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Primary bilateral one-stage cleft lip/nose repair: 40-year Dallas experience: part I.
J Craniofac Surg 2009; 20 Suppl 2:1913-26JC

Abstract

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.

Authors+Show Affiliations

Department of Plastic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19816375

Citation

Xu, Haisong, et al. "Primary Bilateral One-stage Cleft Lip/nose Repair: 40-year Dallas Experience: Part I." The Journal of Craniofacial Surgery, vol. 20 Suppl 2, 2009, pp. 1913-26.
Xu H, Salyer KE, Genecov ER. Primary bilateral one-stage cleft lip/nose repair: 40-year Dallas experience: part I. J Craniofac Surg. 2009;20 Suppl 2:1913-26.
Xu, H., Salyer, K. E., & Genecov, E. R. (2009). Primary bilateral one-stage cleft lip/nose repair: 40-year Dallas experience: part I. The Journal of Craniofacial Surgery, 20 Suppl 2, pp. 1913-26. doi:10.1097/SCS.0b013e3181b6c82d.
Xu H, Salyer KE, Genecov ER. Primary Bilateral One-stage Cleft Lip/nose Repair: 40-year Dallas Experience: Part I. J Craniofac Surg. 2009;20 Suppl 2:1913-26. PubMed PMID: 19816375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary bilateral one-stage cleft lip/nose repair: 40-year Dallas experience: part I. AU - Xu,Haisong, AU - Salyer,Kenneth E, AU - Genecov,Edward R, PY - 2009/10/10/entrez PY - 2009/12/25/pubmed PY - 2010/5/5/medline SP - 1913 EP - 26 JF - The Journal of craniofacial surgery JO - J Craniofac Surg VL - 20 Suppl 2 N2 - 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. SN - 1536-3732 UR - https://www.unboundmedicine.com/medline/citation/19816375/Primary_bilateral_one_stage_cleft_lip/nose_repair:_40_year_Dallas_experience:_part_I_ L2 - http://Insights.ovid.com/pubmed?pmid=19816375 DB - PRIME DP - Unbound Medicine ER -