Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation: Modifications and Analysis of Early Results in 100 Consecutive Cases.

BACKGROUND

The anatomical subunit approximation for unilateral cleft lip repair has gained acceptance; however, outcomes have not been reported since the original description. The purpose of this article is to report the experience using this technique.

METHODS

One hundred two consecutive patients underwent primary cleft lip repair performed by a single surgeon over a 3-year period. Objective analysis involved anthropometric measurements performed on preoperative and postoperative three-dimensional images. Subjective analysis involved Asher-McDade scores by blinded independent surgeons. Observational insights were gained by review of surgical records. Anthropometric measurements were expressed as ratios of the cleft side to the noncleft side. Differences in ratios were assessed by using the rank sum test. Differences in Asher-McDade scores were assessed using the Mann-Whitney test.

RESULTS

Demographic, cleft type, cleft extent, and cleft severity were consistent with our center's norms. The mean age at surgery was 6 months and the mean inferior triangle used was 1.8 ± 0.9 mm. Anthropometric ratios were significantly improved postoperatively and approached 1, regardless of initial cleft severity. Ten subjects who underwent repair early in the experience were compared with 10 subjects who underwent repair late in the experience. There was no significant difference in postoperative anthropometric measures or Asher-McDade scores.

CONCLUSIONS

The anatomical subunit approximation for unilateral cleft lip repair in a single-surgeon series can achieve improvements in anthropometric measures and early favorable postoperative form. The technique could be applied to all cleft types and there was little change in outcome with greater surgeon experience. Long-term follow-up is necessary.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.