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PubMed2026

Effectiveness of Platelet Rich Plasma in Reducing Oronasal Fistula and Scar Width in Primary Cleft Lip and Palate Repair-A Systematic Review and Meta-Analysis.

This review aimed to investigate platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) efficiency in reducing oronasal fistula during primary cleft lip and palate repair. An extensive search of PubMed, Google Scholar, Global Index Medics (WHO), PubMed Scopus, Cochrane Central, Proquest was performed up to march 2025. Eligible studies included prospective RCTs and non-randomized controlled trials in human subjects. Patients aged 6-24 months undergoing primary cleft lip and palate repair were involved. Interventions involved intraoperative use of PRP/PRF compared with controls without PRP/PRF. The primary outcome was occurrence of oronasal fistula; secondary outcomes were scar width, wound infection and postoperative bleeding with wound dehiscence. Study selection followed PRISMA guidelines, and the risk of bias was determined with the ROB-2 and ROBINS-I method of assessment. Seven studies met the required criterion and were qualitatively synthesized. Evidence suggested that PRP/PRF application was associated with a lower incidence of oronasal fistula and reduced scar width compared with controls. Additional benefits included accelerated wound healing and faster recovery. The use of autologous PRP was also reported to decrease the need for further surgical interventions. However, the certainty of evidence was limited due to small sample sizes and methodological heterogeneity. PRP and PRF show promising benefits in cleft lip and palate repair, particularly decreased fistula formation and reduced scar width. Nevertheless, current evidence is of low to very low certainty. Larger, well-designed randomized trials are required to validate the results obtained. Trial Registration: PROSPERO registration no. CRD420251032421.

Humans↗
PubMedDate not supplied

Risk factors in multiple carcinomas of the lip.

Certain risk factors appear to separate subjects with repeated primary carcinomas of the lip from the general population of patients with carcinoma of the lip. Factors that were found statistically significant in increasing the chance of recurrent carcinoma of the lip include outdoor occupations requiring prolonged exposure to sunlight or the use of tobacco on a regular basis. Significant risk factors of a clinical nature include a positive serologic reaction for syphilis; the presence of leukoplakia, hyperkeratosis, or actinic cheilitis; or the presence of a basal cell or squamous cell carcinoma of the facial skin.

Adult↗
PubMed1995

Outcome analysis of Mohs surgery of the lip and chin: comparing secondary intention healing and surgery.

Wounds of the lip and chin resulting from microscopically controlled (Mohs) surgery are often repaired immediately. However, wounds allowed to heal by secondary intention have the advantage of optimal cancer surveillance, simplified wound care, and avoidance of the costs and potential complications associated with reconstructive procedures. Accurate prediction of the course of wound healing would allow a rational approach to selection of surgery or healing by secondary intention. The authors evaluated 105 patients with defects of the lip and chin after Mohs excision for cancer who healed by secondary intention. Forty-six patients treated surgically were followed for comparison. The lip and chin were divided into subunits and the wound location, size, and depth were recorded. Patients were followed at intervals and a final determination regarding cosmesis was made after 6 or more months. It is concluded that the final cosmetic result can be confidently predicted on the basis of location by subunit, size, and depth of the wound.

Adult↗
PubMed2006

Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft).

OBJECTIVE: Evaluation of the effect of infant orthopedics on maxillary arch dimensions in the deciduous dentition in patients with unilateral cleft lip and palate. DESIGN: Prospective two-arm randomized controlled clinical trial with three participating cleft palate centers. SETTING: Cleft palate centers of the Radboud University Nijmegen Medical Center, Academic Center of Dentistry Amsterdam, and University Medical Center Rotterdam, the Netherlands. PATIENTS: Children with complete unilateral cleft lip and palate (n = 54) were included. INTERVENTIONS: Patients were randomly divided into two groups. Half of the patients (IO+) had a presurgical orthopedic plate until surgical closure of the soft palate at the age of 52 weeks; the other half (IO-) did not undergo presurgical orthopedics. MEAN OUTCOME MEASURES: Maxillary arch dimensions were assessed on dental casts at 4 and 6 years of age with measurements for arch width, arch depth, arch length, arch form, and the vertical position of the lesser segment. Contact and collapse were assessed also. RESULTS: There were no clinically significant differences found between IO+ and IO- for any of the variables. CONCLUSIONS: Infant orthopedics had no observable effect on the maxillary arch dimensions or on the contact and collapse scores in the deciduous dentition at the ages of 4 and 6 years. Considering the Dutchcleft results to date, there is no need to perform infant orthopedics for unilateral cleft lip and palate patients.

