title: Primary repair in adult patients with untreated cleft lip-cleft palate.
abstract: BACKGROUND
  The authors have volunteered their services as plastic surgeons in several countries, such as Nepal and Cambodia. In these programs, the authors saw many adults with cleft lips or palates who could not have primary repair at the proper time. The purpose of this report is to discuss the primary repair of untreated cleft lips or palates in adult patients.
  
  
  METHODS
  Subjects were older than 17 years. In Nepal, primary repairs were performed in 129 adults with untreated clefts over the past 11 years. Unilateral cleft lips were repaired by rotation advancement with the small triangular flap method or the straight method with a small triangular flap. Bilateral clefts were repaired using a one-stage repair method. Cleft palates were repaired by a mucoperiosteal push-back or Furlow technique.
  
  
  RESULTS
  Differences between primary cleft repair for infants and for adults were as follows: (1) in adults, aggressive correction was possible, as maxillary growth was not a consideration; (2) correction of the anterior part of the nasal deformity was more difficult than in infants, as adults showed less elasticity and a more severe deformity of the nasal cartilages; (3) simultaneous palatoplasty should be chosen judiciously, as it is more invasive and results in higher morbidity; and (4) cheiloplasty under local anesthesia can reduce cost, time, and manpower.
  
  
  CONCLUSIONS
  These observations should be useful for the local and foreign surgeons who treat clefts in developing regions.
authors: Yokohama, Tokyo, Chiba, and Kumamoto, Japan From the Departments of Plastic and Reconstructive Surgery of Showa University Fujigaoka Hospital, Showa University, and Chiba University, and the Department of Plastic Surgery, Kumamoto Rehabilitation Hospital.
authors: Daichi
authors: D
authors: Morioka
authors: Shinya
authors: S
authors: Yoshimoto
authors: Akikazu
authors: A
authors: Udagawa
authors: Fumio
authors: F
authors: Ohkubo
authors: Astushige
authors: A
authors: Yoshikawa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007391:International Cooperation; D007564:Japan; D008297:Male; D008875:Middle Aged; D009390:Nepal; D009407:Nerve Block; D009666:Nose / Q000601:surgery; D019647:Oral Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D013515:Surgery, Oral / Q000193:education; D013524:Surgical Flaps