Our Summary

This research paper is about a study conducted to figure out the potential benefits of two different types of surgery to repair an asymmetric bilateral cleft lip (a birth defect where the upper lip has a gap on both sides, but the gaps are not the same size). The two surgical options are a one-stage repair (where the surgery is done all at once) and a two-stage repair (where the surgery is split into two separate procedures).

The study took place from 2004 to 2016 and involved 133 patients who had this condition. The researchers had two experienced surgeons evaluate the results of these surgeries six months after they were performed.

They found that for 68 patients who had a complete cleft on one side and an incomplete cleft on the other, the one-stage repair generally yielded better results. For the 50 patients who had an incomplete cleft on one side and a very minor cleft on the other, there was no significant difference in outcomes between the one-stage and two-stage surgeries.

For the 15 patients who had a complete cleft on one side and a very minor cleft on the other, most had the two-stage repair. The researchers found this to be a better option when the two sides of the lip are very different, as it can reduce unnecessary scarring and help to prolong the piece of skin that separates the nostrils.

The study concludes that the one-stage repair is recommended for patients with a complete and an incomplete cleft, or an incomplete cleft and a very minor one. The two-stage repair is suggested for those with a complete cleft and a very minor one. However, the researchers believe more studies are needed to further validate these recommendations.

FAQs

  1. What is the main difference between 1-stage and 2-stage repair for asymmetric bilateral cleft lip (BCL)?
  2. How were the outcomes of the surgeries evaluated in the study?
  3. Based on the study, which type of cleft lip repair is recommended for patients with complete-microform CL?

Doctor’s Tip

A doctor may advise a patient undergoing cleft lip repair to follow post-operative care instructions carefully, including keeping the surgical area clean and avoiding activities that may put pressure on the incision site. It is also important to attend follow-up appointments to monitor the healing process and address any concerns or complications promptly. Additionally, maintaining a healthy lifestyle, including a balanced diet and avoiding smoking, can aid in the healing process and overall outcomes of the surgery.

Suitable For

Patients with asymmetric bilateral cleft lip (BCL) are typically recommended for cleft lip repair, with the choice between 1-stage and 2-stage repair depending on the specific characteristics of the deformity. One-stage repair is recommended for patients with complete-incomplete cleft lip (CL) and incomplete-microform CL, as it can help achieve anatomical reduction of the orbicularis oris and a better contour of the vermilion tubercle. On the other hand, two-stage repair is preferred for patients with complete-microform CL, especially when the deformity degree is very different on the two sides, as it can reduce unnecessary scar tissue and extend the nasal columella. More studies are needed to further support these recommendations.

Timeline

  • Before cleft lip repair:
  1. Patient is born with a cleft lip, which may be complete-incomplete, incomplete-microform, or complete-microform.
  2. Patient undergoes evaluation by a team of medical professionals to determine the best course of treatment.
  3. Decision is made whether to undergo 1-stage or 2-stage repair based on the severity and type of cleft lip deformity.
  4. Pre-operative preparation and counseling takes place to ensure patient and family are informed and prepared for the surgery.
  • After cleft lip repair:
  1. Surgery is performed, either in one stage or two stages, to correct the cleft lip deformity.
  2. Patient undergoes post-operative care and monitoring to ensure proper healing.
  3. Over the course of 6 months, the surgery outcomes are evaluated and graded by experienced surgeons using established scoring methods.
  4. Patients with complete-incomplete cleft lip or incomplete-microform cleft lip tend to have better outcomes with 1-stage repair.
  5. Patients with complete-microform cleft lip may benefit more from 2-stage repair to address the asymmetry and achieve better results.
  6. Ultimately, the goal of cleft lip repair is to achieve anatomical reduction of the lip and improve the overall facial appearance of the patient.

What to Ask Your Doctor

  1. What are the advantages of 1-stage repair versus 2-stage repair for asymmetric bilateral cleft lip?
  2. What are the indications for choosing 1-stage repair over 2-stage repair, and vice versa?
  3. How will the outcome of the surgery be evaluated and graded?
  4. What factors should be considered when deciding between 1-stage and 2-stage repair for cleft lip?
  5. What are the potential risks and complications associated with each type of repair?
  6. How long is the recovery process for each type of repair?
  7. Are there any long-term effects or considerations to keep in mind after undergoing cleft lip repair surgery?
  8. What are the success rates of 1-stage versus 2-stage repair for asymmetric bilateral cleft lip in your practice?
  9. Are there any specific post-operative care instructions or follow-up appointments that I should be aware of?
  10. Are there any additional studies or resources that I can review to learn more about the differences between 1-stage and 2-stage repair for cleft lip?

Reference

Authors: Zhao X, Wu Y, Wang G, Yang Y, Cai M. Journal: Cleft Palate Craniofac J. 2022 Apr;59(4):436-441. doi: 10.1177/10556656211013978. Epub 2021 May 21. PMID: 34018417