Primary Bilateral Cleft Lip-Nose Repair: The Tawanchai Cleft Center’s Integrated and Functional Reconstruction†
Bowornsilp Chowchuen MD, MBA*, Nita Viwattanatipa DDS, MSD**, Tasanee Wangsrimongkol DDS, MS, PhD***, Suteera Pradubwong RN, MSc**** Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
Affiliation : † Some of the material from this manuscript was partly presented at the First Thai International Congress on Interdisciplinary Care for Cleft Lip and Palate 2003, Khon Kaen, Thailand (2003). *Division of Plastic Surgery, Department of Surgery, Faculty of Medicine,Khon Kaen University, Thailand **Department of Orthodontics, Faculty of Dentistry, Mahidol University,Bangkok, Thailand *** Department of Orthodontics, Faculty of Dentistry, Khon Kaen University,Khon Kaen, Thailand **** Surgery and Orthopedic Department, Division of Nursing,
Background : The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical
challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal
reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary
cleft palate, the problems of scar and secondary deformities have been addressed.
Objectives: To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present
the preliminary outcomes of this technique and its advantages.
Material and Method: An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities;
2) interdisciplinary management and use of Tawanchai Center’s protocol for cleft lip and palate care; 3) pre-surgical
orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to
repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional
muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and,
5) final skin closure.
Results : Between 2002 and 2010, this technique was performed and evaluated on 42 patients who received primary bilateral
cleft lip-nose repair, including 31complete, 6 incomplete and 5 right complete and left incomplete, 27 males and 15 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 (0.69) and Cupid’ bow symmetry (0.76) while the mean of the
less satisfactory rating scale was found in scar (1.13) and nasal asymmetry (0.96). These preliminary outcomes showed
satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated.
Discussion and
Conclusion : The authors introduced the Tawanchai Center’s integrated concepts and functional reconstruc-
tion technique for bilateral cleft lip-nose repair. The technique offers the advantages of an integrated assessment for all of the
deformities of the primary cleft palate, the design of an integrated technique together with proper peri-operative care, pre-
surgical orthodontic treatment, and a well-coordinated, holistic, interdisciplinary management. A satisfactory preliminary
outcome was demonstrated but more improvement of the outcome can be achieved by: 1) continuing assessment of this group
of patients until they reach maturity; 2) refining techniques; 3) improving interdisciplinary care; and, 4) setting benchmarks
for the outcome.
Keywords : Integrated, Functional reconstruction, Protocol, Primary bilateral cleft lip-nose repair, Tawanchai Center
