today, surgeons can provide a complete and immediate relief to the patient.[1] Several techniques depending on the number, position, depth, and involvement of perioral musculature have been advised by pioneering surgeons.[1],[2] Undoubtedly, this may seem as an easy task, but when considering all factors and deciding on the functional outcome depending on preferred method, this easy task becomes the toughest one.

Unfavorable outcomes may be immediate or delayed. Immediate, visible outcomes such as dehiscence and scarring are the most commonly occurring outcomes. Dehiscence often occurs when the sutural tension of the orbicularis muscle is placed highest. With this muscle being constantly used, higher degree of tension of suture would cause snap of the suture leading to dehiscence. Infection and trauma also could lead to this condition. Simple debridement and repetition of the sutures would help to solve the issue. Scarring often occurs with excessive strain (intrinsic or extrinsic) and/or the host's reaction to surgical trauma. Most of the scars get remodeled, especially in children, and if such a scar persists for more than a year, it might require revision.[2]

Delayed abnormalities include vermillion notching, a shortening or unequal lip, deficiency in the height of the lateral vermillion on the cleft side, white roll mal-alignment, oro-vestibular fistula, the cleft lip nose deformity, a narrow nostril and a “high-riding” nostril.

Such defects could originate due to inadequate rotation of flaps, inadvertent inversion of the sutured edges, musculature deficiency, orbicularis oris marginalis muscle deficiency, straight line scar contracture, breakdown of the nasal floor repair or improper repair [2] and reflection of abnormality of lip repair in nose, especially the nares and length of columella.[3],[4] The correction of such defects rests with identification of the correct problem and addressing it rather than camouflaging the defect.

The prevention of such defects rests with an understanding of the uniqueness of each cleft, the extent of involvement of other tissues and its loco-regional impact. The correction would also require identification of proper design and material as well as surgical dexterity.

A trained surgeon anticipates such problems and would always take adequate steps to prevent and has set of remedial plans to act, in case such an unfavorable outcome arises.

 
  References Top

1.
Fisher DM. Unilateral cleft lip repair: An anatomical subunit approximation technique. Plast Reconstr Surg 2005;116:61-71.  Back to cited text no. 1
    
2.
Narayanan PV, Adenwalla HS. Unfavourable results in the repair of the cleft lip. Indian J Plast Surg 2013;46:171-82.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Balaji SM. Cleft-rhinoplasty constricted nasal floor reconstruction. Ann Maxillofac Surg 2014;4:182-5.  Back to cited text no. 3
  Medknow Journal  
4.
Balaji SM. One-stage correction of severe nasal deformity associated with a unilateral cleft lip. Scand J Plast Reconstr Surg Hand Surg 2003;37:332-8.  Back to cited text no. 4
    



This article has been cited by
1 Facial Anthropometric Evaluation of Unilateral Cleft Lip and Palate Patients
Mahboobe Dehghani,Arezoo Jahanbin,Maryam Omidkhoda,Mostafa Entezari,Elaheh Shadkam
Journal of Craniofacial Surgery. 2018; 29(2): 353
[Pubmed] | [DOI]



 

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