Asymmetrical Bilateral Cleft Lip: Complete or Incomplete and Contralateral Lesser Defect (Minor-Form, Microform, or Mini-Microform)

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Background:Complete or incomplete cleft lip can be associated with a contralateral lesser form of incomplete cleft lip, constituting an asymmetrical bilateral malformation.Methods:The cleft lip registry was searched for patients with complete or incomplete cleft lip and contralateral minor-form, microform, or mini-microform defects. Methods of repair were documented and results were assessed by reviewing photographs and recording revisions.Results:Of 309 patients with bilateral cleft lip, 72 patients (23 percent) had asymmetrical cleft lip, with 40 patients having contralateral minor-form, microform, or mini-microform defects. All infants with complete cleft lip and palate on the greater side underwent preoperative dentofacial orthopedic alignment, nasolabial adhesion, and gingivoperiosteoplasty. Infants with a contralateral minor-form defect (n = 7) had second-stage, synchronous bilateral nasolabial repair. Contralateral microform defects (n = 6) were not addressed during rotation-advancement repair on the complete/incomplete side; the later repair was a double unilimb Z-plasty. Contralateral mini-microform defects (n = 27) were corrected by vertical lenticular excision and, if necessary, alar base Y-V advancement, either synchronously with closure on the greater side or at another stage. The revision rate correlated with the degree of preoperative asymmetry. The most common revisions were augmentation of the median tubercle and free margin on the lesser side and repositioning of the lower lateral cartilage and alar base on the greater side.Conclusions:The operative strategy for repair of an asymmetrical bilateral cleft lip is determined by the extent of the vermilion-cutaneous dysjunction on the lesser side. Synchronous bilateral nasolabial repair is indicated for a contralateral minor-form defect. Correction of a contralateral microform or mini-microform defect is usually deferred to achieve symmetry.

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