Сучасний підхід до лікування вроджених однобічних незрощень верхньої губи

O. Holubchenko

doi:10.33295/1992-576X-2025-4-103

Authors

O. Holubchenko Bogomolets National Medical University, Kyiv, Ukraine https://orcid.org/0009-0001-2104-6222

DOI:

https://doi.org/10.33295/1992-576X-2025-4-103

Keywords:

deformity, nonunion, upper lip, orthognathic surgery, scar

Abstract

Abstract. The birth of children with cleft lip is quite common today; according to the latest data, the rate reaches 1 in 1000 of all children born. Since this pathology causes significant developmental disorders of the craniomaxillofacial area, doctors have been trying to optimize the treatment process for this category of patients since the last millennium. Despite significant successes in this direction, children with cleft lip often retain residual facial deformities. That is why the current task of pediatric maxillofacial surgeons is to develop and implement the most effective treatment protocols for children with a cleft lip of the upper lip.
Purpose: Analyze literary sources regarding modern approaches to the treatment of upper lip nonunions.
Material and methods. An information search and analysis of scientific sources on approaches to treating upper lip nonunions was conducted using the scientometric databases PubMed, ResearchGate, Google Scholar, and Cochrane.
Results. Firstly, the treatment of patients with upper lip nonunion begins with establishing nutrition, as children with this pathology often cannot eat adequately. Consequently, their growth and development are disrupted. It is due to the lack of adequate weight gain that it is sometimes impossible to perform surgery due to the child’s unwillingness to undergo surgery under general anesthesia. After establishing nutrition, the child can be prepared for surgery. The main task of surgical intervention is to minimize the degree of deformation of the craniomaxillofacial area in the future. Today, one of the standard surgical methods for treating upper lip nonunion is the Fisher intervention. Treatment of patients with upper lip nonunion does not end with the surgical part but requires full postoperative rehabilitation, which is primarily intended to preserve the results of surgical intervention and eliminate residual phenomena of facial deformation. Primary postoperative rehabilitation consists of reducing scar tissue deformation. More distant rehabilitation involves performing orthognathic surgery, which patients with nonunions typically require.
Conclusions. Only a correctly selected, comprehensive concept, which encompasses all stages of treating patients with nonunions, can ensure the maximum possible rehabilitation of this category of individuals. The involvement of related specialists is necessary for both preoperative and postoperative treatment of patients with nonunions of the upper lip. Therefore, the task of a pediatric maxillofacial surgeon in introducing patients with nonunions is to create conditions for the correct preparation of the child for surgical intervention, as well as to ensure the maximum possible full rehabilitation of these patients in the postoperative period.

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Author Biography

O. Holubchenko, Bogomolets National Medical University, Kyiv, Ukraine

Postgraduate student of the Department of Maxillofacial Surgery and Modern Dental Technologies

References

Peck, C.J., Parsaei, Y., Jazayeri, H.E. et al. (2024). A National Assessment of Racial and Ethnic Disparities in Cleft Lip Repair. Plast. Reconstr. Surg., 154(5), 1058–1066. DOI: https://doi.org/10.1097/PRS.0000000000011203.

Raghavan, U., Vijayadev, V., Rao, D., Ullas, G. (2018). Postoperative Management of Cleft Lip and Palate Surgery. Facial Plast. Surg., 34(6), 605–611. DOI: https://doi.org/10.1055/s-0038-1676381.

Randall, P. (1959). A triangular flap operation for the primary repair of unilateral clefts of the lip. Plast. Reconstr. Surg. Transplant. Bull., 23(4), 331–347. DOI: https://doi.org/10.1097/00006534-195904000-00003.

Tennison, C.W. (1952). The repair of the unilateral cleft lip by the stencil method. Plast. Reconstr. Surg. (1946), 9(2), 115–120. DOI: https://doi.org/10.1097/00006534-195202000-00005.

Cronin, T.D. (1966). A modification of the Tennison-type lip repair. Cleft Palate J., 3, 376–382. PMID: 5330850.

Millard, D.R., Jr. (1964). Rotation-Advancement Principle in Cleft Lip Closure. Cleft Palate J., 12, 246–252. PMID: 14140821.

Page, M.J., McKenzie, J.E., Bossuyt, P.M. et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.), 372, n71. DOI: https://doi.org/10.1136/bmj.n71.

