Treatment of Bilateral Cleft Lip and Palate: Protocol for Surgical Treatment

Abstract

Bilateral cleft lip and palate (BCLP), although representing around 20% of cleft cases (Trindade and Silva Filho 2007), is one of the greatest challenges faced by craniofacial surgeons, well summarized by Dr. James Barrett Brown as “Bilateral cleft lip is twice as difficult to repair as unilateral, and the results are only half as good” (Brown et al. 1947). Bilateral clefts tend to represent the more severe cases of cleft lip and palate, for which reason an in-depth analysis is warranted, with special attention paid to treatment choice (Brown et al. 1947; Semb 1991). The major surgical challenges of treating BLCP stay from the technical difficulty of achieving symmetry of the lips, muscular continuity, lengthening of the columella, nasal projection, and proper positioning of the premaxilla. Of these challenges, nasal asymmetry, malpositioned or projected premaxilla, and prolabium underdevelopment, which are associated with a lack of muscular continuity, are some of the most difficult to overcome (Mulliken 1985; Millard 1977; Spina et al. 1978).