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. 2009 Oct;42 Suppl(Suppl):S62-70.
doi: 10.4103/0970-0358.57189.

Primary unilateral cleft lip repair

H S Adenwalla  1 , P V Narayanan
Affiliations

Primary unilateral cleft lip repair

H S Adenwalla et al. Indian J Plast Surg. 2009 Oct.

Abstract

The unilateral cleft lip is a complex deformity. Surgical correction has evolved from a straight repair through triangular and quadrilateral repairs to the Rotation Advancement Technique of Millard. The latter is the technique followed at our centre for all unilateral cleft lip patients. We operate on these at five to six months of age, do not use pre-surgical orthodontics, and follow a protocol to produce a notch-free vermillion. This is easy to follow even for trainees. We also perform closed alar dissection and extensive primary septoplasty in all these patients. This has improved the overall result and has no long-term deleterious effect on the growth of the nose or of the maxilla. Other refinements have been used for prevention of a high-riding nostril, and correction of the vestibular web.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1a
Figure 1a
Pre-operative
Figure 1b
Figure 1b
Early post operative
Figure 1c
Figure 1c
Delayed post operative
Figure 2
Figure 2
The Millard incisions marked
Figure 3a
Figure 3a
Pre-operative
Figure 3b
Figure 3b
Long term post-operative
Figure 15a
Figure 15a
Marking of Pinto's Z plasty for the vestibular web
Figure 15b
Figure 15b
Completed Z plasty
Figure 4
Figure 4
Back-cut completed. Cupid's bow peak points are at same horizontal level
Figure 5
Figure 5
Undermining the vermillion on the cleft side. The non-cleft side vermillion is also similarly undermined
Figure 6
Figure 6
Shows the excess of orbicularis oris left behind while paring the vermillion
Figure 7
Figure 7
The muscle left behind on both the sides being sutured with 6.0 Nylon. A minimum of 3 stitches
Figure 8
Figure 8
Z plasty on the mucosa
Figure 9a
Figure 9a
Pre-operative
Figure 9b
Figure 9b
Post-op – long-term follow-up
Figure 10a
Figure 10a
Closed alar dissection on the left side
Figure 10b
Figure 10b
Closed alar dissection on the non-cleft side
Figure 11
Figure 11
Septal cartilage dissected off the mucoperichondrium on both sides and from vomer and perpendicular plate of ethmoid
Figure 12
Figure 12
Septal cartilage showing the excised portion (shaded) and the scoring on the concave non-cleft side
Figure 13
Figure 13
The septal cartilage is fixed to the nasal floor
Figure 14a
Figure 14a
High-riding nostril
Figure 14b
Figure 14b
Jackson's Z plasty – lateral and medial
See this image and copyright information in PMC

References

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    1. Peet E. The Oxford technique of cleft palate repair. Plast Reconstr Surg Transplant Bull. 1961;28:282–94. - PubMed
    1. Mirault G. Deux lettres sur l'operation du bec-de-lievre. J Chir Paris. 1844;2:257.
    1. Blair VP, Brown JB. Mirault operation for single harelip. Surg Gynecol Obstet. 1930;51:81.