Preoperative Correction Using Barbed Sutures as an Alternative to Lip Adhesion for Complete Bilateral Cleft Lip With Prominent Protrusion of the Premaxilla: A Case Report

Abstract

Lip adhesion (LA), performed in the treatment of wide cleft lip, is a technique used to relieve tension on the reconstructed lip and improve the outcome of definitive cleft lip repair; however, there are some limitations that need to be addressed, such as the formation of new scarring on the lip and postoperative wound dehiscence, with prominent protrusion of the premaxilla in bilateral cases. A 3-month-old boy underwent preoperative correction for complete bilateral cleft lip with prominent premaxillary protrusion, in which we pulled and attached the lateral lip to the premaxilla and then the contralateral lip to each other with barbed sutures. Definitive cleft repair was performed 1.5 months after the preoperative correction. Adequate preoperative retraction of the protruding premaxilla and reduced suture tension allowed for a definitive cleft lip repair, which resulted in a good lip shape. Preoperative lip and premaxilla correction with barbed sutures is a minimally invasive, simple procedure that can be performed in a short time, and is believed to provide stronger fixation than current methods because of its multi-point fixation with multiple barbs. It also leaves the lip with almost no scarring, which may be advantageous for the definitive repair procedure. Continued follow-up of the patient's lips after development and alveolar cleft surgery is warranted, as is the accumulation of additional cases using the same technique.

Keywords: barbed sutures; complete bilateral cleft lip; lip adhesion; preoperative correction.

FIGURE 1

Preoperative findings: The patient had a prominent anterior protrusion of the premaxilla.

FIGURE 2

Lip and premaxilla correction. (a) Two barbed sutures were threaded from the oral mucosa side to the lateral lip, through the premaxilla, and to the contralateral lip. Since the sutures are pulled, cut, and implanted submucosally, they do not need knots. (b, c) Immediately after the operation, the premaxilla was pulled back by the lips.

FIGURE 3

Findings at the time of the definitive repair. (a, b) Preoperatively, the premaxilla was well retracted. (c, d) Postoperatively, good lip morphology was obtained. (e) 3.5 months after the definitive repair—good morphology was maintained.