† Some of the material from this manuscript was partly presented at the First Thai International Congress on

Background: The repair of a bilateral cleft is more difficult than a unilateral repair because of numerous anatomical challenges, such as difficulty of repairing the skin and muscle overlying the protruded premaxilla and bilateral nasal reconstruction with shortening of the columella. An optimum outcome is achieved when all of the deformities of the primary cleft palate, the problems of scar and secondary deformities have been addressed. Objectives: To propose an integrated and functional reconstruction of the primary bilateral cleft lip-nose repair and to present the preliminary outcomes of this technique and its advantages. Material and Method: An integrated, functional reconstruction process includes: 1) analysis of the bilateral cleft deformities; 2) interdisciplinary management and use of Tawanchai Center’s protocol for cleft lip and palate care; 3) pre-surgical orthopedic treatments; and, 4) integrated primary cleft lip-nose repair and post-operative management. This approach to repair includes: 1) design of a prolabial flap and a modified, rotation advancement technique for skin surgery; 2) functional muscle reconstruction; 3) correction of nasal deformities and columella lengthening; 4) reconstruction of the vermillion; and