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cleft lip, cleft palate

Botulinum Toxin to Improve Results in Cleft Lip Repair

Arch Facial Plast Surg. 2006;8:221-222.

INTRODUCTION

Traditionally, cleft lip deformities are repaired when the infant reaches about age 3 months. Many surgeons may delay repair in certain cases of severely wide clefts to allow for presurgical preparations such as nasoalveolar molding, lip taping, and, less commonly, lip adhesion procedures.

Repair of cleft lip deformities requires meticulous attention to recreating the 3-dimensional characteristics of the lip and nasal structures by reestablishing the muscular continuity of the orbicularis oris to achieve a functional and aesthetically pleasing upper lip contour.1 One of the many factors influencing the final result of the cleft lip repair is the amount of wound tension present during healing. Creating too much tension when closing a widely separated cleft lip may result in unacceptable scars and, although rare, wound breakdown (fistula or a dehiscence).

The use of botulinum toxin to minimize facial scarring has been described by Sherris and Gassner2 and Gassner et al3 as an adjunct to other techniques for decreasing wound tension (ie, orienting scars within relaxed skin tension lines,4 tissue undermining, deep-tissue closure, or rotation-advancement flap techniques5). To our knowledge, no reports in the medical literature describe the use of botulinum toxin to minimize wound tension in cleft lip repairs. We suggest that preoperative botulinum toxin injection into the orbicularis oris of patients with cleft lip should be considered along with the traditional techniques (ie, lip adhesion, delayed repair, nasoalveolar molding, and lip taping) to decrease wound tension and improve outcomes in wide cleft lip repairs.

Figure 1. Six-month-old infant with a wide bilateral cleft lip and nasal deformity. A, Appearance after 3 months of presurgical nasoalveolar molding, columellar lengthening, and lip taping. B, Appliance in place prior to injection of 5 U of botulinum toxin into the orbicularis oris at the cleft margins and nasal base. C, Three-month postoperative view.

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