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Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures. [ABSTRACT FROM AUTHOR]

Patients these days are increasingly conscious of personal appearance, and much attention is being focused on the smile. Cosmetic dentistry is also in the race to become the most advanced and demanding dental subspecialty. Recently, aesthetic lip surgeries have been introduced, like lip repositioning, lip reduction and lip enhancement surgeries, to improve facial aesthetics. The authors present a case of a 28-year-old healthy male who reported to the Department of Periodontics with the chief complaint of poor aesthetics and large lips. His lower lip was double the size of the upper lip. Therefore, an aesthetic lip reduction surgery was planned. The lip reduction operation could successfully manage the large lower lip with no intra or postoperative complications. No recurrence was observed within a period of 12 months. Cheiloplasty balances the look of the top and lower lips, improving the appearance of the face as a whole. [ABSTRACT FROM AUTHOR]

Background and objective. The aged lip is produced by changes related to the passage of time at the level of skin, subcutaneous cellular tissue, muscle and bone, resulting in elongation and loss of volume of the lip. We propose a clinical classification of the senescent lip to establish its surgical treatment according to its grades. Methods. We conduct a non-experimental, descriptive and prospective research in 2 phases: the first one with 180 patients taking the clinical measurements of the white lip, and a second one consisting on 20 patients who were classified according to the degree of labial rhytidosis and the corresponding treatment was applied. Statistical tests chi-square and Shapiro-Wilk were applied for association and statistical significance. Results. It was evidenced the beginning of the labial rhytidosis from the age group of 30 to 34 years and it was possible to classify the labial rhytidosis in 4 grades. Modified surgical treatment was applied in "bull's horn". Postoperative complications were identified: hematoma, partial dehiscence and recurrences. All the patients reported high satisfaction with the results. Conclusions. The proposed classification allows to establish a safe and effective surgical treatment of labial rhytidosis, adapted to the anatomical characteristics of each patient. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of preoperative nasal alveolar moulding (PNAM) on nasal symmetry in unilateral complete cleft lip/palate patients after primary cheiloplasty. Methods From February 2014 to 2017, 60 children with unilateral complete cleft lip/palate were selected as the study subjects. The patients were divided into two groups: children with unilateral complete cleft lip/palate who underwent PNAM (PNAM group, n=30) and children with unilateral complete cleft lip/palate who did not undergo PNAM (control group, n=30). The nasal symmetry between both groups was compared before the beginning of PNAM (T1), after nasoalveolar molding but before surgery (T2), 1 week after surgery (T3) and 12 months after surgery (T4), and the nasal contour of the patients was evaluated by 10 reviewers at T4. Results In PNAM treatment, erythra was a common complication, with an incidence of 33.3% (10/30), followed by surface skin damage caused by tape (16.7%, 5/30), nasal ulcer (3.3%, 1/30) and alveolar ulcer (3.3%, 1/30). At T2 time, the ratio of nostril height [(0.81 ± 0.20)颐(0.67±0.13); P = 0.044], the ratio of nostril area [(1.27±0.28)颐(1.00±1.24); P=0.040] and the ratio of nostril width [(2.64±0.51)颐(2.27±0.45); P=0.033] in PNAM group were significantly lower than those in control group. At other time points, there were no significant differences in the ratio of nostril height, ratio of nostril bridge height, ratio of nostril area and ratio of nostril width between the two groups (P > 0.05). The average total score of nasal contour evaluation in PNAM group and control group at 1 year after operation was (66.61±14.24) and (66.30±15.11), respectively, the difference was not statistically significant(F= 0.010, P=0.918). Conclusion PNAM as an early-stage adjunctive therapy for nasal deformity correction was helpful to improve nasal symmetry before primary cheiloplasty. [ABSTRACT FROM AUTHOR]

