Current surgical management of bilateral cleft lip in North America.

BACKGROUND: This study was undertaken to determine contemporary surgical management of bilateral cleft lip.

METHODS: A survey was sent to North American cleft surgeons. Variables included number of bilateral cleft lip repairs per year, surgical specialty, and methods of nasolabial correction. The authors analyzed possible relationships between surgical specialty/volume and operative techniques.

RESULTS: The response rate was 40 percent (241 of 600). Annual bilateral nasolabial repairs per surgeon were as follows: zero to two, 30 percent; three to five, 46 percent; and six or more, 25 percent. For bilateral complete cleft lip, dentofacial orthopedics was used by 71 percent of respondents; synchronous closure was most commonly performed (88 percent); infrequent techniques were preliminary labial adhesions (11 percent) and staged labial closure (1 percent); and 50 percent undertook primary nasal repair. One half of respondents used nostril splinting following primary or secondary nasal correction. For bilateral incomplete cleft lip, 90 percent of surgeons performed synchronous labial repair and 36 percent did primary nasal correction. For both complete and incomplete bilateral cleft lips, high-volume surgeons were more likely to excise prolabial vermilion and use lateral vermilion-mucosal flaps to form the median tubercle. For bilateral asymmetrical cleft lip, 85 percent of surgeons practiced synchronous labial repair and 54 percent used dentofacial orthopedics on the complete side.

CONCLUSIONS: Synchronous repair was the most frequent method for bilateral cleft lip; one-half of surgeons practiced primary nasal correction. There were no associations between surgical specialty/volume and operative principles or techniques for bilateral nasolabial repair, except for construction of the median tubercle.