Two-stage unilateral cleft lip repair

Reconstruction of the unilateral cleft lip deformity remains a challenge. The Millard repair is the most commonly employed technique of lip closure. Wide clefts with malaligned alveolar arches and very short cleft-side philtral ridges are particularly difficult to reconstruct well. These cases frequently require some degree of cleft-side alotomy with attendant scarring and potential growth disturbance. Additionally, the lip scar tends to cross the philtrum at an aesthetically unsatisfactory low level. Nasoalveolar molding is one method to address these problems, but is not always available or practical. Alternatively, a two-stage lip repair serves as a reasonable means of managing these problems as well. The first stage, performed at approximately 4 to 6 weeks of age, is a full-thickness straight-line repair with tip rhinoplasty. The second stage is a modified Millard repair done at approximately 6 months of age. An alotomy is never needed. The lip scar does not cross the philtrum until the nasolabial crease. The alveolar segments are passively brought closer together by the early lip repair facilitating anterior palate closure. This technique has been used for more than 10 years with satisfying aesthetic and functional results.