title: Midline Cleft Lip and Bifid Nose Deformity: Description, Classification, and Treatment.
abstract: BACKGROUND
  Midline facial clefts are rare and challenging deformities caused by failure of fusion of the medial nasal prominences. These anomalies vary in severity, and may include microform lines or midline lip notching, incomplete or complete labial clefting, nasal bifidity, or severe craniofacial bony and soft tissue anomalies with orbital hypertelorism and frontoethmoidal encephaloceles. In this study, the authors present 4 cases, classify the spectrum of midline cleft anomalies, and review our technical approaches to the surgical correction of midline cleft lip and bifid nasal deformities. Embryology and associated anomalies are discussed.
  
  
  METHODS
  The authors retrospectively reviewed our experience with 4 cases of midline cleft lip with and without nasal deformities of varied complexity. In addition, a comprehensive literature search was performed, identifying studies published relating to midline cleft lip and/or bifid nose deformities. Our assessment of the anomalies in our series, in conjunction with published reports, was used to establish a 5-tiered classification system. Technical approaches and clinical reports are described.
  
  
  RESULTS
  Functional and aesthetic anatomic correction was successfully achieved in each case without complication. A classification and treatment strategy for the treatment of midline cleft lip and bifid nose deformity is presented.
  
  
  CONCLUSIONS
  The successful treatment of midline cleft lip and bifid nose deformities first requires the identification and classification of the wide variety of anomalies. With exposure of abnormal nasolabial anatomy, the excision of redundant skin and soft tissue, anatomic approximation of cartilaginous elements, orbicularis oris muscle repair, and craniofacial osteotomy and reduction as indicated, a single-stage correction of midline cleft lip and bifid nasal deformity can be safely and effectively achieved.
authors.affiliation: *Division of Plastic Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY †Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA ‡Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Kolker
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Sailon
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Holmes
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000145:classification / Q000601:surgery*; D005152:Facial Muscles / Q000002:abnormalities / Q000601:surgery; D005260:Female; D006801:Humans; D006972:Hypertelorism / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008046:Lip / Q000601:surgery; D008297:Male; D055171:Nasal Cartilages / Q000002:abnormalities / Q000601:surgery; D009666:Nose / Q000002:abnormalities* / Q000601:surgery; D009668:Nose Diseases / Q000601:surgery*; D009915:Orbit / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D013524:Surgical Flaps / Q000637:transplantation