Unilateral Cleft Lip: Principles and Practice of Surgical Management

Abstract

Management of cleft lip and palate requires a unique understanding of the various dimensions of care to optimize outcomes of surgery. The breadth of treatment spans multiple disciplines and the length of treatment spans infancy to adulthood. Although the focus of reconstruction is on form and function, changes occur with growth and development. This review focuses on the surgical management of the primary cleft lip and nasal deformity. In addition to surgical treatment, the anatomy, clinical spectrum, preoperative care, and postoperative care are discussed. Principles of surgery are emphasized and controversies are highlighted.

Unilateral Cleft Lip Repair Using the Anatomical Subunit Approximation

“…Focus was placed on reconstruction of the nasal floor and lateral nasal wall to retain the basal nose components in space. 2 Through the course of this series, muscle dissection evolved to be more aggressive, emphasizing the creation of an empty triangle of muscle lateral to the alar base. This dissection accentuates the alar crease when the muscle is repaired and may add to soft-tissue stability.…”

“…2 The orbicularis muscle is released from the base of the columella at the level of the alveolus to allow the medial lip to drop. The orbicularis on the lateral side is dissected as a single layer between mucosa and skin and is released from the alveolus and alar base.…”

“…2 These have been previously described in further detail 2 and are summarized in Figure 2. Each of these flaps provide mucoperiosteum to fill the dead space left by mucoperiosteal release of the lateral nasal wall with anterior repositioning of the ala.…”

Reliability of Nasolabial Anthropometric Measures Using Three-Dimensional Stereophotogrammetry in Infants with Unrepaired Unilateral Cleft Lip

“…3 and Table 1) that is recorded immediately before cleft lip repair to assist with planning and documentation of the cleft deformity. 14 This point was used to define the lateral segment Cupid's bow peak (cphi′′), as the Noordhoff point is an identifiable landmark that does not vary with technique of cleft lip repair (i.e., rotation-advancement versus inferior triangle) 12 or surgeon preference. The Noordhoff point was defined as the point along the vermilion border of the lateral lip element where the vermilion is at its greatest height.…”

Novel Technique to Repair Unilateral Cleft Lip: Separated Multiple Y-to-V-Plasty under Magnification

“…Abnormal muscle insertion beneath the columella, alar base and nasal floor was adequately released as described before. 16 Muscle cuff was completely released from the skin mucosa and lip border bilaterally through the alar base on the cleft side and midline philtrum on the non-cleft side based on previous reports. 17 , 18 Closure was started at wet-dry junction as a key point and then, the mucosal layer was closed from the sulcus up to this point.…”