The Role of Lip Adhesion in the Treatment of Cleft Lips

Background:Wide complete cleft lips, if repaired under tension result in a tight lip with inadequate lip elements, often with a thin vermilion and a whistle deformity. This is made worse by the inextensible, excessive scar tissue that results. In case of bilateral complete clefts, the problems are even more severe as seen by the dystrophic and dyschromic scar tissue. This combined by large alar bases and an almost absent columella make the picture very unaesthetic Though lip adhesion has been proved to diminish the cleft width, some authors have questioned its benefits as exaggerated and others like, George Scrimshaw, has called it "a passing fad". This study was done to show the effectiveness of lip adhesion and to reassert its importance in the treatment of wide clefts.
Methods:Twenty-two patients were treated with lip adhesion (LA) between May 2000 and May 2003 in the Department of Plastic Surgery Cisanello Hospital, Pisa, Italy. The indication for LA was presence of a wide alveolar cleft (gap>7mm) with severely malpositioned maxillary segments. LA was performed at an average age of 6 weeks and final cheiloplasty at average age of 9 weeks. Photographs and impressions were taken prior to the operations.
Results: LA achieved a reduction in the cleft width of 64.1% for unilateral complete clefts after 42.8 days and for bilateral clefts percentage reduction was 64.1: 70%.
Conclusion: LA converts a complete wide cleft lip to an incomplete cleft in both unilateral and bilateral clefts. Although this adds an operative procedure to the usual lip repair, it makes the definitive closure simpler and easier with less need for secondary operations.