Summary

It is unusual to see a variety of approaches to a single problem presented side-by-side. We do not expect a single answer to come from these suggestions; rather, we hope that the surgeon might feel comfortable with addi- tional techniques that he or she could use when needed. In most cases, for example, I prefer to use a straightfor- ward MiUard rotation advancement technique. 1 When the philtrum on the normal side is laterally placed, how- ever, as described by Mohler in (type I), I do not hesitate to use an incision similar to what he has described. I also find useful an alternative to this approach that is soon to be published by J. K. Salomonson. I also do not hesitate to put in a small flap in the lower part of the lip if needed, as suggested by both Noordhoff and LaRossa. The taping as described by Pool and Rutrick would seem to be an excellent approach that uses the maxillary plate if needed.

Unilateral clefts present a variety of problems. One that has not been addressed is the minimum cleft, the

microform, or the forme fruste. Here, there would seem to be no need for opening the entire lip or for the use of any but the tiniest of flaps (Fig 1).

There are several authors we had hoped to include, but for one reason of another, mostly the limitation of space, we could not. One is G. C. Park of Seoul, Korea, who wrote about the two parts of the orbicularis oris muscle and their reconstruction. This paper had to be with- drawn because the publication of this journal will precede the publication of a similar article by the same author in Plastic and Reconstructive Surgery. When his paper is published (probably in December), we think you will find it interesting.

My muscle reconstruction is a little more complicated than those described here. 2 In clefts with a severe amount of upward displacement of the Cupid's bow, I like to use a triangular flap similar to those described by Thomson and Bardach. 2 My nasal tip reconstruction is similar to McComb's, but we had hoped to include a

Fig 1. A microform of cleft lip (occasionally also seen on the "noncleft" side of a unilateral cleft). The simplest type of repair Is usually sufficient, done here with s straight line and s very small z-plssty just above the white roll.

206 Operative Techniques in Plastic and Reconstructive Surgery, Vol 2, No 3 (August), 1995: pp 206-207

chapter using nasal conformers, as described by Matsuo, which also produces excellent results. So it would seem that all of these techniques have their usefulness, and "it is better to fit the operation to the child than to fit the child to the operation" (author unknown).

Peter Randall, MD Guest Editor

Reference

1. MiUard, DR: Cleft Craft (vol I). The Unilateral Deformity. Little, Brown, Boston, MA, 1976

2. LaRossa D, Randall P: Unilateral cleft lip, in Georgiade GS, Geor- giade NF, Riepkohl R, et al (eds): Textbook of Plastic, Maxillofacial and Reconstructive Surgery. Williams & Wilkins, Baltimore, MD, 1992, pp 279-288

207