Ravi, B.K., Padmasani, L.N., Hemamalini, A.J., Murthy, J. (2015). Weight Gain Pattern of Infants with Orofacial Cleft on Three Types of Feeding Techniques. Ind. J. Pediatr., 82(7), 581–585. DOI: https://doi.org/10.1007/s12098-014-1668-0.

Ranzer, M., Daniele, E., Purnell, C.A. (2021). Perioperative Management of Cleft Lip Repair: A Meta-Analysis and Clinical Practice Guideline. Cleft Palate Craniofac. J., 58(10), 1217–1225. DOI: https://doi.org/10.1177/1055665620984909.

Bessell, A., Hooper, L., Shaw, W.C. et al. (2011). Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate. Cochrane Database Syst. Rev., 2011(2), CD003315. DOI: https://doi.org/10.1002/14651858.CD003315.pub3.

Matsuo, K., Hirose, T., Tomono, T. et al. (1984). Nonsurgical correction of congenital auricular deformities in the early neonate: a preliminary report. Plast. Reconstr. Surg., 73(1), 38–51. DOI: https://doi.org/10.1097/00006534-198401000-00009.

Altuğ, A.T. (2017). Presurgical Nasoalveolar Molding of Bilateral Cleft Lip and Palate Infants: An Orthodontist’s Point of View. Turk. J. Orthod., 30(4), 118–125. DOI: https://doi.org/10.5152/TurkJOrthod.2017.17045.

Esenlik, E., Gibson, T., Kassam, S. et al. (2020). NAM Therapy-Evidence-Based Results. Cleft Palate Craniofac. J., 57(4), 529–531. DOI: https://doi.org/10.1177/1055665619899752.

Retnakumari, N., Divya, S., Meenakumari, S., Ajith, P.S. (2014). Nasoalveolar molding treatment in presurgical infant orthopedics in cleft lip and cleft palate patients. Arch. Med. Health Sci., 2, 36. DOI: https://doi.org/10.4103/2321-4848.133804.

Wang, Q., Zhou, L., Zhao, J.Z., Ko, E.W. (2013). An extraoral nasoalveolar molding technique in complete unilateral cleft lip and palate. Plast. Reconstr. Surg. Global open, 1(4), e26. DOI: https://doi.org/10.1097/GOX.0b013e31829e0d4b.

Chen, Y.F., Liao, Y.F. (2015). A modified nasoalveolar molding technique for correction of unilateral cleft nose deformity. J. Craniomaxillofac. Surg., 43(10), 2100–2105. DOI: https://doi.org/10.1016/j.jcms.2015.10.003.

Padovano, W.M., Skolnick, G.B., Naidoo, S.D., Snyder-Warwick, A.K., Patel, K.B. (2022). Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac. J., 59(4), 462–474. DOI: https://doi.org/10.1177/10556656211009702.

Likitkulthanaporn, A., Boonpratham, S., Honglertnapakul, Y. et al. (2024). Effects of nasoalveolar molding on nasolabial aesthetics in patients with cleft lip and palate during pre-adolescence: A systematic review and meta-analysis of retrospective studies. Orthodont. Craniofac. Res., 27(3), 350–363. DOI: https://doi.org/10.1111/ocr.12762.

Grayson, B.H., Garfinkle, J.S. (2014). Early cleft management: the case for nasoalveolar molding. Am. J. Orthod. Dentofac. Orthop., 145(2), 134–142. DOI: https://doi.org/10.1016/j.ajodo.2013.11.011.

Murthy, P.S., Deshmukh, S., Bhagyalakshmi, A., Srilatha, K. (2013). Pre surgical nasoalveolar molding: changing paradigms in early cleft lip and palate rehabilitation. J. Int. Oral Health, 5(2), 70–80. PMID: 24155594.

Shetye, P.R., Grayson, B.H. (2017). NasoAlveolar molding treatment protocol in patients with cleft lip and palate. Seminars Orthodont., 23(3), 261–267. DOI: https://doi.org/10.1053/j.sodo.2017.05.002.

Chaudhari, P.K., Rajasekaran, A., Haldar, P. et al. (2024). Treatment outcomes of digital nasoalveolar moulding in infants with cleft lip and palate: A systematic review with meta-analysis. Orthodont. Craniofac. Res., 27(2), 164–182. DOI: https://doi.org/10.1111/ocr.12809.

Alzain, I., Batwa, W., Cash, A., Murshid, Z.A. (2017). Presurgical cleft lip and palate orthopedics: an overview. Clin., Cosm. Investig. Dent., 9, 53–59. DOI: https://doi.org/10.2147/CCIDE.S129598.

