Repair of Asymmetric Bilateral Cleft lip: 1 Stage or 2 Stage

Abstract

Objective: To verify the advantages and indications of 1-stage and 2-stage repair for asymmetric bilateral cleft lip (BCL). Design: Retrospective study. Setting: From January 2004 to December 2016 in our department. Patients: Patients with BCL. Main Outcome Measure(s): Over 6 months after the operation, the surgery outcomes were evaluated and graded by 2 experienced surgeons. Results: The result of surgery was evaluated using the scoring method of Mortier et al and Anastassov and Chipkov. Among 133 patients with asymmetric BCL, 61 (45.9%) had 1-stage repair and 72 (54.1%) had 2-stage repair. Sixty-eight (51.1%) patients had complete-incomplete cleft lip (CL), and those who underwent 1-stage repair showed a trend of better outcome ( P = .028). Fifty (37.6%) patients with incomplete-microform CL showed no significant difference between the outcomes of 2 surgery plans ( P = .253). In 15 (11.3%) patients with complete-microform CL, only one had 1-stage repair with a score of 8.5. The other 14 patients with 2-stage repair were scored 3.68 ± 1.28. Two-stage repair was preferable when the deformity degree was very different on 2 sides, as it could reduce unnecessary scar tissue and extend the nasal columella. One-stage repair could help to achieve the anatomical reduction of the orbicularis oris and a better contour of the vermilion tubercle. Conclusion: One-stage repair is recommended for patients with complete-incomplete CL and incomplete-microform CL. Two-stage repair for patients with complete-microform CL is preferred in our center, but more studies are required to support this conclusion.