The authors have volunteered their services as plastic surgeons in several countries, such as Nepal and Cambodia. In these programs, the authors saw many adults with cleft lips or palates who could not have primary repair at the proper time. The purpose of this report is to discuss the primary repair of untreated cleft lips or palates in adult patients.
Subjects were older than 17 years. In Nepal, primary repairs were performed in 129 adults with untreated clefts over the past 11 years. Unilateral cleft lips were repaired by rotation advancement with the small triangular flap method or the straight method with a small triangular flap. Bilateral clefts were repaired using a one-stage repair method. Cleft palates were repaired by a mucoperiosteal push-back or Furlow technique.
Differences between primary cleft repair for infants and for adults were as follows: (1) in adults, aggressive correction was possible, as maxillary growth was not a consideration; (2) correction of the anterior part of the nasal deformity was more difficult than in infants, as adults showed less elasticity and a more severe deformity of the nasal cartilages; (3) simultaneous palatoplasty should be chosen judiciously, as it is more invasive and results in higher morbidity; and (4) cheiloplasty under local anesthesia can reduce cost, time, and manpower.
These observations should be useful for the local and foreign surgeons who treat clefts in developing regions.
Yokohama, Tokyo, Chiba, and Kumamoto, Japan
From the Departments of Plastic and Reconstructive Surgery of Showa University Fujigaoka Hospital, Showa University, and Chiba University, and the Department of Plastic Surgery, Kumamoto Rehabilitation Hospital.
Received for publication April 10, 2006; accepted July 26, 2006.
Presented at the 15th China-Japan Joint Meeting for Plastic Surgery, in Tokyo, Japan, October of 2005.
Daichi Morioka, M.D., Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan, firstname.lastname@example.org