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Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or mini-microform).
Plast Reconstr Surg 2008; 122(5):1494-504PR

Abstract

BACKGROUND

Complete or incomplete cleft lip can be associated with a contralateral lesser form of incomplete cleft lip, constituting an asymmetrical bilateral malformation.

METHODS

The cleft lip registry was searched for patients with complete or incomplete cleft lip and contralateral minor-form, microform, or mini-microform defects. Methods of repair were documented and results were assessed by reviewing photographs and recording revisions.

RESULTS

Of 309 patients with bilateral cleft lip, 72 patients (23 percent) had asymmetrical cleft lip, with 40 patients having contralateral minor-form, microform, or mini-microform defects. All infants with complete cleft lip and palate on the greater side underwent preoperative dentofacial orthopedic alignment, nasolabial adhesion, and gingivoperiosteoplasty. Infants with a contralateral minor-form defect (n = 7) had second-stage, synchronous bilateral nasolabial repair. Contralateral microform defects (n = 6) were not addressed during rotation-advancement repair on the complete/incomplete side; the later repair was a double unilimb Z-plasty. Contralateral mini-microform defects (n = 27) were corrected by vertical lenticular excision and, if necessary, alar base Y-V advancement, either synchronously with closure on the greater side or at another stage. The revision rate correlated with the degree of preoperative asymmetry. The most common revisions were augmentation of the median tubercle and free margin on the lesser side and repositioning of the lower lateral cartilage and alar base on the greater side.

CONCLUSIONS

The operative strategy for repair of an asymmetrical bilateral cleft lip is determined by the extent of the vermilion-cutaneous dysjunction on the lesser side. Synchronous bilateral nasolabial repair is indicated for a contralateral minor-form defect. Correction of a contralateral microform or mini-microform defect is usually deferred to achieve symmetry.

Authors+Show Affiliations

Department of Plastic Surgery, Children's Hospital and Harvard Medical School, Boston, Mass, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18971734

Citation

Yuzuriha, Shunsuke, et al. "Asymmetrical Bilateral Cleft Lip: Complete or Incomplete and Contralateral Lesser Defect (minor-form, Microform, or Mini-microform)." Plastic and Reconstructive Surgery, vol. 122, no. 5, 2008, pp. 1494-504.
Yuzuriha S, Oh AK, Mulliken JB. Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or mini-microform). Plast Reconstr Surg. 2008;122(5):1494-504.
Yuzuriha, S., Oh, A. K., & Mulliken, J. B. (2008). Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or mini-microform). Plastic and Reconstructive Surgery, 122(5), pp. 1494-504. doi:10.1097/PRS.0b013e318189169b.
Yuzuriha S, Oh AK, Mulliken JB. Asymmetrical Bilateral Cleft Lip: Complete or Incomplete and Contralateral Lesser Defect (minor-form, Microform, or Mini-microform). Plast Reconstr Surg. 2008;122(5):1494-504. PubMed PMID: 18971734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or mini-microform). AU - Yuzuriha,Shunsuke, AU - Oh,Albert K, AU - Mulliken,John B, PY - 2008/10/31/pubmed PY - 2008/12/17/medline PY - 2008/10/31/entrez SP - 1494 EP - 504 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 122 IS - 5 N2 - BACKGROUND: Complete or incomplete cleft lip can be associated with a contralateral lesser form of incomplete cleft lip, constituting an asymmetrical bilateral malformation. METHODS: The cleft lip registry was searched for patients with complete or incomplete cleft lip and contralateral minor-form, microform, or mini-microform defects. Methods of repair were documented and results were assessed by reviewing photographs and recording revisions. RESULTS: Of 309 patients with bilateral cleft lip, 72 patients (23 percent) had asymmetrical cleft lip, with 40 patients having contralateral minor-form, microform, or mini-microform defects. All infants with complete cleft lip and palate on the greater side underwent preoperative dentofacial orthopedic alignment, nasolabial adhesion, and gingivoperiosteoplasty. Infants with a contralateral minor-form defect (n = 7) had second-stage, synchronous bilateral nasolabial repair. Contralateral microform defects (n = 6) were not addressed during rotation-advancement repair on the complete/incomplete side; the later repair was a double unilimb Z-plasty. Contralateral mini-microform defects (n = 27) were corrected by vertical lenticular excision and, if necessary, alar base Y-V advancement, either synchronously with closure on the greater side or at another stage. The revision rate correlated with the degree of preoperative asymmetry. The most common revisions were augmentation of the median tubercle and free margin on the lesser side and repositioning of the lower lateral cartilage and alar base on the greater side. CONCLUSIONS: The operative strategy for repair of an asymmetrical bilateral cleft lip is determined by the extent of the vermilion-cutaneous dysjunction on the lesser side. Synchronous bilateral nasolabial repair is indicated for a contralateral minor-form defect. Correction of a contralateral microform or mini-microform defect is usually deferred to achieve symmetry. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/18971734/Asymmetrical_bilateral_cleft_lip:_complete_or_incomplete_and_contralateral_lesser_defect__minor_form_microform_or_mini_microform__ L2 - http://Insights.ovid.com/pubmed?pmid=18971734 DB - PRIME DP - Unbound Medicine ER -