Primary unilateral cleft lip-nose repair: the Tawanchai cleft center's integrated and functional reconstruction.

BACKGROUND: The challenges of previously described techniques in unilateral cleft lip repairs inadequately address all deformities of the primary palate, the problems of scar and secondary deformities and achievement of optimum outcome.

OBJECTIVE: To propose the integrated and functional reconstruction of primary unilateral cleft lip-nose repair and to present the preliminary outcome and advantages of this technique.

MATERIAL AND METHOD: The integrated concepts and functional reconstruction includes analysis of the deformities, interdisciplinary management and The Tawanchai Center's interdisciplinary protocol for cleft lip and palate care, pre-surgical orthopedic treatments, the integrated primary cleft lip-nose repair and post-operative management. This technique of repair includes modified rotation advancement technique for skin surgery, functional muscle reconstruction, the correction of nasal deformities, the reconstruction of vermillion and final skin closure.

RESULTS: Between 2002 and 2010, this technique was performed and evaluated on 122 patients who received primary unilateral cleft lip-nose repair, including 72 complete and 50 incomplete, 81 males and 41 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.25) and muscle function (0.36), while the mean of the those with less satisfactory rating scales were achieved found in scar (0.82) and nasal asymmetry (0.72). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated.

DISCUSSION AND CONCLUSION: The authors introduce The Tawanchai Center's integrated concepts and functional reconstruction technique for unilateral cleft lip-nose repair. The technique provides the advantages of integrated assessment of all deformities of the cleft of primary palate, the design of integrated techniques together with the proper perioperative care, presurgical orthodontic treatment and a holistic and well-coordinated interdisciplinary management. The good preliminary outcome has been demonstrated. More improvement in outcome can be achieved by continuing assessment of these groups of patients until they reach maturity, continuing refinement of technique, improvement of interdisciplinary care and benchmarking of the outcome.