La déformation nasale résiduelle chez les patients porteurs de fente labiopalatine reste la demande principale de ces derniers. La réalisation d'une chirurgie primaire nasale a considérablement amélioré les résultats. Cependant, il est encore souvent nécessaire d'améliorer la morphologie nasale. Le respect des tissus lors de la chirurgie primaire est essentielle et autorise des corrections secondaires plus aisées. La reconstruction anatomique facilite grandement le traitement des déformations secondaires. Il ne faut pas hésiter en cas de séquelles labionasales importante, à reprendre selon les règles de la chirurgie primaire, l'intégralité de la lèvre et du nez. Residual nasal deformity in patients with cleft palate remains the main demand of these patients. Performing primary nasal surgery has significantly improved the results. However, it is still often necessary to improve the nasal morphology. Respect of tissues during primary surgery is essential and allows easier secondary corrections. Anatomical reconstruction greatly facilitates the treatment of secondary deformities. Do not hesitate in case of major labionasales sequelae, to make revision, according to the rules of primary surgery, of the entire lip and nose. [ABSTRACT FROM AUTHOR]

Background: Cleft lip, and its association with cleft palate, is the most common craniofacial malformation worldwide, having a high incidence in the Hispanic population, with 9.6 cases being reported per 10,000 newborns. The standard treatment is cheiloplasty with satisfying functional result. However, the presence of the hypertrophic scar constitutes the most frequent sequel, requiring, in some cases, a new surgery. Said scar often becomes a social stigma of this pathology. Methods: Aim: To determine if the application of type A botulinum toxin prior to the surgery, improves the aesthetical results of the surgery evaluated by the Vancouver scale. A randomized triple-blind clinical trial was performed that included all patients from 4 to 24 months of age, with unilateral or bilateral cleft lip and palate, without any history of prior surgery, at the HRAEB in Mexico. The surgery was performed by the same senior surgeon in both groups. Patients were randomized into two groups: a study group of 11 patients who received a type A Botulinum toxin injection at least 7 days before the surgery and a control group of 11 patients who received placebo. Both groups were evaluated by a different investigator, 3 and 6 months postoperatively using the Vancouver scale. Results: There was statistical significance in the width of the scar in millimeters, in the study group, of 2 mm (0–3) and in the control group of 4 mm with p value of < 0.001. There was also a difference in Vancouver scale, obtaining in the study group a mean of 2 points (IC 0–3) and in the control group one of 4 points (IC 0–6) with a p value of < 0–001. No side effects of the toxin were documented during the study and there were less surgical complications. Conclusion: The use of type A botulinum toxin decreases the presence of a hypertrophic scar in patients with a cleft lip who undergo primary cheiloplasty; however, more studies with a larger number of patients are needed. Level of evidence: level II, therapeutic study. [ABSTRACT FROM AUTHOR]

Résumé Nous rapportons le premier cas décrit dans la littérature de fente labiale inférieure para-commissurale droite retrouvée chez un enfant de 2 ans. Cette anomalie causait une incompétence labiale nécessitant une correction chirurgicale. Différentes techniques chirurgicales ont été décrites pour le traitement des fentes labiales supérieures. Nous avons étudié chacune d’elles, analysé les avantages et inconvénients de ces techniques en les inversant et en les adaptant pour la lèvre inférieure. Nous avons opté pour la plastie en double « Z » de Malek car la différence de hauteur entre le côté fendu et le côté sain était importante. De plus, cette technique dissimule une partie de la cicatrice dans le sillon labio-mentonnier. Le résultat fonctionnel et esthétique à 6 mois postopératoire est satisfaisant. Summary We report the first case described in the literature of lateral, paracommissural cleft of the lower lip in a 2-year-old child. This anomaly caused labial incompetence requiring surgical correction. Different surgical techniques have been described for the treatment of the cleft of the upper lip. We studied each of them, analyzed the advantages and disadvantages of these techniques by inverting them and adapting them for the lower lip. We opted for the double “Z” plasty of Malek because the difference in height between the cleft side and the healthy side was important. In addition, this plasty hides part of the scar in the labiomental groove. The functional and aesthetic result at 6 months after surgery is satisfactory. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In the children born with a cleft lip, surgery is the first step in correcting the inborn anomaly. In comparison with usually made 3-month surgery, benefits of the surgery in neonates have been reported: a very good wound healing, feeding facilitation, and good socialization of a child from neonatal age. The aims of the present study were to perform cheiloplasty in early newborns affected by the total cleft lip and palate (CLP) by the technique modified to search for optimum aesthetic result, and to assess the surgery outcome from qualitative and quantitative aspects. Methods: The operations were performed by the same surgeon in 97 neonates 1–8 days old during 2005–2008. The original technique by Tennison was modified and used. Aesthetic outcome of the surgery was evaluated according to scar visibility, and the shape and symmetry of the lip and nose. The effect of cheiloplasty on the formation of the upper jaw segments was evaluated in a sample of unilateral CLP patients using the 3D-finite element scaling analysis (FESA). We compared 3D models of dental plaster casts made prior to lip surgery (in neonates under 8 days of age) and prior to palate surgery (at 12 months of age). Results: Only the children in excellent health state and without an associated inborn defect were allowed to pass the operation. There were no per-operative complications (except the correction of tracheal tube position in several cases). The parents appreciated bringing home a neonate with no visible cleft. This aspect not only facilitated baby feeding, but had important positive psycho-social impact on the whole family. The wound healing and aesthetic effect of the cheiloplasty were very good. The scar was barely visible and lip and nose were symmetric in majority of children. After lip closure, the growth and approximation of jaw segments was observed. This aspect was also associated with incisors development in the anterior portion of the segment including premaxilla. Conclusions: Our results show, that early neonatal lip surgery of CLP is promising technique with very good aesthetic results and important positive psychological impact on the child and its family. [Copyright &y& Elsevier]

