eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Unilateral Cleft Lip Repair: Multimedia

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: Jun 19, 2009

Multimedia

(Enlarge Image)

Media file 1: Figure illustrates important anatomic landmarks used in all cleft lip repairs. Measurements of various distances are used to guide the surgeon in creating a symmetric lip.

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Figure illustrates important anatomic landmarks used in all cleft lip repairs. Measurements of various distances are used to guide the surgeon in creating a symmetric lip.

(Enlarge Image)

Media file 2: The Rose-Thompson repair involves curved or angled paring of the cleft margins to lengthen the lip as a straight-line closure.

[ CLOSE WINDOW ]

The Rose-Thompson repair involves curved or angled paring of the cleft margins to lengthen the lip as a straight-line closure.

(Enlarge Image)

Media file 3: Hagedorn-LeMesurier repair. The medial lip element is lengthened by introducing a quadrilateral flap developed from the lateral lip element.

[ CLOSE WINDOW ]

Hagedorn-LeMesurier repair. The medial lip element is lengthened by introducing a quadrilateral flap developed from the lateral lip element.

(Enlarge Image)

Media file 4: Tennison-Randall repair. The medial lip element is lengthened by introducing a triangular flap from the inferior portion of the lateral lip element.

[ CLOSE WINDOW ]

Tennison-Randall repair. The medial lip element is lengthened by introducing a triangular flap from the inferior portion of the lateral lip element.

(Enlarge Image)

Media file 5: Skoog repair. The medial lip element is lengthened by introducing two small triangular flaps developed from the lateral lip element.

[ CLOSE WINDOW ]

Skoog repair. The medial lip element is lengthened by introducing two small triangular flaps developed from the lateral lip element.

(Enlarge Image)

Media file 6: Millard repair. The medial lip element [R] is rotated inferiorly and the lateral lip element [A] is advanced into the resulting upper lip defect. The columellar flap [C] is then used to create the nasal sill (see text for details).

[ CLOSE WINDOW ]

Millard repair. The medial lip element [R] is rotated inferiorly and the lateral lip element [A] is advanced into the resulting upper lip defect. The columellar flap [C] is then used to create the nasal sill (see text for details).

(Enlarge Image)

Media file 7: Millard repair. Two of the most common variations described with utilization of the C Flap to correct the hemi-columellar deficiency (Millard II] and the nasal sill alar base region [Millard I]

[ CLOSE WINDOW ]

Millard repair. Two of the most common variations described with utilization of the C Flap to correct the hemi-columellar deficiency (Millard II] and the nasal sill alar base region [Millard I]

(Enlarge Image)

Media file 8: Millard repair. With maximal rotation of the R flap, any residual lip length discrepancy can be corrected with an inferior Z-plasty or a triangular flap. In a secondary correction, further rotation of the R flap can be considered.

[ CLOSE WINDOW ]

Millard repair. With maximal rotation of the R flap, any residual lip length discrepancy can be corrected with an inferior Z-plasty or a triangular flap. In a secondary correction, further rotation of the R flap can be considered.

(Enlarge Image)

Media file 9: Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.

[ CLOSE WINDOW ]

Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.

More on Craniofacial, Unilateral Cleft Lip Repair

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Multimedia: Craniofacial, Unilateral Cleft Lip Repair

