Cleft Lip/Nasal Deformities After Plastic Surgery for Unilateral Cleft Lip/Palate: A Prospective Study at a Large Hospital in Vietnam

Figures & data

Table 1 Evaluation of Lip/Nasal Deformity After Unilateral Cleft Lip Plastic Surgery

Anatomical Factors	Evaluation	Point
Red lip	Convex/Keloid	0.5
	V-notch	0.5
	Unilateral thickening of lip	1
	Unilateral thinning of lip	3
	Deviation of lip contour	0.5
Vestibular groove	Narrow	1
	Too wide	2
Labial skin (White lip)	Too short	1
	Too long	1
	M. orbicularis oris deficit	3
	Narrow Cupid’s bow and philtrum	4
	Wide Cupid’s bow and philtrum	2
Scar	Good	0
	Contracture	1
	Keloid	1
Nose	Short columella	0.5
	Septal deviation	2
	Wide nostril	0.5
	Narrow nostril	0.5
	Subnasale too wide	0.5
	Subnasale too narrow	0.5
	Slight curl of ala of nose	0.5
	Excessive curl of ala of nose	0.5
	Defect in superior nostril contour	0.5
	High subnasale	0.5
	Low subnasale	0.5
	Hypotrophic and flat ala of nose	3

Figure 1 Evaluation of red lip ((A) Convex/Keloid; (B) V-notch; (C) Unilateral thickening of lip; (D) Unilateral thinning of lip; (E) Deviation of lip contour) and vestibular groove ((F) Narrow; (G) Too wide).

Figure 2 Evaluation of labial skin (White lip) ((A) Too short; (B) Too long; (C) M. orbicularis oris deficit; (D) Narrow Cupid’s bow and philtrum; (E) Wide Cupid’s bow and philtrum) and scar ((F) Good; (G) Contracture; (H) Keloid).

Figure 3 Evaluation of nose. (A) Short columella; (B) Septal deviation; (C) Wide nostril; (D) Narrow nostril; (E) Subnasale too wide; (F) Subnasale too narrow; (G) Slight curl of ala of nose; (H) Excessive curl of ala of nose; (J) Defect in superior nostril contour; (K) High subnasale; (L) Low subnasale; (M) Hypotrophic and flat ala of nose.

Table 2 Classification of Surgery Results

Classification	Point
Excellent	0–1.5
Very good	2–3.5
Good	4–5.5
Acceptable	6–8
Difficult to accept	8.5–16

Table 3 Red Lip Deformities

Feature	Number of Patients (n = 46)	Percentage (%)
Keloid	0	0
V-notch	24	52.2
Unilateral thickening lip	2	4.3
Unilateral thinning lip	4	8.7
Deviation of lip contour	24	52.2

Figure 4 These images illustrate red lip deformities. (A) Convex and Deviation of lip contour, (B) Deviation of lip contour, (C) Unilateral thickening of lip.

Table 4 Lip Skin Deformities

Feature	Number of Patients (n=46)	Percentage (%)
Too short	16	34.8
Too long	0	0
M. orbicularis oris deficit	0	0
Narrow cupidon bow and philtrum	0	0
Wide cupidon bow and philtrum	0	0

Table 5 Features of Scars Postoperatively

Scar	Number of Patients (n = 46)	Percentage (%)
Good	22	47.8
Contracture	10	21.7
Keloid	14	30.5
Total	46	100

Figure 5 These images (A and B) illustrate too short lip skin deformities.

Figure 6 These images illustrate scar revisions. (A) Contracture, (B) Good, (C) Keloid.

Table 6 Nasal Deformities

Feature	Number of Patients (n = 46)	Percentage (%)
Short columella	6	13.0
Deviation of nasal septum	36	78.3
Narrow nostril	24	52.2
Wide nostril	0	0
Wide subnasale	0	0
Narrow subnasale	0	0
Slight curl of ala of nose	16	26.1
Excessive curl of ala of nose	0	0
Defect of superior nostril contour	36	78.3
High ala of nose	4	8.7
Low ala of nose	22	47.8
Hyotrophic and flat ala of nose	2	4.3

Table 7 Results of the First Surgery and Methods

Results Method	Excellent	Very Good	Good	Acceptable	Hard to Accept	Total	Percentage (%)
Veau	0	4	0	0	0	4	8.7
Tennison	0	0	16	0	0	16	34.8
Millard	0	8	16	2	0	26	56.5
Total	0	12	32	2	0	46	100
p-value	p = 0.0452

Figure 7 These images illustrate nose deformities. (A) Defect of superior nostril contour; (B) Hypotrophic and flat ala of nose; (C) Narrow nostril, short columella; (D) Deviation of nasal septum, slight curl of ala of nose, narrow nostril.

Table 8 Comparison of Labial Skin Deformity Results with Other Authors’ Results

Authors Evaluation	Rajanikanth B.R et al^Citation6 (2012)	Cheema S.A và Asim M^Citation7 (2014)	Our Results (2018)
Too short	10 (25%)	119 (63%)	32 (34,8%)
Too long	2 (5%)	5 (3%)	0
M. orbiscularis oris deficit	0	0	0
Narrow cupidon bow and philtrim	0	5 (3%)	0
Wide cupidon bow and philtrim	0	0	0
Total patients	40	189	46

Table 9 Scar Comparison with Other Authors’ Results

Authors Evaluation	Rajanikanth B.R et al^6 (2012)	Cheema S.A, Asim M^7 (2014)	Our Results (2018)
Normal	28 (70%)	39 (21%)	22 (47.8%)
Contracture	6 (15%)	150 (79%)	10 (21.7%)
Keloid	6 (15%)		14(30.4%)
Total patients	40	189	46

Rajanikanth BR, Rao KS, Sharma SM, Rajendra Prasad B. Assessment of deformities of the lip and nose in cleft lip alveolus and palate patients by a rating scale. J Maxillofac Oral Surg. 2012;11(1):38–46. doi:10.1007/s12663-011-0298-6

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Cheema SA, Asim M. An analysis of deformities in revision surgeries for secondary unilateral cleft lip. J Coll Physicians Surg Pak. 2014;24(9):666–669.

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