Primary Unilateral Cleft Lip-Nose Repair: The Tawanchai Cleft Center’s Integrated and Functional Reconstruction†
Bowornsilp Chowchuen MD, MBA*, Chutimaporn Keinprasit DDS, MS (Orthodontics)**, Suteera Pradubwong RN, MSc***
Affiliation : † Some of the material in this manuscript was presented at the 2nd World Cleft Congress of the International Cleft Lip and Palate Foundation, Munich, Germany (2002); the First Thai International Congress on Interdisciplinary Care for Cleft Lip and Palate 2003, Khon Kaen, Thailand (2003) and the 10th International Congress on Cleft Palate and Related Craniofacial Anomalies, Durban South Africa (2006) * Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Department of Orthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand *** Surgery and Orthopedic Department, Division of Nursing, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Background : The challenges of previously described techniques in unilateral cleft lip repairs inadequately address all
deformities of the primary palate, the problems of scar and secondary deformities and achievement of optimum outcome.
Objective : To propose the integrated and functional reconstruction of primary unilateral cleft lip-nose repair and to present
the preliminary outcome and advantages of this technique.
Material and Method: The integrated concepts and functional reconstruction includes analysis of the deformities, interdisci-
plinary management and The Tawanchai Center’s interdisciplinary protocol for cleft lip and palate care, pre-surgical
orthopedic treatments, the integrated primary cleft lip-nose repair and post-operative management. This technique of repair
includes modified rotation advancement technique for skin surgery, functional muscle reconstruction, the correction of nasal
deformities, the reconstruction of vermillion and final skin closure.
Results : Between 2002 and 2010, this technique was performed and evaluated on 122 patients who received primary
unilateral cleft lip-nose repair, including 72 complete and 50 incomplete, 81 males and 41 females. Six parameters (scar,
Cupid’s bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were
used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were
achieved in philtrum anatomic fidelity (0.25) and muscle function (0.36), while the mean of the those with less satisfactory
rating scales were achieved found in scar (0.82) and nasal asymmetry (0.72). These preliminary outcomes showed satisfac-
tory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated.
Discussion and
Conclusion : The authors introduce The Tawanchai Center’s integrated concepts and functional reconstruc-
tion technique for unilateral cleft lip-nose repair. The technique provides the advantages of integrated assessment of all
deformities of the cleft of primary palate, the design of integrated techniques together with the proper perioperative care, pre-
surgical orthodontic treatment and a holistic and well-coordinated interdisciplinary management. The good preliminary
outcome has been demonstrated. More improvement in outcome can be achieved by continuing assessment of these groups
of patients until they reach maturity, continuing refinement of technique, improvement of interdisciplinary care and benchmarking
of the outcome.
Keywords : Integrated concepts, Functional reconstruction, Primary unilateral cleft lip-nose repair, Tawanchai Center
