Cleft lip repair: technical refinements for the wide cleft

Area of Science:

• Plastic Surgery
• Congenital Malformations
• Craniofacial Surgery

Background:

• Cleft lip and palate are common congenital anomalies.
• Unilateral cleft lip presents significant aesthetic challenges due to associated facial distortions.
• Current surgical approaches aim for optimal aesthetic outcomes, but variety in cleft presentation necessitates diverse techniques.

Purpose of the Study:

• To compare the aesthetic outcomes of two primary unilateral cleft lip repair techniques.
• To emphasize the importance of selecting appropriate surgical methods based on cleft severity.
• To review subtle techniques that enhance aesthetic results in cleft lip reconstruction.

Main Methods:

• A retrospective comparison of Millard rotation-advancement and Tennison-Randall flap repairs.
• Surgical procedures performed by a single surgeon over a 30-year period.
• Analysis focused on aesthetic outcomes in relation to cleft size and complexity.

Main Results:

• The Millard technique is effective for smaller unilateral clefts, utilizing the philtral line for scar placement.
• The Tennison-Randall repair offers advantages for wider unilateral clefts, providing better tissue rearrangement.
• Appropriate technique selection based on cleft morphology is crucial for superior aesthetic results.

Conclusions:

• A "one-size-fits-all" approach to unilateral cleft lip repair can be limiting.
• Mastery of multiple incisional patterns and subtle techniques is essential for surgeons.
• Tailoring surgical repair to individual cleft characteristics yields the best aesthetic outcomes.