Primary repair of binderoid bilateral cleft lip and palate: Synchronous nasolabial repair with premaxilla ostectomy and fixation

Binderoid cleft lip and palate refers to patients who have complete unilateral or bilateral cleft lip and palate with nasolabiomaxillary hypoplasia and orbital hypotelorism without evidence of holoprosencephaly. These patients are characterized by hypoplastic nasal tip, conical columella, tiny prolabium, underdeveloped lateral labial elements, and small/mobile premaxilla. The ipsilateral central and lateral incisors are absent in patients with unilateral cleft, and single-toothed premaxilla is typically found in bilateral patients.Special considerations and several modifications are needed not only in the operative technique, but also in the entire treatment process, starting from the preoperative period until childhood and adolescence.A 4-year-old Indonesian girl with binderoid bilateral cleft lip and palate visited our department with the help of a relief agency.We present the surgical management of the binderoid cleft lip and palate using synchronous nasolabial repair with premaxillary ostectomy and fixation following Mulliken's principle and special considerations for the late primary repair are discussed.