Primary bilateral one-stage cleft lip/nose repair: 40-year Dallas experience: part I.J Craniofac Surg 2009; 20 Suppl 2:1913-26JC
A 40-year experience with a proven protocol of repair for primary bilateral cleft lip/nose is presented. The Dallas surgical protocol for primary bilateral cleft lip/nose repair depends on the anatomy of the deformity. In cases of complete and partial bilaterally symmetric cleft lip, alveolus, and palate, 1-stage lip closure was performed at 3 months of age. In cases of asymmetric or incomplete bilateral clefts, an extremely small prolabium (<6 mm in vertical height), or a displaced or severely projected premaxilla, a 2-stage lip closure is more feasible ("Primary Bilateral Cleft Lip/Nose Repair Part II"). Primary nasal reconstruction was at 1 year of age. Early nasal reconstruction eliminates severe secondary deformity and the need for major early surgery. Orthognathic surgery was performed in approximately 40% of the senior surgeon's bilateral cleft patients to achieve optimal facial balance and aesthetics. Ten completed cases are presented with their long-term outcomes. The long-term outcomes of speech, occlusion, and facial balance are good to excellent in most of our bilateral patients. But in many cases, outcome of the lip/nose is still unsatisfying in the senior author's opinion compared with the results of unilateral cleft patients. These long-term outcomes are determined by the severity of the cleft deformity, primary repair technique, secondary surgery, and, most important, a protocol performed by a multidisciplinary experienced team until growth is complete. This technique should be considered in the treatment of all bilateral clefts, depending on the anatomy and team availability.