Background: The Smile Train is an international charity with an aim to restore satisfactory facial appearance and speech for poor children with cleft abnormalities who would not otherwise be helped. A total of 241 children of cleft lip and palate anomaly, scheduled for surgery under general anesthesia, were studied. Cleft abnormality requires early surgery. Ideally cleft lip in infants should be repaired within the first 6 months of age; and cleft palate, before development of speech, i.e., at the age of 2 years. But in our study, only 27% of children underwent corrective surgery by ideal age of 2 years, which may be due to ignorance, poverty or unawareness about the fact that cleft anomaly can be corrected by surgery. Context: Smile Train provides care for poor children with clefts in developing countries. The guidelines were designed to promote safe general anesthesia for cheiloplasty and palatoplasty. Aims: Smile Train promotes free surgery for cleft abnormalities to restore satisfactory facial appearance and speech. Settings and Design: This was a randomized prospective cohort observational study. Materials and Methods: A total of 241 consenting patients of American Society of Anesthesiologt (ASA) I and II aged 6 months to 20 years of either sex, scheduled for elective cheiloplasty and palatoplasty, were studied. Children suffering from anemia, fever, upper respiratory tract infections or any associated congenital anomalies were excluded. Approved guidelines of the Smile Train Medical Advisory Board were observed for general anesthesia and surgery. Statistical Analysis: The Student t test was used. Results: The infants were anemic and undernourished, and two thirds of the children were male. Only 27% of the children presented for surgery by the ideal age of 2 years. Conclusions: Pediatric anesthesia carries a high risk due to congenital anomaly and shared airway, venous access and resuscitation; however, cleft abnormality requires surgery at an early age to make the smiles of affected children more socially acceptable. [ABSTRACT FROM AUTHOR]

Background: Appropriate sizes (internal diameters) and insertion depths of uncuffed preformed endotracheal tubes in children with cleft lip and palate, who generally have delayed growth and development in early infancy have not been elucidated. Methods: The sizes and insertion depths of endotracheal tubes in patients who received primary cheiloplasty and/or palatoplasty in relation to age, height, and weight were retrospectively analyzed. Tube sizes were determined using an appropriate air leakage at an airway pressure of 15–20 cmH2O. Tube insertion depths were confirmed by auscultation of bilateral breathing sounds at several tube depths, placing the tip 1.5 cm above the carina. Obtained data sets were compared with previously published studies. Results: The number of cases analyzed was 236 in total. The mean age, height, and weight were 327.4 ± 199.2 days, 69.7 ± 7.5 cm, and 8.2 ± 1.8 kg, respectively (mean ± sd). Neither the tube size nor tube depth in cleft lip and palate children was smaller or shorter than those of normal subjects. Discrepancies between the preformed bend and the tube insertion depth increased as the tube size increased. Conclusions: The current findings suggest that it is reasonable to apply the currently available standards for normal children, e.g. Motoyama’s general guide, to predict the tube size and insertion depth for Japanese cleft lip and palate children, and that the use of the uncuffed preformed endotracheal tube is associated with a risk of endobronchial intubation, which appears to increase with age. [ABSTRACT FROM AUTHOR]

