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. 2022 Jan-Feb;12(1):102-108.
doi: 10.1016/j.jobcr.2021.11.001. Epub 2021 Nov 11.

Cleft lip, alveolus and palate: Defect or dislocation malformation? Importance of adopting a physiological concept for surgical repair in achieving optimal outcomes in LMICs. Part 1: Physiological processes in facial development

Ulrich Joos  1
Affiliations

Cleft lip, alveolus and palate: Defect or dislocation malformation? Importance of adopting a physiological concept for surgical repair in achieving optimal outcomes in LMICs. Part 1: Physiological processes in facial development

Ulrich Joos. J Oral Biol Craniofac Res. 2022 Jan-Feb.

Abstract

The conventional surgical procedures for the closure of cleft-lip and palate are based on proven plastic-surgical procedures from tumour surgery or traumatology. These flap surgeries take little account of the fact that the treatment of such malformations takes place during the time of a child's increased growth and is known to lead to pronounced scarring and skeletal growth disorders. It is therefore imperative to develop modified surgical procedures based on physiological growth processes. These physiological procedures must include the reconstruction of all facial structures such as orofacial, palatal and pharyngeal muscles, complete nose, upper jaw and palate. Transfer of this know how to low resource LMIC and training is essential if optimal outcomes are to be achieved.

Keywords: CLAP malformation; Dislocation malformation; Facial growth chromatography; Functional reconstruction; Primary rhinoplasty.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Head bonnet by Johan Philip Hofmann in 1686 1.
Fig. 2
Fig. 2
Major improvement by muscular reconstruction combined with primary rhinoplasty.
Fig. 3
Fig. 3
Traditional bilateral lip closure with lip adhesion incorporation of premaxilla skin into lip. Note short lip and columella, widening of the nose.
Fig. 4
Fig. 4
Arteries of the upper lip. a: non-cleft, b: unilateral CLAP, c: bilateral CLAP. Lip arteries: blood flow direction from caudal to cranial. Columella arteries: blood flow direction from cranial to caudal.
Fig. 5
Fig. 5
Cyclopic malformation.
Fig. 6
Fig. 6
formula imageCorrect muscle insertion incorrect muscle insertion in CLAP. formula imageNormal skeletal development leads to skeletal malformation in CLAP.
Fig. 7
Fig. 7
Change of nose, midface and maxillary arch after physiological muscle restoration in 6 months without any other treatment.
Fig. 8
Fig. 8
Unilateral CLAP, Physiological reconstruction. Lip, nose, maxillary cleft at 3 months Hard and soft palate muscle reconstruction at 9 months Maxillary osteoplasty 7 years, no additional corrective surgery Orthodontic treatment and implant lateral incisor.
See this image and copyright information in PMC

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