Alveolar Process↗
PubMed1994

Facial growth in patients with bilateral cleft lip and palate: a cephalometric study.

In this study, sagittal facial growth of bilateral cleft lip and palate (BCLP) patients between 6 and 20 years of age is analyzed. The data of Nijmegen were derived from 131 lateral cephalograms taken in 21 BCLP patients who were treated in the Cleft Lip and Palate Center of the University Hospital of Nijmegen. Reported data of 90 BCLP patients treated at the Center of Oslo were used as a reference for comparison. Results of this investigation showed mandibular growth to be similar in both centers. In the premaxillary region some differences were found: The Nijmegen patients presented a more protrusive premaxilla than those at Oslo. The upper front teeth and hence, the premaxilla, were more retroclined in the Nijmegen sample. There were also statistically significant differences in the soft tissue profile. The mean z-score was positive for the nasolabial angle and negative for the angle N'-Sn-Pg'. At 18 years of age, these differences are still apparent. In comparison with Broadbent's values of normal individuals, the SNPg-angle was smaller and the mandibular angle greater in Nijmegen and Oslo. The profiles of the BCLP patients are more convex in Nijmegen and more concave in Oslo than in the noncleft group. Finally, the different treatment strategies of the Cleft Lip and Palate Centers of Nijmegen and Oslo are compared and discussed in terms of their long-term results.

Adolescent↗
PubMed1995

Intrauterine repair of surgically created defects in mice (lip incision model) with a microclip: preamble to endoscopic intrauterine surgery.

We compared the difference between a nonpenetrating silver microclip and suture on wound healing, inflammatory response, and application time in the repair of surgically created standardized unilateral cleft lip type defects in fetal mice. Excellent lip continuity and dermal reconstitution were achieved by both methods of repair. Furthermore, collagen accumulation did not occur. Occasional mononuclear cells were seen around sutured repairs in contrast to microclipped repairs. The most significant difference, however, was in application time with the microclip requiring an average of 7 seconds (+/- 2) compared to 90 seconds (+/- 15) for suture. We conclude that the microclip offers distinct advantages for intrauterine cleft lip repair: (1) nonpenetrating tissue approximation; (2) less inflammatory response than suture; (3) technically more rapid and less difficult to apply than suture; and (4) can be utilized more readily than suture for endoscopic approaches limiting the risks of fetal surgery for both the mother and the fetus.

Animals↗
PubMed1997

Rhinoplasty in the cleft lip patient.

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.

Adolescent↗
PubMed1998

Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. DESIGN: The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). SETTING: The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. PATIENTS: The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. INTERVENTIONS: Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. RESULTS: The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. CONCLUSION: Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.

Adult↗
PubMed2000

The diamond vermilion flap--a new technique for vermilion augmentation in cleft lip repair.

OBJECTIVE: In most cleft lips patients, the vermilion on the medial aspect of the repair is deficient in height. Not many surgeons have dealt with ways to augment the height of the vermilion at this location. In the unilateral cleft lip, the repair may include the insertion of a small triangular vermilion flap from the cleft side into an incision made for it in the muco-vermilion junction of the noncleft side. We have developed a new technique to further augment the vermilion in incomplete cleft lip patients. METHOD: Vermilion remnants may be present in these patients on the scar tissue between the margins of the cleft. A diamond-shaped vermilion flap based on its attachments to the orbicularis oris muscle may be transposed into the noncleft side to an incision made caudal and parallel to the muco-vermilion border. Then the triangular vermilion flap may be inserted just distal to the island flap. Using this method, the vermilion is augmented and the muco-vermilion line parallels more the white skin roll.

Cleft Lip↗
PubMed2000

Repair of bilateral complete cleft lip and nasal deformity--state of the art.