Abstract: The cure without after-effect of an hemangioma is classic but sometimes the spontaneous involution, a premature surgical treatment or an evolutionary complication can be at the origin of a definitive after-effect. In these cases, the treatment of the hemangioma, often multidisciplinary, will be begun in a late way during the late childhood or the adolescence. Surgical excision of an excess tissue or of a wide scar, lipoaspiration of a fat remainder, lasertherapy and fat tissue reinjection are simple and mostly sufficient procedures. In the most complex cases, notably at the facial site, a surgery heavier as a rhinoplasty, a resection of lip, a local flap or orthognatic surgery can be necessary. [Copyright &y& Elsevier]

The history of lip repair shows significant parallelism with the evaluation of ideas in plastic and reconstructive surgery. The first attempts were addressed mainly to full-thickness lower lip repair as the resulting labial incompetence was more handicapping. However, techniques and knowledge evolved rapidly to the modern state of the art. Almost all the procedures used today were already described in the early 20th century and their progress based on a profound knowledge of functional anatomy established the principles of labial sphincter dynamic repair by tissue redistribution. [Copyright &y& Elsevier]

Background and Objectives: Infra orbital nerve block is utilized for postoperative pain control in children undergoing cleft lip repair. This study was conducted to compare the effectiveness, advantages and disadvantages of infra orbital nerve block and opioids for postoperative pain relief following cheiloplasty. Materials and Methods: Sixty paediatric patients aged 3 months – 13 years undergoing cheiloplasty were selected by simple random sampling and were divided into two groups. All the children received standardized premedication with midazolam, were operated upon under general anaesthesia and the block was performed at the end of surgery before reversal. Group B patients were administered bilateral infra orbital nerve block with 0.25% Bupivacaine (upto 2 mg/kg). Group O patients received Pentazocine 0.5 mg / kg IV. Postoperatively, the heart rate and respiratory rates were recorded every 15 minutes for the first 60 minutes, half hourly till 4 hours and then at 12 and 24 hours. Behavioural assessment for pain / discomfort was done at intervals of 1/2, 1, 2, 3, 4, 12 and 24 hours. Need for supplementary analgesics and duration between the administration of block/opioid and the first dose of supplementary analgesics were noted. Side effects such as nausea and vomiting, pruritus, respiratory depression and bradycardia during each of these periods were noted. Results: Both the groups were comparable for age, sex, weight and operative time with no statistical difference. The mean duration of analgesia for infra orbital nerve block was 357.5 minutes i.e. 5 hours 58 minutes and that for opioid was 231 minutes i.e. 3 hours 51 minutes which was significantly lower than the hours of analgesia provided by the block. Further, at the 4th hour, 76.6% of the patients in Group O required supplementary analgesics, in contrast to only 16.6% in Group B. The incidence of nausea and vomiting and pruritus was also higher in Group O. Conclusion: The results indicate that bilateral infra orbital nerve block provides effective analgesia in the postoperative period, lasting for 6 hours in comparison to 31/2 - 4 hours following the administration of intravenous Pentazocine, with no major untoward effects. [ABSTRACT FROM AUTHOR]

Treacher Collins Syndrome (TCS) is an autosomal dominant disorder of craniofacial development. It is characterized by bilateral and symmetric abnormalities of the structures derived from the first and second branchial arch region. The patients with TCS can have difficult intubation because of retrognathia and severe facial deformity. Here we report a case of 11 months old boy with TCS with anticipated difficult airway posted for cheiloplasty under general anesthesia which was successfully managed. [ABSTRACT FROM AUTHOR]