xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

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ALKEBSI ET AL.

Table 1. The aesthetic results and intraclass correlation coefficient test of the lip and nose Mean – SD ICC

3.89 – 3.86 0.93 – 0.10 0.92 – 0.11 0.87 – 0.10 1.03 – 0.24 0.97 – 0.22 1.28 – 0.36 4.95 – 4.24 0.82 – 0.22

ML-MCPh angle

0.954 0.911 0.957 0.961 0.908 0.932 0.947 0.919 0.957 0.884 0.988 0.913 0.984 0.968 0.965

VPh

Cph-Sn CPh-Ab

CPh-MCPh

CPh-Ch

VH

CPhs angle

CL NH NW AW NA

0.8228 – 0.14 1.28 – 0.21 1.10 – 0.13 0.74 – 0.15 3.12 – 3.59 1.95 – 1.52

CA

ABA

was obtained using SM. Furthermore, the null hypothesis (no difference between the authors’ measurements) was supported by ANOVA results ( p < 0.05). Discussion Significant progress has been made in cleft lip repair over the past century 13,14 : The SM showed satisfactory level ing of the Cupid’s bow and enhanced the lip height with preserving the lip width. Furthermore, the nasal symme try was satisfactory, as shown by the anthropometric measurements (Fig. 4). For many years, the short lip was observed after treat ment of the UCCL patients in our departments. This observation is consistent with what Lazarus et al. repor ted. 15 Other studies reported better lip and nose width with Millard technique as compared with Tennison– Randall technique. 12 Previous studies pointed out the possibility of using the inferiorly placed triangular flap to overcome the short lip height. 5,6 Therefore, our tech nique aimed to preserve the advantages and eliminate disadvantages inherent to Millard technique. In the Millard method, rotation of the Cupid’s bow to the symmetrical position is achieved by performing a back-cut. All points in the design of the Millard method are precisely localized. However, the back-cut incision length is not de termined and, therefore, it is highly dependent on the sur geon’s experience. Using the cut-as-you-go principle in the Millard method may result in an unexpected or unsuc cessful situation 16 and may lead to short lip height. 8,17 Incising the back-cut blindly without standard parameters may lead to either excessive rotation of the Cupid’s bow and thus increased lip height, or may lead to insufficient ro tation of the Cupid’s bow resulting in a short lip. 8 By analyzing the geometric rotation of the Cupid’s bow during cleft lip repair, together with the natural Ab, alar base; ABA, alar base angle; AW, ala width; CA, columellar angle; Ch, chelion; CL, columellar length; CPh, christa philtrum; ICC, intraclass correlation coefficient; MCPh, middle christa philtrum; ML, mid line; NA, nostril angle; NH, nostril height; NW, nostril width nostril width; Sn, subnasal, VH, vermillion height; VPh, vertical pheltrum height. Downloaded by Travis T Tollefson from www.liebertpub.com at 03/02/25. For personal use only.

Fig. 4. (Above) Preoperative views of 1-year old patient with left complete cleft lip. (Below) Postoperative views of 4 years after simultaneous primary repair of cleft lip and nasal deformity by SM showing good overall appearance. SM, Shi modifications.

shape of the upper lips, Shi shows that an incision on the noncleft side ends on a bisector of the angle 2-1-3 (representing the labial midline), ensures sufficient rota tion of the Cupid’s bow to its symmetrical position. 8,18 Bisector theory in cleft lip repair design helps guide clin ical practice and improves the ability to predict the post operative effect. Satisfactory repositioning of the Cupid’s bow was obtained using our method, as shown by the cleft and noncleft side ratio of the VPh 0.93. Marking the CPh in the cleft side could be performed either by mirroring the distance between the CPh commissures on the cleft and noncleft sides marking the point where the white roll disappears, or the vermil lion has the maximum thickness. 19 However, a short ver tical and/or horizontal lip may result despite the method used to mark the CPh on the noncleft side. Previous stud ies have reported that cleft lip surgeons should pay greater attention to lip width than vertical lip height. The reason behind this is the impossibility of correcting the short horizontal lip 20 and the ability to restore the short vertical lip height during revision. In contrast, re garding the aesthetic outcome, Gundlach et al. 21 have emphasized the significance of lip height symmetry be cause asymmetries in lip height are more likely to be no ticed by observers than asymmetries in lip width. Furthermore, it has been reported that a deficiency in lip width is normalized in growth 22 and that asymmetry in the lip height created on cleft lip repair is retained without relief. 17