eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Bilateral Cleft Lip Repair: Follow-up

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): Raja Ramaswamy, MS, The Chicago Medical School; Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery; David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children
Contributor Information and Disclosures

Updated: Apr 13, 2009

Outcome and Prognosis

While maintaining symmetry typically is not the main issue in reconstructing the bilateral cleft lip, the outcome can be less satisfying than with unilateral clefts. Careful preoperative assessment of the cleft lip deformity and attention to appropriate presurgical management and detail in the reconstruction typically results in an acceptable repair that achieves some of the characteristics of the natural lip and nose. Many variables are involved beyond the technical aspects of a particular repair. Ultimately, the outcome depends on the natural course of uncomplicated healing of the initial repair, alignment of the skeletal framework on which the lip rests, and the differential effect of normal growth and development on the operated lip.

While a poor initial result is unlikely to improve with time, an excellent initial result may require some revision because of uncontrolled variables. Moreover, while the lip repair may be acceptable, additional procedures to achieve nasal symmetry are commonly required, despite the initial primary nasal surgery incorporated as an integral part of lip repair. Realistically, one must realize that, despite physicians' best attempts, the stigmata of a bilateral cleft deformity remains in many children.

Future and Controversies

Bilateral cleft lip surgery has evolved from discarding the premaxillary and prolabial elements in a simple approximation of the cleft margins to, currently, a definitive single-stage lip and primary cleft nasal repair that incorporates the underlying musculature. Accompanying the evolution of the surgical repair is the increasingly important involvement of early presurgical alveolar and nasal molding to possibly improve surgical outcome.

The basics of cleft surgery are to achieve a good philtrum size, shape, and positioning of the cartilages, and muscular continuity. Although the basics are the same, the development of presurgical techniques continue to evolve and provide an exciting scaffold to the management of bilateral cleft lip.  

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Kara K Criswell, MD; Bryan K Criswell, MD; and Mimis Cohen, MD, FACS, FAAP to the development and writing of this article.



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References
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Further Reading

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Keywords

bilateral cleft lip repair, bilateral cleft lip, cleft lip and palate, cleft lip, cleft palate, facial cleft, congenital deformities, hare lip, birth defect, cleft lip pictures, cleft lip treatment, cleft lip surgery, birth defect reconstruction

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Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS, The Chicago Medical School
Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children
David E Morris, MD is a member of the following medical societies: Chicago Medical Society and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

R Edward Newsome, MD, Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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