Unilateral cleft lip repair by rotation/advancement: potential errors and how to avoid them

The surgical repair of unilateral cleft lip has been refined over the centuries. During the past few decades, two techniques have emerged as ideal: (1) the rotation/advancement technique and (2) the triangular flap repair, the former more commonly utilized. Underrotation and insufficient advancement represent two potential errors when using this technique. In this review, these errors in flap development will be examined and strategies discussed for their avoidance. Insufficiencies in both rotation and advancement produce functionally and aesthetically suboptimal results. Although the principles of rotation and advancement are well described, differences in opinions exist as to the precise details of flap development. The extent of rotation and the paring point (Millard point #8) of the advancement flap will specifically be addressed. It stands to reason that the severity of the cleft deformity will determine the required surgical intervention. By appropriately applying the techniques herein, satisfactory results can be achieved in even severe clefts.