Szarejko, K., Kuć, J., Aleksandrowicz, K., Gołębiewska, M. (2016). The essence of kinesiotaping in cranio-mandibular and cranio-facial area. Literature review. Part II. Prosthodontics, 6. 437–444. DOI: https://doi.org/10.5604/.1226739.

Dawjee, S.M., Julyan, J.C., Krynauw, J.C. (2014). Lip tape therapy in patients with a cleft lip — a report on eight cases. SADJ, 69(2), 62–70. PMID: 24974519.

Fisher, D.M. (2005). Unilateral cleft lip repair: an anatomical subunit approximation technique. Plast. Reconstr. Surg., 116(1), 61–71. DOI: https://doi.org/10.1097/01.prs.0000169693.87591.9b.

Zaleckas, L., Linkevičienė, L., Olekas, J., Kutra, N. (2011). The comparison of different surgical techniques used for repair of complete unilateral cleft lip. Medicina (Kaunas, Lithuania), 47(2), 85–90. PMID: 21734440.

Cutting, C.B., Dayan, J.H. (2003). Lip height and lip width after extended Mohler unilateral cleft lip repair. Plast. Reconstr. Surg., 111(1), 17–26. DOI: https://doi.org/10.1097/01.PRS.0000036045.22434.D4.

Adetayo, A.M., James, O., Adeyemo, W.L., Ogunlewe, M.O., Butali, A. (2018). Unilateral cleft lip repair: a comparison of treatment outcome with two surgical techniques using quantitative (anthropometry) assessment. J. Korean Assoc. Oral Maxillofac. Surg., 44(1), 3–11. DOI: https://doi.org/10.5125/jkaoms.2018.44.1.3.

Campbell, A., Restrepo, C., Deshpande, G. et al. (2017). Validation of the Unilateral Cleft Lip Severity Index for Surgeons and Laypersons. Plast. Reconstr. Surg. Global open, 5(9), e1479. DOI: https://doi.org/10.1097/GOX.0000000000001479.

Campbell, A., Restrepo, C., Deshpande, G. et al. (2017). Validation of a Unilateral Cleft Lip Surgical Outcomes Evaluation Scale for Surgeons and Laypersons. Plast. Reconstr. Surg. Global open, 5(9), e1472. DOI: https://doi.org/10.1097/GOX.0000000000001472.

Deshmukh, M., Vaidya, S., Deshpande, G., Galinde, J., Natarajan, S. (2019). Comparative Evaluation of Esthetic Outcomes in Unilateral Cleft Lip Repair Between the Mohler and Fisher Repair Techniques: A Prospective, Randomized, Observer-Blind Study. J. Oral Maxillofac. Surg., 77(1), 182.e1–182.e8. DOI: https://doi.org/10.1016/j.joms.2018.08.029.

Bartkowska, P., Komisarek, O. (2020). Scar management in patients after cleft lip repair-Systematic review Cleft lip scar management. J. Cosmet. Dermatol., 19(8), 1866–1876. DOI: https://doi.org/10.1111/jocd.13511.

Chang, C.S., Wallace, C.G., Hsiao, Y.C. et al. (2018). Clinical evaluation of silicone gel in the treatment of cleft lip scars. Sci. Rep., 8(1), 7422. DOI: https://doi.org/10.1038/s41598-018-25697-x.

Ostrowski, H., Roszak, J., Komisarek, O. (2019). Botulinum toxin type A as an alternative way to treat trigeminal neuralgia: a systematic review. Neurol. Neurochir. Pol., 53(5), 327–334. DOI: https://doi.org/10.5603/PJNNS.a2019.0030.

Chang, C.S., Wallace, C.G., Hsiao, Y.C., Chang, C.J., Chen, P.K. (2014). Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial. PloS one, 9(12), e115690. DOI: https://doi.org/10.1371/journal.pone.0115690.

Peng, L., Tang, S., Li, Q. (2018). Intense pulsed light and laser treatment regimen improves scar evolution after cleft lip repair surgery. J. Cosmet. Dermatol., 17(5), 752–755. DOI: https://doi.org/10.1111/jocd.12684.

Hattori, Y., Pai, B.C., Saito, T. et al. (2023). Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study. Int. J. Surg. (London, England), 109(6), 1656–1667. DOI: https://doi.org/10.1097/JS9.0000000000000406.