Outcomes of primary unilateral cheiloplastyin same-day surgical settings

Khyber Teaching Hospital Peshawar, Pakistan
Mansoor Khan, M.B.B.S, F.C.P.S (Plast.)
Outcomes of primary
unilateral cheiloplasty
in same-day surgical settings

ne of the most common
congenital craniofacial
deformities…
•Shapira Y, Haklai Z, Blum I et al. Prevalence of non-syndromic orofacial clefts among Jews and Arabs, by type, site,
gender and geography: a multi-center study in Israel. IMAJ 2014 Dec;16(12):759-63.
•Kling RR, Taub PJ, Ye X et al. Oral clefting in china over the last decade: 205,679 patients.PlastReconstrSurg Glob
Open 2014;2(10):e236.

ncidence is highest in Asians
(1/500), followed by Caucasians
(1/1000) and Africans (1/2500)I•Shapira Y, Haklai Z, Blum I et al. Prevalence of non-syndromic orofacial clefts among Jews and Arabs, by type, site,
gender and geography: a multi-center study in Israel. IMAJ 2014 Dec;16(12):759-63.
•Kling RR, Taub PJ, Ye X et al. Oral clefting in china over the last decade: 205,679 patients.PlastReconstrSurg Glob
Open 2014;2(10):e236.

eported incidence in
Pakistan is 1.46 per
1000 live birthsR
•Elahi MM, Jackson IT, Elahi O et al. Epidemiology of cleft lip and cleft palate in P
•akistan. PlastReconstSurg 2004;113:1548-55.

urgical repairs dates
back to China’s Qin
Dynasty (221-206 BC)S
•Margulis A, Alperson E, Billig A. Cephalometric evaluation of upper lip symmetry after functional unilateral cleft
lip repair with the Kernahan and Bauer technique and primary cleft rhinoplasty. Isr Med Assoc J. 2014;16(11):693-6.
Shkoukani MA, Chen M, Vong A. Cleft lip - a comprehensive review. Front Pediatr. 2013;1:53.

ose & Thompson
introduced the basic
technique to build on in
early 20th century

uadrilateral/triangular flaps &
rotation advancement
incorporates lateral lip tissue
into the medial lip segment, a
concept introduced by
Mirault

c Comb, Cutting & Tajima
provided the concept of
incorporating primary rhinoplasty
with the lip repair

or aesthetic evaluation of lip
repair, preoperative severity
and multiple postoperative
nasolabial anthropometric
parameters are considered, making it
a challenging job

ingle-day surgery is becoming
more common for an increasing
number of procedures in different
surgical specialities
•Wig J. The current status of day care surgery….a review. Indian J. Anaesth.2005;49(6):459-466.
•Wood BC, Boyajian MJ, Zurakowski D, Rogers GF, Oh AK. Evaluating the need for routine admission following primary
cleft palate repair: An analysis of 100 consecutive cases. Plast Reconstr Surg.2015;136(4):502e-10e.
S

inancial benefits, fewer SSI rates,
expedites patients’ postoperative
recovery in the home environment
& avoids the psychological effects
of hospitalization

lastic surgery procedures,
especially cleft lip and palate
repair, have been no exception to
this trend for single-day surgery to
become more common

im; To evaluate the preoperative
severity and postoperative
outcomes of single-day primary
unilateral cleft nasoslabial repair

bjectives: shortening the patients’
hospital stay and decreasing their
economic burden on the
healthcare facility.

onducted from
January 2011 to
December 2014

less than 3 months of age, syndromic
associations & co-morbidities, lack of
competent parents/relatives,
psychologically unstable, or lived far
from the hospital
EXCLUSION
CRITERIA

•Bermudez L. Ciruestetic [Internet]. Bogota:Cirugia plastic;2013[cited 2015 October 16]. Available from
http://www.ciruestetic.com/resources/nasolabiaeval2013red.pdf
Pre-op
evaluation
Mild: Incomplete cleft lip
Moderate:
Complete/not wide
(Some tissue contact at rest )
Severe: Complete/wide
(No tissue contact)

Rotation advancement with uni-
limb z-plasty (Noordhoff’s)

Semi-open rhinoplasty (inverted
“U” incision) & Tajima
suspension stitch

Patients were kept in OT till
maintenance of oxygen saturation
without supplemental oxygen, breathing
without difficulty & responsive to verbal
stimulus
post operative
recovery/discharge

atients were monitored in the
recovery room till fulfilment of
discharge criterias: full
alertness, ambulation, pain free
& alimentation

who could drive him home and supervise
him for 24 hours with clear verbal & written
instructions for contacting the surgical staff
in case of pain/vomiting (refractory to the
prescribed medications), bleeding, fever,
infection, or other concerns.
Discharged under the
supervision of at least one
mentally/physically capable
escort

Post-op Nasolabial
Evaluation System
(NES)…?

