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Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation

Modifications and Analysis of Early Results in 100 Consecutive Cases

Tse, Raymond M.D.; Lien, Samuel M.D.

Plastic and Reconstructive Surgery: July 2015 - Volume 136 - Issue 1 - p 119–130
doi: 10.1097/PRS.0000000000001369
Pediatric/Craniofacial: Original Articles

Background: The anatomical subunit approximation for unilateral cleft lip repair has gained acceptance; however, outcomes have not been reported since the original description. The purpose of this article is to report the experience using this technique.

Methods: One hundred two consecutive patients underwent primary cleft lip repair performed by a single surgeon over a 3-year period. Objective analysis involved anthropometric measurements performed on preoperative and postoperative three-dimensional images. Subjective analysis involved Asher-McDade scores by blinded independent surgeons. Observational insights were gained by review of surgical records. Anthropometric measurements were expressed as ratios of the cleft side to the noncleft side. Differences in ratios were assessed by using the rank sum test. Differences in Asher-McDade scores were assessed using the Mann-Whitney test.

Results: Demographic, cleft type, cleft extent, and cleft severity were consistent with our center’s norms. The mean age at surgery was 6 months and the mean inferior triangle used was 1.8 ± 0.9 mm. Anthropometric ratios were significantly improved postoperatively and approached 1, regardless of initial cleft severity. Ten subjects who underwent repair early in the experience were compared with 10 subjects who underwent repair late in the experience. There was no significant difference in postoperative anthropometric measures or Asher-McDade scores.

Conclusions: The anatomical subunit approximation for unilateral cleft lip repair in a single-surgeon series can achieve improvements in anthropometric measures and early favorable postoperative form. The technique could be applied to all cleft types and there was little change in outcome with greater surgeon experience. Long-term follow-up is necessary.


Seattle, Wash.

From Seattle Children’s Hospital, University of Washington.

Received for publication October 21, 2014; accepted January 27, 2015.

Presented at the 71st Annual Meeting of the American Cleft Palate-Craniofacial Association, in Indianapolis, Indiana, March 24 through 29, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No external funding was received.

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Raymond Tse, M.D., Seattle Children’s Hospital, 4800 Sand Point Way NE, M/S OB.9.527, Seattle, Wash. 98105,

©2015American Society of Plastic Surgeons