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The Four-line Algorithm for the Treatment of Unilateral Cleft Lip
Franklin J Paredes1, Edwar C Alvarez2, Emily M Jones3
1From the Department of Plastic Surgery, Instituto Ecuatoriano de Seguridad Social, Hospital Carlos Andrade Marin, Quito, Ecuador.
Plastic and Reconstructive Surgery. Global Open
|February 10, 2025
Summary
A new four-line algorithm improves unilateral cleft lip repair outcomes by guiding surgeons to use case-specific techniques. This approach significantly reduces deficient results and enhances symmetry for better functional and aesthetic outcomes.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Unilateral cleft lip (UCL) repair outcomes are influenced by various factors, some difficult to quantify.
- Objective evaluation of UCL repair success can be improved by assessing cleft severity and surgical techniques.
- The Unilateral Cleft Asymmetry Index (UCAI) provides a framework for evaluating cleft severity.
Purpose of the Study:
- To evaluate the effectiveness of a novel four-line algorithm in improving unilateral cleft lip (UCL) repair outcomes.
- To correlate cleft severity, surgical technique, and patient outcomes in UCL repair.
- To develop and validate a case-specific surgical approach for UCL repair.
Main Methods:
- Retrospective analysis of 298 UCL patients treated between 2015-2017 to identify factors influencing outcomes.
- Development of a four-line algorithm based on retrospective case-technique analysis.
- Prospective application of the algorithm to 136 UCL patients treated between 2018-2019.
Main Results:
- Retrospective analysis revealed significant outcome variability and 34% deficient results among different UCAI classifications.
- Prospective application of the four-line algorithm resulted in 0% deficient cases and 81% optimal outcomes.
- The algorithm demonstrated significantly better results for UCAI degrees III and IV (P < 0.001 and P = 0.041, respectively).
Conclusions:
- Cleft severity is a key prognostic factor in UCL repair, but universal surgical techniques do not guarantee optimal results.
- The developed four-line algorithm promotes tailored, case-specific surgical techniques for optimal functional and aesthetic outcomes in UCL repair.
- This algorithm-guided approach enhances predictability and success rates in unilateral cleft lip reconstruction.
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