Background: While cleft lip and palate is a widely recognized orofacial deformity, it is less commonly appreciated that it has a wide spectrum of presentations. It occurs in basic categories of combined cleft lip and palate and isolated cleft lip and isolated cleft palate, but every possible variation in between these basic categories occurs. Its diverse presentations has to do with the remarkable formation of the upper lip due to the embryologic union (and lack of adhesion in clefts) of the lateral lip and nasal elements.
The incomplete cleft, as the name implies, involves just one element of the lip and palate. Externally this would be an incomplete cleft lip without any palatal involvement. Careful inspection of the incomplete cleft lip, however, shows that there is still some nasal involvement and a notch may also appear on the underlying alveolus as well.
Other than isolated cleft palate, which presents no visible external deformity, incomplete cleft lip would be the next most favorable cleft deformity to have.
Case Study: This 4 month-old female was born with an incomplete cleft lip that spared the nasal sill. There was still nasal malformation with a misshapen nostril. There was no underlying involvement of the alveolus.
Under general anesthesia she had a unilateral cleft lip repair using a rotation-advancement technique. (central lip element rotates downward and the lateral lip element advances in behind it. Primary nose repair was done by alar cartilage dissection and the placement of a small overlying resorbable plate for support.
One year follow-up shows good length and alignment of the philtral column, adequate vermilion fullness and an improved nostril shape. Some visible scarring is seen at the nasal sill. Whether a cleft lip revision will eventually be needed will require years of growth to determine.
Highlights:
- The incomplete cleft lip usually spares the alveolus and palate, making it a more ‘favorable’ orofacial cleft
- Primary repair of the incomplete cleft lip is the one cleft lip deformity that has a chance of being a one time surgery.
- The incomplete cleft lip repair his usually performed around 3 to 4 months of age.
Dr. Barry Eppley
Indianapolis, Indiana