OBJECTIVE: Dissatisfaction with the stigmata of repaired bilateral cleft lip has stimulated surgeons to change conventional operative strategies. The old staged labial repairs, one side and later the other, have been replaced by simultaneous closure. For nasal correction, most surgeons no longer believe that the columella is deficient, and thus there is no need to recruit tissue from the lip or nostril sills as a secondary procedure. The columella is concealed in the nose. The new strategy is to construct the columella and nasal tip by anatomic positioning of the alar cartilages and sculpting the investing skin. Furthermore, nasal correction is done at the time of bilateral labial repair and, whenever possible, the alveolar clefts are closed as well. The goal is primary repair of the primary palate. CONCLUSION: Although the principles of synchronous repair of the bilateral complete cleft lip and nasal deformity are established, the techniques continue to evolve. Bilateral nasolabial repair requires continual study of three-dimensional form and fourth-dimensional changes that are normal and altered by the deformity. Every surgeon who lifts a knife to care for these children has an obligation to periodically assess outcome.

Alveolar Process↗
PubMed2001

Imaging of cartilage and mimic muscles with MRI: anatomic study in healthy volunteers and patients with unilateral cleft lip and palate.

OBJECTIVE: The aim of the study was to visualize different soft tissues in the perioral, nasal, and paranasal region by means of magnetic resonance imaging (MRI) in patients with unilateral cleft lip and palate (UCLP). DESIGN: In this descriptive study, images of different MRI systems were assessed and compared. METHOD: MRI was applied in five consecutive patients operated on for UCLP who underwent secondary lip and nasal correction, two patients who had not had UCLP operations, and five healthy volunteers as controls. The mimic muscles, vessels, and nasal cartilages were evaluated. RESULTS: It was possible to visualize different parts of the paranasal and perioral mimic muscles and their interlacement in the upper lip. The nasal cartilages were also visible, and the changes after operation were demonstrated. CONCLUSIONS: MRI shows differentiated visualization of soft tissues in the cleft region and their changes after surgery. It is a valuable tool in the preoperative planning and postoperative follow-up in patients with UCLP.

Adolescent↗
PubMed2003

A survey of cleft lip and palate management taught in training programs in Korea.

OBJECTIVE: A national survey was conducted to obtain an overall view of the status, assess changes in trends of cleft management, and study new categories of interest. METHOD: Questionnaires were sent to 90 chief residents of all Korean institutes with plastic surgery training programs. RESULTS: Forty-eight respondents returned completed questionnaires. The results were: (1) the most common unilateral cleft lip repair method used is the rotation-advancement technique (100%); (2) 73% of respondents correct cleft lip nasal deformity at preschool age; (3) the Millard technique is the most common management in bilateral cleft lip repair (65%); (4) in the management of protruding premaxilla, 44% of the respondents choose presurgical orthopedics; (5) the usual cleft palate repairs are the pushback (64%) and double-opposing Z-plasty (43%) in complete cleft palates and the double-opposing Z-plasty (75%) and pushback (36%) comprised the common techniques in incomplete cases; (6) 86% of responding programs perform alveolar cleft repairs during the period of mixed dentition; the most common treatment of velopharyngeal incompetence is pharyngeal flap (71%); and (8) the interdisciplinary team approach is practiced by 64% of respondents. CONCLUSIONS: Many changes were noted since a previous 1995 survey. We hope that this study provides the necessary information needed for the eventual establishment of standard cleft management in Korea.

Age Factors↗
PubMed1985

Midline sinuses of the upper lip. Case report.

Nine midline sinuses of the upper lip in eight patients have been described previously. They have been located from the skin under the columella to the frenulum, and have always been directed towards the frenulum. Three new cases are presented: a sinus reaching from the skin of the philtrum to the frenulum in a child with Pierre Robin syndrome, another one in the frenulum of a patient with two separate midline sinuses of the nose, and a third in the frenulum of a child with a partial median cleft lip. The midline sinus is probably caused by disturbed development of the nasofrontal process. The combination of upper lip sinus and Pierre Robin's syndrome is hardly coincidental and supports the concept that the latter is not caused solely by a foetal malposition.

Adult↗
PubMed1987

The influence of lip function on the sagittal and transversal development of the maxilla in cleft patients.

Cleft patients who have undergone surgery often show considerable inhibition in the sagittal development of the mid-face after completed growth. This is partly attributed to scar contraction in the lip region following surgery. The present investigation deals with the etiological factors involved in the development disturbances caused by the cleft in the maxilla of 100 cleft patients. Particular attention was paid as to the unfavourable effect of the operated cleft lip. This was tested electromyographically and correlation between the electromyographic and the skeletal measurements was sought. Electromyographic changes in lip activity during orthodontic treatment was also investigated. The effect of these changes is discussed.

Adolescent↗
PubMed1998

[Surgical treatment methods for the short saddle nose and high skin portion of the upper lip].