1. Symmetry at the Cupid’s bow; Distance from the
base of the columella to bow’s peak.
2. Nasal symmetry; The shape of nostril, the dome
of nose and the distance from the midline of the
columella to the alar base.
3. Symmetry of lateral lip; Distance from the alar
base to white roll and angle of white roll.
4. Symmetry of the free vermilion;Two
measurements should be considered; distance
from the Cupid’s bow to free vermilion and from
the columella base to free vermilion.
5. The wet and dry vermillion relationship.

Symmetry at the Cupid’s bow;
Distance from the base of the columella
to bow’s peak.
1.

Nasal symmetry; The shape of nostril, the
dome of nose and the distance from the
midline of the columella to the alar base.2.

Symmetry of lateral lip; Distance
from the alar base to white roll and
angle of white roll.3.

Symmetry of the free vermilion;Two measurements
should be considered; distance from the Cupid’s bow to
free vermilion and from the columella base to free
vermilion.4.

The wet and dry vermillion
relationship (red-line)5.

0 ~ Poor 1~ Fair 2 ~ Good
> 2mm 1-2mm < 1mm
Symmetry at the Cupid’s bow;1

Grossly
asymmetrical
Symmetrical size
but not shape
Size & shape
symmetrical
Nasal Symmetry2

Severe
asymmetrical
Some
asymmetry
Good
symmetrical
Symmetry of the lateral lip3

clear notch
& asymmetry
small notch
& bulge
Continuous
Smooth curved
line
Symmetry at of free vermilion;4

Severe
discrepancy some mismatch Good red line
Wet & dry vermillion relationship/redline
5

Good 8–10
Fair 5–7
Poor 0–4
Outcome score:

23 primary unilateral
cleft lip patients were
included
4

ale to female
ratio was1.6:1
m

ge from 3 months
to 384 months

44.9% mild, 14.9%
moderate, and
40.2% severe

Fisher’s anatomical
subunit approximation
technique was the most
common procedure,
followed by Noordhoff’s
technique

postoperative
outcome was good
in 89.8% of cases,
fair in 9.9% of cases,
and poor in 0.2% of
cases

symmetry of the nose
was good in 57.4%,
satisfactory in 38.3% &
unsatisfactory in 4.3%
of cases

Cleft lip severity versus postoperative outcomes.
Postop.
outcome
Severity of cleft lip
TotalMild Moderate Severe
Poor 0 0 1 1
Fair 3 2 37 42
Good 187(98.4%) 61(96.8%) 132(77.6%) 380
Total 190 63 170 423

Fisher’s repair,
89.4% good overall outcomes,
good Cupid’s bow symmetry 85.4%
Noordhoff’s technique
100% good outcomes &
good Cupid’s bow symmetry
But results were not statistically significant due to small sample
size in Noordhoff’s group during the study period

Symmetry of nasal deformity
Because we switched from closed technique to semi-open
with inverted U incision

Complications rate was 1.18% (n=5)
most common was stitch sinus 0.71%,
nasal hematoma (0.24%)
LRTI in (0.24%).

Average hospital stay
7.5 hours (6–9 hours).
Hospital cost was reduced
by 19% (3800 PKR)
Re-admission rate
was 0.24%
compared to the reductions of 15%–30% and 40% that have been
reported for the USA and UK, respectively

Mild and severe
unilateral cleft lip were the
most common deformities

Fisher’s anatomical subunit
approximation technique was
performed, with satisfactory
postoperative outcomes

Improvement in results was
observed over the study period by
including Noordhoff’s technique in
the procedure for severe forms

Refinements in the cleft
rhinoplasty techniques over
the course of the study
improved the results

Single-day primary unilateral cleft
cheiloplasty is a cost-effective
procedure that did not pose an
additional risk of complications.

Outcomes of primary unilateral cheiloplastyin same-day surgical settings

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Outcomes of primary unilateral cheiloplastyin same-day surgical settings

Similar to Outcomes of primary unilateral cheiloplastyin same-day surgical settings (20)

More from Mansoor Khan

More from Mansoor Khan (20)

Recently uploaded

Recently uploaded (20)

Outcomes of primary unilateral cheiloplastyin same-day surgical settings