Repair of bilateral complete cleft lip: Intraoperative nasolabial anthropometry

Synchronous repair of bilateral complete cleft lip and nasal deformity requ ires conception of three-dimensional form and fourth-dimensional changes wi th growth, as distorted by the malformation. The aim is to obviate typical postoperative nasolabial stigmata. The strategy is to construct fast-growin g features on a smaller scale and slow-growing features on a normal or slig htly larger scale. In this study, intraoperative alterations in nasolabial dimensions were documented by anthropometry in 46 consecutive infants with bilateral complete cleft lip. These values were averaged and compared with measures from normal Caucasian infants at ages 0 to 5 months and 6 to 12 mo nths. Nasal height (n-sn) and nasal width (al-al), both fast-growing featur es, were set smaller (88 percent and 96 percent, respectively) than those o f age-matched normal infants. In contrast, the slow-growing features, nasal protrusion (sn-prn) and columellar length, were constructed longer than no rmal (130 percent and 167 percent, respectively). Because all labial featur es grow rapidly, they were made diminutive in this study, with the exceptio n of central vermilion-mucosal height (median tubercle), which was purposiv ely made full. These maneuvers resulted in a normal, average overall upper- lip height (sn-sto). Two technical refinements also are described: (1) cons truction of deepithelialized bands flanking the philtral flap to improve su rface contour; and (2) positioning and fixation of the dislocated alar cart ilages, performed entirely through superiomedial nostril rim incisions.