Remote results of treatment are analyzed in 10 patients with deformations of the nose combining a shortened nose and pulled in skin of the septum. The patients were operated on according to Burian. Good results were obtained in 4 cases, satisfactory in 5. A higher share of satisfactory results of Burian's operation is explained by the fact that it is very difficult to draw down the thick porous skin into a proper position, particularly at the tip of the nose. Additional operations are needed, deteriorating the cosmetic effect. The method proposed by the authors yields better results: 89% good and 16% satisfactory. The intervention is aimed directly at removal of the deformation and tissue defect. Mutual transposition of three flaps, one of which is a drawn columella and two other flaps from the upper lip fill the mucosal defect, repairs the pulled in skin part of the septum and elongates the tip of the nose. In addition, transposition of skin flaps from the upper third of the upper lip to the site of mucosal defect shortens the height of the upper lip, thus creating a correct proportion of the middle and lower thirds of the face.

Adult↗
PubMed1999

[3-D model analysis of the maxilla of infants with lip-jaw-palate clefts].

For the investigation of three-dimensional morphological changes in the maxilla of children with cleft lip and palate, the use of two-dimensional test analysis is inadequate. Since no standardised three-dimensional method has so far been available, a three-dimensional digital, computer-aided procedure was developed to visualize and metrically analyse the growth of the edentulous maxilla of infants with cleft lip and palate. Chronologically consecutive casts of the maxillas (obtained at the ages of one week, and three, six and twelve months) of five children with complete unilateral CLP were measured optically with the instrument Micromeasure 70. Following digitation, the casts were reconstructed in the computer, aligned and superimposed using the Orthosurf program. The distances between the surfaces were then measured; in addition, the surfaces were segmented perpendicular to the alveolar crest at reference points C1, C1', C2, C2' and I. The volumes of the resulting segments were determined and compare with one another. Specially designed software automated the following steps: 1. identification of reference points; 2. alignment of the cloud of points in a system of coordinates, and 3. identification of the alveolar crest. Our initial results show that (1) the new method enables visualization of the extent and direction of morphological changes of the mucosal surface, and (2) reproducible quantification of these changes via the determination of changes in the volume of defined alveolar segments. The three-dimensional analysis presented here permits a comprehensive three-dimensional measurement of the models of the edentulous maxilla of infants with cleft lip and palate.

Cephalometry↗
PubMed2001

[Changes of soft tissue profile in operated unilateral cleft lip and palate patients after maxillary protraction].

OBJECTIVE: The aim of this study is to investigate effects of maxillary protraction on soft tissue profile in operated operated unilateral cleft lip and palate (UCLP) patients. METHODS: A total of 10 growing UCLP patients (male 7, female 3), age from 8.2 to 12 years old (Average: 10.4 years old), were selected to be treated with maxillary protraction using head gear-chin cap-long hook protraction appliance. The appliance was worn 12-14 hours per day, and the protraction force was 400-500 g each side. The protraction direction was forward and slightly downward. The treatment period was 4.7 months (Average: 5.8 months). Cephalometrics were taken before and after treatment. The changes of soft-tissue profile were studied using the computer-aid X-ray cephalometric analysis. RESULTS: After protraction, the points of Prn, Sn and Ls moved forward significantly. The distance from points Ls to E plane changed significantly from 0.46 mm before treatment to 1.18 mm after treatment. The angle G-Prn-Pg' decreased significantly, and G-Sn-Pg' changed significantly from -0.30 before treatment to 6.260 after treatment. The anterior-posterior position of mandible and lower lip did not change significantly, the changes of angles Cm-Sn-Ls, A'ls/SiLi had no statistical significance. The results indicated that maxillary protraction could make maxilla and upper lip move forward, and the convexity of soft tissue profile improve significantly. CONCLUSION: Maxillary protraction is an effective way to improve the facial deformity of operated UCLP patients. UCLP patients should have early interrupted treatment.

Cephalometry↗
PubMedDate not supplied

Congenital double lip associated to hemangiomas: report of a case.

Double lip is a developmental abnormality which may occur either isolated or as a component of Aschers syndrome. A case of congenital double lip associated to hemangiomas and enlargement of the thyroid is reported. The oral and facial hemangiomas were excised under local anesthesia. Surgical reconstruction of the upper lip was done in order to reduce the interference with speech and mastication. The recognition and treatment of these abnormalities are discussed.

Aged↗