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Hughes EB, Tatum SA. Current trends in unilateral cleft lip repair. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00065. [PMID: 37144507 DOI: 10.1097/moo.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers. There is much room for growth, with new and exciting technologies on the horizon to improve upon cosmesis, functionality, and the operative experience.
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Affiliation(s)
- Evan B Hughes
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Abstract
Pediatric septorhinoplasty has been an area of controversy because early surgical intervention can prevent normal growth. There are certain conditions where early correction of the nose is indicated, such as in cleft lip nasal deformities, severe traumatic deformities, and congenital nasal lesions. Animal and clinical studies have been helpful in elucidating certain areas of the nose that are potential growth zones that should be left undisturbed when performing nasal surgeries on pediatric patients. We discuss the timing, indications, and surgical technique in pediatric septorhinoplasty.
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Affiliation(s)
- Aditi Bhuskute
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Mika Sumiyoshi
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Craig Senders
- Department of Otolaryngology, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA.
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Abstract
Nasal surgery in children, most often performed after trauma, can be performed safely in selected patients with articulate, deliberate, and conscientious operative plan. All nasal surgery in children seeks to avoid disruption of the growth centers, preserving and optimizing nasal growth while improving the form and function of the nose. A solid appreciation of long-term outcomes and effects on growth remain elusive.
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Affiliation(s)
- Matthew D Johnson
- Facial Plastic & Reconstructive Surgery, Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, 747 N Rutledge Street, 5th floor, PO box 19649, Springfield, IL 62794-9649, USA.
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Abstract
The cleft nasal deformity seen in patients with unilateral and bilateral cleft lip presents a formidable challenge for the facial plastic surgeon. The underlying anatomic deformities combined with scarring from previous procedures make secondary cleft rhinoplasty a difficult procedure for even the most experienced surgeons. Numerous techniques for secondary cleft rhinoplasty have been described in the literature over the past several decades, yet the lack of wide adoption of any given technique highlights the great variability seen with this problem. Regardless, the fundamental goals of achieving nasal symmetry with definition of the nasal base and tip, correction of nasal airway obstruction, and repair of nasal scarring or webbing have driven the progressive evolution of techniques developed to correct various aspects of the cleft nasal deformity. Despite the number of techniques that have been published, very few studies have looked specifically at outcomes in secondary cleft rhinoplasty, and further work is needed in this area. In this article, we will review anatomy of the cleft nasal deformity, repair strategies and timing, surgical techniques for both unilateral and bilateral cleft nasal deformity, and outcomes for secondary cleft rhinoplasty.
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Affiliation(s)
- Sachin S Pawar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Tom D Wang
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
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Moreira I, Suri S, Ross B, Tompson B, Fisher D, Lou W. Soft-tissue profile growth in patients with repaired complete unilateral cleft lip and palate: A cephalometric comparison with normal controls at ages 7, 11, and 18 years. Am J Orthod Dentofacial Orthop 2014; 145:341-58. [PMID: 24582026 DOI: 10.1016/j.ajodo.2013.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this retrospective longitudinal study, we aimed to study differences in the soft-tissue profiles in growing children with clefts in comparison with controls through the period of facial growth from 7 to 18 years. METHODS Lateral cephalometric measurements made at 7 years (T1), 11.1 years (T2), and 17.9 years (T3) of age of 70 white children (35 boys, 35 girls) with complete unilateral cleft lip and palate (UCLP) who received primary lip and palate repair surgeries at The Hospital for Sick Children, Toronto, were compared with those of a control group of similar ages, sexes, and racial backgrounds, and having skeletal Class I facial growth, selected from the Burlington Growth Study. None of the included subjects had received any surgeries other than the primary lip and palate repairs, and none had undergone nasal septum surgery or nasal molding during infancy. Between-group comparisons were made at each time point using generalized linear models adjusted for age and sex effects. Longitudinal comparisons across all time points were conducted using the mixed model approach, adjusting for these effects and their interactions with time. RESULTS Bimaxillary retrognathism, progressive maxillary retrognathism, and increasing lower anterior face height with downward and backward growth rotation of the mandible in the UCLP group were seen. Unlike the hard-tissue face height ratio, their soft-tissue face height ratio was not affected. The upper lips in the UCLP group were shorter by 1.81 mm at T2 (P <0.001) and by 1.16 mm at T3 (P = 0.018), whereas their lower lips were 2.21 mm longer at T3 (P = 0.003). A reduced upper lip to lower lip length ratio at T2 and T3 (P <0.001) resulted. Their upper lips were relatively retruded by 1.44 mm at T1, 1.66 mm at T2, and 1.86 mm at T3 (all, P <0.001), and their lower lips were relatively protruded by 1.07 mm at T1 (P = 0.003), 1.40 mm at T2 (P <0.001), and 1.62 mm at T3 (P <0.001). Nose depths in the UCLP group were shallower by at least 1 mm from T1 to T3, and columellar length was shorter by almost 2 mm (all, P <0.001). Their columellae and nose tips rotated downward with growth, with the most significant rotations experienced from T2 to T3, and progressive reductions in their soft-tissue profile convexity were seen from T1 to T3 (P <0.001). CONCLUSIONS Key attributes of the imbalance in the soft-tissue profile in children with repaired UCLP were identified in the lip and nose regions. Although many profile differences were visible as early as 7 years of age, they became more apparent by 11 years of age and increased in severity thereafter. The short upper lip combined with a long lower lip resulted in the characteristic lip length imbalance, whereas the progressively retruding upper lip and protruding lower lip led to developing a step relationship in the sagittal lip profile during the adolescent growth period. Their columellae and nose tips rotated downward during this time.
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Affiliation(s)
- Iris Moreira
- Research associate, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; former clinical orthodontic fellow, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunjay Suri
- Associate professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Bruce Ross
- Professor, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; staff orthodontist, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryan Tompson
- Associate professor and head, Discipline of Orthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; head, Division of Orthodontics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Fisher
- Medical director, Cleft Lip and Palate Program, Hospital for Sick Children, Toronto, Ontario, Canada; associate professor, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Professor and head, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Canada Research Chair in Statistical Methods for Health Care, Toronto, Ontario, Canada
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