Bilateral cleft lip includes cases of various degrees, from types with a relatively large amount of the central lip to those with a wide cleft in which the central lip is small and the premaxilla protrudes. Primary surgery for bilateral cleft lip involves two-stage surgery in which the left and right clefts are closed in separate procedures and one-stage surgery in which both clefts are closed at the same time, In cases where the premaxilla is conspicuously protruding, closing each cleft separately in a two-stage operation reduces the post surgical tension on the sutured area compared to a one-stage operation. However, a one-stage operation is superior to a two-stage operation in obtaining symmetry of the upper vermilion. Regarding changes in the techniques we have used, from about 1980 we used unilateral cheiloplasty by Onizuka's method in a two-stage primary operation, From 1995 we introduced a modified Mulli-ken procedure as a basic one-stage operation, which made it easier to obtain balance of the upper vermilion. In 2004 we introduced a presur-gical nasoalveolar molding (PNAM) system combined with a modified Mulliken procedure. In this way it became easy to perform one-stage surgery even on types with a wide alveolar cleft.
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