Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation: Modifications and Analysis of Early Results in 100 Consecutive Cases. R Tse, S Lien.

Date: July 2015.
Source: Plastic and Reconstructive Surgery, 136(1):119-30.
Abstract: The “Anatomic Subunit Approximation” for unilateral cleft lip repair has gained acceptance, however, outcomes have not been reported since the original description. The purpose of this study is to report the experience using this technique.
Methods: One hundred two consecutive patients underwent primary cleft lip repair by a single surgeon over a 3-year period. Objective analysis involved anthropometric measurements performed on pre- and post-operative 3D 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 cleft to non-cleft side. Differences in ratios were assessed by rank sum test. Differences in Asher-McDade scores were assessed using Mann-Whitney.
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 mm (SD 0.9). Anthropometric ratios were significantly improved post-op and approached 1, regardless of initial cleft severity. Ten subjects repaired early in the experience were compared to 10 subjects repaired late in the experience. There was no significant difference in post-operative anthropometric measures or Asher-McDade scores.
Conclusions: The Anatomic Subunit Approximation for unilateral cleft lip repair in a single surgeon series can achieve improvements in anthropometric measures and early favorable post-operative 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.

Article: Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation: Modifications and Analysis of Early Results in 100 Consecutive Cases.
Authors: Tse, Raymond MD; Lien and Samuel MD. Seattle Children’s Hospital, University of Washington, Seattle, Wash.

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