British Journal of Plastic Surgery (I976), 29, 41-42

THE P R E S U R G I C A L M A N A G E M E N T OF A DISTINCTIVE F O R M OF BILATERAL CLEFT LIP A N D P A L A T E

By N. R. E. ROBERTSON,D.D.S., F.D.S.

Department of Orthodontics, The Welsh National School of Medicine, University of Wales, Dental School, Heath, Cardiff CF4 4 X Y IN the variations of bilateral clefts of the lip and palate, the cleft on one side may be incomplete to a greater or lesser extent in the alveolar area. Where the cleft in the alveolus is not extensive the total facial deformity and the arch deformity more closely resembles that found in unilateral complete clefts; presurgical orthodontic care is as for a unilateral cleft. Where the tissue bridge is narrow either across the lip or more rarely the alveolus, the facial and arch deformity is distinctive; there is a forward displacement of the premaxilla and the protruding element is deviated to the side with the tissue bridge. I believe that the following presurgical procedure is required in such cases: As soon as is practicable a simple feed plate is inserted. The bridge of connecting tissue is then removed by tying a silk ligature round it to cut off the blood supply;

FIG. I. A, T h e initial deformity before dividing the tissue band on the right. B, The premaxilla has moved to a more central position. Restraint has been applied for 2 weeks. C, After I2 weeks of pre-surgical therapy.

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B R I T I S H J O U R N A L OF P L A S T I C SURGERY

FIG. 2.

A, T h e u p p e r arch at birth.

B, T h e u p p e r arch at 3 months.

within 2- 3 days it will have atrophied completely. A few days later the premaxilla will have taken up a more central position and extra-oral strapping can be applied to restrain its forward growth in the same way as for a complete bilateral cleft. A typical case is illustrated in Figures I and 2.

The presurgical management of a distinctive form of bilateral cleft lip and palate.

British Journal of Plastic Surgery (I976), 29, 41-42 THE P R E S U R G I C A L M A N A G E M E N T OF A DISTINCTIVE F O R M OF BILATERAL CLEFT LIP A...
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