One-Stage vs. Two-Stage Repair of Asymmetric Bilateral Cleft Lip: A 20-Year Retrospective Study of Clinical Outcome

Background: The one-stage or two-stage approaches have been a widely used technique for patients with an asymmetric bilateral cleft lip (ABCL). There is insufficient long-term outcome data between these two methods. The purpose of this retrospective study is to compare the clinical outcome over the last 20 years. Methods: The senior author's database was searched for patients with ABCL from 1995 to 2015. Qualified patients were divided into two groups: one-stage vs. two-stage. The postoperative photographs of patients were subjectively evaluated by surgical professionals and the laypersons. Ratios of the nasolabial region calculated for objective analysis. Finally, the revision procedures in the nasolabial area were reviewed. Statistical analyses were performed. Results: A total of 95 consecutive patients were qualified for evaluation. Average follow-up was 13.1 years. 35% of the patients had a two-stage method, and 65% had a one-stage approach. All received primary nasal reconstruction. Among the satisfaction rating scores, the one-stage repair was significantly higher than two-stage reconstruction (p= 0.0001). Long-term outcomes of the two-stage patients and the unrepaired mini-microform deformities were unsatisfying in both professional and non-professional evaluators. Revision rate was higher in patients with a greater-side complete cleft lip and palate as compared with those without palatal involvement. Conclusion: The results suggested that one-stage repair provided better results to achieve more symmetric and smooth lip and nose after primary reconstructions. The revision rate is slightly higher in the two-stage patient group. The long-term outcome of unrepaired mini-microform cleft lip remains unsatisfactory. Conflicts of interest statement: No conflicting relationship exists for all authors Meeting presentation: Asian Pacific Craniofacial Association Meeting, December 2016, Nara, Japan; American Cleft Palate- Craniofacial Association Meeting, March 2017, Colorado Springs, USA Financial Disclosure: None of the authors have any source of financial or other support or any financial or professional relationship that may pose a competing interest. Author's role/participation: KHC was responsible for data collection, analysis, and writing manuscript. LJL was responsible for analysis and editing of manuscript. Acknowledgement: Special thanks to Miss Yi-Tan Hung for data collections, measurement and analysis. * Corresponding author: Lun-Jou Lo, M.D. Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital. 5 Fu-Shin Street, Kwei Shan, Taoyuan, Taiwan 333. Tel: 886-3- 3281200, ext. 2430. Fax: 886-3-3271029. Email: lunjoulo@cgmh.org.tw ©2018American Society of Plastic Surgeons