Primary bilateral cleft lip repair with management of premaxilla without preoperative orthopedics.

OBJECTIVE: In developing countries, children with cleft lip and palate present at various age for primary repair. Even if they come at an appropriate age, logistic and financial problems prevent us from providing preoperative orthopedic treatment for children with bilateral complete cleft lip and palate (BCLP). We present our protocol and technique of primary repair for BCLP without preoperative orthopedics at different ages.

SETTING AND DESIGN: We operated on 240 children with BCLP from 2001 to 2003. One hundred ten children younger than 1 year were operated on for primary surgeries, 99 children were between 2 and 10 years, and 40 were older than 10 years. Of the 110 patients who had primary repairs for BCLP without preoperative orthopedic before age of 1 year, seventy children were studied for dental occlusion and premaxillary position at age of 5 to 7 years. Children operated on after the age of 1 year had palate repair before lip repair. Children operated on after 10 years, the protocol was modified to tackle protruding premaxilla at the time of palate repair.

OUTCOME: Of 70 patients operated on before 1 year of age, 83% had an occlusion with anterior and deep bites of the premaxilla of variable degree at age of 5 to 7 years. Thirteen percent had buccal bite, and these patients had small premaxilla before lip repair.

CONCLUSIONS: Modification of protocol was necessary for children with BCLP who approached later than 1 year of age for primary treatment. Bilateral cleft lip repair without any preoperative orthopedic in young babies will mould the premaxilla. The size of premaxilla can predict the growth potential of maxilla.