Search

Whatever method of closure, a cleft lip scar extends along the full labial height. A smaller scar is possible in repair of limited forms of incomplete cleft lip. This retrospective study was undertaken to define the subgroups of lesser-form cleft lip, describe technical alternatives, and review results of repair.The senior author's (J.B.M.) registry was searched for patients with lesser-form cleft lip, defined by the extent of vermilion-cutaneous dysjunction as either minor-form, microform, or mini-microform. Techniques for repair of these three anatomical variants were examined and the revisions were analyzed.Of 393 patients with unilateral incomplete cleft lip, 59 lesser-form variants were identified. Minor-form clefts (n = 20), defined as a defect extending 3 mm or more above the normal Cupid's bow peak, were repaired by rotation-advancement. Microform clefts (n = 28), defined as a vermilion-cutaneous notch less than 3 mm above the normal peak, were corrected by double unilimb Z-plasty. Mini-microform clefts (n = 11), defined as a disrupted vermilion-cutaneous junction without elevation of the bow peak, were repaired by vertical lenticular excision. Primary nasal correction was necessary in all minor-form and microform types and in some mini-microform types. In all three lesser-forms, the rate of nasolabial revision was relatively low in comparison with that for unilateral complete cleft lip.The extent of disruption at the vermilion-cutaneous junction defines minor-form, microform, and mini-microform cleft lip. These anatomical designations determine the method of nasolabial repair and correlate with types and frequency of revision.

Complete or incomplete cleft lip can be associated with a contralateral lesser form of incomplete cleft lip, constituting an asymmetrical bilateral malformation.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.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.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.