Correction of Complete Bilateral Cleft Lip with Noordhoff Method: Problems and Solutions

ABSTRACT

Bilateral cleft lip shows various clinical characteristics and the typical bilateral complete cleft lip usually features prominent premaxilla, short columella, non-protruded nasal tip, flared alar base and asymmetrical alar cartilage. The prolabium is usually short and demonstrate total absence of oricularis oris muscle. Therefore a satisfactory reconstruction of the lip in both the functional and cosmetic aspect is very difficult, especially in philtral column, columella, and nasal portion. Various techniques of cleft lip repair are being developed. The staged repair of bilateral cleft lip, one side and then the other, has been superseded by simultaneous/symmetrical repair of both sides that also included complete muscular closure. And by Mulliken1 and Cutting2,3, simultaneous/symmetrical repair also has been changed to one stage repair of bilateral complete cleft lip together with nasal deformity correction. The authors performed one stage closure by means of Noordhoff method without presurgical orthopedics, which provided simultaneous/symmetrical repair including complete muscular closure and at the same time reproduced the tubercle and Cupid's bow by using both lateral lip segment. There were some problems after surgical repair. First, short or absent columella were inevitably present which could be corrected by columellar lengthening. Secondly in complete cleft lip without cleft palate, there is persistent protruding of the premaxilla and finally resultant scar widening of the cupid's bow and philtral column, which could be corrected by orthognathic surgery. But these procedures are only secondary solutions for correction of already-made deformity. We demonstrated problems and their solutions in the performance of the Noordhoff method and introduced Cutting's presurgical nasoalveolar molding as a fundamental solution2,3.