Experiences with unilateral cleft lip in a humanitarian mission in Mali

Abstract

Humanitarian surgery missions generally cover populations with a strong tendency to develop unsightly cheloid scarring, a particular concern in facial surgery. Another specific feature of humanitarian surgery missions is that many are episodic, with no possibility of medium- or long-term post-surgical follow-up. In a study carried out over five consecutive years at the Luxembourg Mother and Child Hospital in Bamako (Mali), patients undergoing cleft lip surgery were seen again at least one year after the operation. We investigated possible correlations between the type of cheilorhinoplasty used to treat cleft lip (Tennison or Millard) and the risk of cheloid scarring. We included 19 of the patients undergoing cheilorhinoplasty at the hospital between 2001 and 2005, all of whom were seen in consultation more than one year after surgery. Millard's technique was used for nine of these patients, between 2001 and 2003, and Tennison's technique was used for ten patients, between 2004 and 2005. We found that all cases of cheloid scarring in our series concerned children over the age of two years at the time of surgery. No significant difference was found between the two techniques in terms of the percentage of cases with cheloid scarring of the lip. However, in cases of cheloid progression, the C flap of Millard's technique was found to be particularly visible and unsightly. We therefore recommend the use of Tennison's technique for cheilorhinoplasty in black children over the age of two years.