Mulliken John B, Wu June K, Padwa Bonnie L
Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Craniofac Surg. 2003 Sep;14(5):609-20. doi: 10.1097/00001665-200309000-00003.
Rarely does the appearance of a child with a repaired bilateral cleft lip compare favorably with that of a child with a repaired unilateral cleft lip. However, there has been a major change in operative strategy during the past decade, and as a result, the typical bilateral cleft nasolabial stigmata are no longer so obvious. The senior author restates the principles for correction of bilateral cleft lip and nasal deformity, and underscores the essential role of preoperative premaxillary positioning. He reviews his method of single-stage closure of the cleft primary palate, including three-dimensional adjustments based on predicted four-dimensional changes. Operative modifications are described for variations of bilateral cleft lip. The authors emphasize the surgeon's obligation for periodic assessment. In a consecutive series of 50 patients with repaired bilateral complete cleft lip/palate, the revision-rate was 33% as compared with 12.5% if the secondary palate is intact. No revisions were necessary for philtral size or columellar length. The authors propose that nasolabial appearance and speech are the priorities in habilitation of the child with bilateral cleft lip/palate rather than the traditional emphasis on maxillary growth.
双侧唇裂修复后的患儿外观很少能与单侧唇裂修复后的患儿相媲美。然而，在过去十年中手术策略发生了重大变化，因此，典型的双侧唇裂鼻唇畸形不再那么明显。资深作者重申了双侧唇裂和鼻畸形矫正的原则，并强调了术前前颌骨定位的重要作用。他回顾了自己的原发性腭裂一期关闭方法，包括基于预测的四维变化进行的三维调整。描述了针对双侧唇裂变异的手术改良。作者强调了外科医生进行定期评估的义务。在连续的50例双侧完全性唇腭裂修复患者中，修复率为33%，而继发腭完整的患者修复率为12.5%。唇弓大小或鼻小柱长度无需修复。作者提出，在双侧唇腭裂患儿的康复中，鼻唇外观和语音是优先考虑的因素，而不是传统上对上颌生长的强调。