References

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References

Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair--long-term outcome. Clin Plast Surg. Apr 2004;31(2):191-208. [Medline].
Millard DR Jr. Cleft Craft. Vol 1, 2, 3. Boston, Mass: Little Brown & Company; 1976.
Noordhoff MS. Bilateral cleft lip reconstruction. Plast Reconstr Surg. Jul 1986;78(1):45-54. [Medline].
Sitzman TJ, Girotto JA, Marcus JR. Current surgical practices in cleft care: unilateral cleft lip repair. Plast Reconstr Surg. May 2008;121(5):261e-270e. [Medline].
Sykes JM, Tollefson TT. Management of the cleft lip deformity. Facial Plast Surg Clin North Am. Feb 2005;13(1):157-67. [Medline].
Da Silveira AC, Oliveira N, Gonzalez S. Modified nasal alveolar molding appliance for management of cleft lip defect. Journal of Craniofacial Surgery. 2003;14(5):700-3. [Medline].
Liou EJ, Subramanian M, Chen PK, Huang CS. The progressive changes of nasal symmetry and growth after nasoalveolar molding: a three-year follow-up study. Plast Reconstr Surg. Sep 15 2004;114(4):858-64. [Medline].
Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. Nov 1999;36(6):486-98. [Medline].
Millard DR. Extensions of the rotation-advancement principle for wide unilateral cleft lips. Plast Reconstr Surg. Dec 1968;42(6):535-44. [Medline].
Cohen M, Smith BE, Daw JL. Secondary unilateral cleft lip nasal deformity: functional and esthetic reconstruction. Journal of Craniofacial Surgery. 2003;14(4):584-93. [Medline].
Trier WC. Repair of unilateral cleft lip: the rotation-advancement operation. Clin Plast Surg. Oct 1985;12(4):573-94. [Medline].
American Cleft Palate-Craniofacial Association. Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies. Vol 30. Pittsburgh, Pa: American Cleft Palate-Craniofacial Association; 1993.
Bardach J. Salyer & Bardach's Atlas of Craniofacial & Cleft Surgery: Cleft Lip and Palate Surgery. Vol 2. Lippincott-Raven Publishers; 1999.
Bardach J, Salyer KE. Surgical Techniques in Cleft Lip and Palate. 2^nd ed. Chicago: Mosby Yearbook; 1991.
Berkowitz S, ed. Cleft Lip and Palate. San Diego, Calif: Singular Publishing Group Inc;1996.
Clifford RH, Pool R. The analysis of the anatomy and geometry of the unilateral cleft lip. Plast Reconstr Surg. 1959;24:311.
Grabb WC, Rosenstein SW, Bzoch KR, eds. Cleft Lip and Palate. Boston, Mass: Little Brown & Company; 1971.
McComb H. Treatment of the unilateral cleft lip nose. Plast Reconstr Surg. May 1975;55(5):596-601. [Medline].
McComb HK, Coghlan BA. Primary repair of the unilateral cleft lip nose: completion of a longitudinal study. Cleft Palate Craniofac J. Jan 1996;33(1):23-30; discussion 30-1. [Medline].
Menard RM, Schendel SA. Rotation-Advancement Repair of the Unilateral Cleft Lip: Current Status and Future Horizons. St. Louis, Mo: Mosby-Yearbook; 1997:247-78.
Muller W. Differentiated reconstruction of the orbicularis oris muscle in unilateral labioplasty. J Craniomaxillofac Surg. Dec 1989;17 Suppl 1:11-3. [Medline].
Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair--long term outcome. Clin Plast Surg. 2004;Apr;31(2):191-208. [Medline].

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Keywords

cleft lip, cleft lip repair, cleft palate, cleft palate repair, unilateral cleft lip repair, unilateral cleft lip, cleft lip and palate, facial cleft, cleft, lip, palate, congenital deformities, Kernahan, Kernahan classification, Millard technique, Millard repair, Millard cleft repair, face embryology, facial development, facial defect, embryonic development

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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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eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Unilateral Cleft Lip Repair: Multimedia

Multimedia

Figure illustrates important anatomic landmarks used in all cleft lip repairs. Measurements of various distances are used to guide the surgeon in creating a symmetric lip.

The Rose-Thompson repair involves curved or angled paring of the cleft margins to lengthen the lip as a straight-line closure.

Hagedorn-LeMesurier repair. The medial lip element is lengthened by introducing a quadrilateral flap developed from the lateral lip element.

Tennison-Randall repair. The medial lip element is lengthened by introducing a triangular flap from the inferior portion of the lateral lip element.

Skoog repair. The medial lip element is lengthened by introducing two small triangular flaps developed from the lateral lip element.

Millard repair. The medial lip element [R] is rotated inferiorly and the lateral lip element [A] is advanced into the resulting upper lip defect. The columellar flap [C] is then used to create the nasal sill (see text for details).

Millard repair. Two of the most common variations described with utilization of the C Flap to correct the hemi-columellar deficiency (Millard II] and the nasal sill alar base region [Millard I]

Millard repair. With maximal rotation of the R flap, any residual lip length discrepancy can be corrected with an inferior Z-plasty or a triangular flap. In a secondary correction, further rotation of the R flap can be considered.

Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.

More on Craniofacial, Unilateral Cleft Lip Repair

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor