F I S H e R

Unilateral
Cle+ Lip Repair

Anatomic Subunit Approach
Vivek Panchapakesan BSc MD FRCSC DABPS Toronto, Canada
Tuesday, 22 November, 11
Goals of Unilateral Cle+ Lip Repair

Symmetric Lip Length Level Cupids Bow Adequate Vermilion Thickness Inconspicuous Scar Restore Muscle ConKnuity Address Nasal Deformity
Historical Background
ROSE-THOMPSON EFFECT
W. ROSE On Harelip and Cle- Palate. London: HK Lewis, 1891
J.E. THOMPSON An arKsKc and mathemaKcally accurate method of repairing the defect in cases of harelip. Surg Gynaecol Obstet 14: 498, 1912
Picture from Patel P.K, Unilateral Cle- Lip Repair Treatment & Management h[p://emedicine.medscape.com/arKcle/1279641-treatment#a1133 Tuesday, 22 November, 11
THE REPAIR OF THE UNILATERAL CLEFT LIP BY THE STENCIL METHOD

C. TENNISON San Antonio, Texas Plast Reconstr Surg 9: 115, 1952
A TRIANGULAR FLAP OPERATION FOR THE PRIMARY REPAIR OF UNILATERAL CLEFTS OF THE LIP
P. RANDALL Philadelphia, Pennsylvania Plast Reconstr Surg 23: 331, 1959
COMPLETE UNILATERAL CLEFTS OF THE LIP

D. RALPH MILLARD Miami, Florida Plast. Reconstr. Surg. 25: 595, 1960
The Primary Camouage of the Unilateral Hare- look. TransacGons of the InternaGonal Society of PlasGc Surgeons, First Congress, Stockholm (1955); 1957. pp. 160e166
ROTATION-ADVANCEMENT MODIFICATIONS
Millard DR, Renements in rotaKon- advancement cle+ lip technique. Plast Reconstr Surg 33:26, 1964
Millard DR, Extensions of the rotaKon- advancement principle for wide unilateral cle+ lips. Plast. Reconstr. Surg 42: 535, 1968
ROTATION-ADVANCEMENT MODIFICATIONS
Millard DR, Renements in rotaKon- advancement cle+ lip technique. Plast Reconstr Surg 33:26, 1964
Millard DR, Extensions of the rotaKon- advancement principle for wide unilateral cle+ lips. Plast. Reconstr. Surg 42: 535, 1968
UNILATERAL CLEFT LIP REPAIR

L.R. MOHLER Columbus, Ohio Plast Reconstr Surg, Vol 80(4): 1960,

M.S. NOORDHOFF Taipei, Taiwan The Surgical Technique for the Unilateral Cle- Lip-Nasal Deformity OperaGve Syllabus 1997 Noordho Craniofacial FoundaKon

The Red Line

The Red Line

The Red Line
Noordhos Point

The Red Line
Noordhos Point

The Red Line
Noordhos Point









QUADRILATERAL MIRAULT FLAP OPERATION

A.B. LE MESURIER Toronto, Ontario Plast Reconstr Surg 16:425, 1955

H.G. THOMSON Toronto, Canada Oper Tech Plas. Reconstr. Surg 2: 175, 1995.






b c

b c
a b + c

b c
a b + c

b c
a b + c
THE SUBUNIT PRINCIPLE IN NASAL RECONSTRUCTION

G.C. BURGET, F.J. MENICK Chicago, Illinois & Tuscon, Arizona Plast Reconstr Surg 76: 239, 1985
Ideal Line of Repair

Ascends from cle+ side of cupids bow Mirrors the non-cle+-side philtral column Reaches base of the nose ConKnues superolaterally Borders lip-columellar crease, ascending to the nostril sill
Ideal Line of Repair

Ascends from cle+ side of cupids bow Mirrors the non-cle+-side philtral column Reaches base of the nose ConKnues superolaterally Borders lip-columellar crease, ascending to the nostril sill
UNILATERAL CLEFT LIP REPAIR: AN ANATOMICAL SUBUNIT APPROXIMATION TECHNIQUE

DAVID M. FISHER Toronto, Canada Plast Reconstr Surg 116: 61, 2005
UNILATERAL CLEFT LIP REPAIR: AN ANATOMICAL SUBUNIT APPROXIMATION TECHNIQUE

DAVID M. FISHER Toronto, Canada Plast Reconstr Surg 116: 61, 2005
a b 1mm = c
Markings
Lesser Lip Height (Base width of inferior triangle)
Lesser Lip Height (Base width of inferior triangle) = Total Lip Height Greater Lip Height 1mm
ModicaKons
Fisher D.M., Plast Reconstr Surg 2005; 116(1): 61-71.

ModicaKons
Base width of Inferior Triangle: = 1.24mm (0 2mm)
Fisher D.M., Plast Reconstr Surg 2005; 116(1): 61-71.

Protocol (Sickkids)
Presurgical NAM Lip Repair/ Rhinoplasty Palatoplasty M&T Lip Revision VPI CorrecKon Lobule Rhinoplasty Alveolar Bone Gra+ Septorhinoplasty Orthognathic Surgery 2 weeks Lip Repair 3 5 months 11 14 months > 3 years prn > 4 years prn > 6 years prn 8 12 years > 12 years prn Skeletal Maturity prn
Primary Rhinoplasty
ConservaKveGoal = Improvement
CentralizaKon of columellar base Symmetrical alar base reposiKoning Nostril margins of equal circumference Release LLC-ACC from piriform Anteromedial advancement of cle+-side lateral crus CreaKon of ULC-LLC overlap No dissecKon of dome
Conclusions
Reliable
Based on previously described repairs and principles
Rose-Thomson lengthening allows for a smaller triangle Triangle posiKoned according to Noordhos descripKon Repair along lines of anatomical subunits ConservaKve approach to the nose

F I S H e R

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Unilateral

Cle+ Lip Repair

Goals of Unilateral Cle+ Lip Repair

THE REPAIR OF THE UNILATERAL CLEFT LIP BY THE STENCIL METHOD

COMPLETE UNILATERAL CLEFTS OF THE LIP

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

The Red Line

UNILATERAL CLEFT LIP REPAIR

The Red Line

UNILATERAL CLEFT LIP REPAIR

The Red Line

UNILATERAL CLEFT LIP REPAIR

The Red Line

UNILATERAL CLEFT LIP REPAIR

The Red Line

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

QUADRILATERAL MIRAULT FLAP OPERATION

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

UNILATERAL CLEFT LIP REPAIR

THE SUBUNIT PRINCIPLE IN NASAL RECONSTRUCTION

Ideal Line of Repair

Ideal Line of Repair

UNILATERAL CLEFT LIP REPAIR: AN ANATOMICAL SUBUNIT APPROXIMATION TECHNIQUE

UNILATERAL CLEFT LIP REPAIR: AN ANATOMICAL SUBUNIT APPROXIMATION TECHNIQUE

Lesser Lip Height (Base width of inferior triangle)

Fisher D.M., Plast Reconstr Surg 2005; 116(1): 61-71.

Base width of Inferior Triangle: = 1.24mm (0 2mm)

Fisher D.M., Plast Reconstr Surg 2005; 116(1): 61-71.

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