Treatment of Complete Bilateral Cleft Lip-Nasal Deformity

ABSTRACT The modern technique of presurgical orthopedics and nasoalveolar molding produces a better skeletal foundation and nasal shape for the repair of the bilateral cleft lip-nasal deformity. The general principles are as follows: (1) preserve the presurgical columellar length; (2) keep the width of the central lip segment narrow without compromising the blood supply; (3) advance the columella prolabium complex superiorly to allow reconstruction of the orbicularis oris muscle behind the prolabium; (4) release the alar cartilage attachment from the pyriform rim and provide additional coverage of this soft tissue deficiency with the use of inferior turbinate flaps; (5) release and reposition the lower lateral cartilage; (6) adequately dissect above the maxillary periosteum; (7) reconstruct the nasal floor by local mucosal flaps; (8) reconstruct the prolabial buccal sulcus with tissue from the prolabium; (9) reconstruct the orbicularis muscle sphincter and attach it to the anterior nasal spine; (10) reconstruct a new Cupid's bow, central vermilion, and lip tubercle with tissue from the lateral lips; (11) balance the height of both lateral lips without any incision around the ala; and (12) maintain the presurgical nasolabial angle. The residual nasal deformity remains a problem that needs further improvement. The long-term result in Chang Gung Craniofacial Center suggests overcorrection of columella height before, during, and after lip repair.