Unilateral cleft lip repair: Standardized key steps for Cupid's bow reconstruction

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Cleft lip repair is a complex surgical procedure with persistent challenges in achieving optimal outcomes.
• Improving surgical results in cleft lip repair significantly benefits patients but requires standardized approaches.
• Variability in surgical techniques can impact the consistency and success of cleft lip repairs.

Purpose of the Study:

• To develop and present a systematic, stepwise surgical protocol for Cupid's bow reconstruction in unilateral cleft lip repair.
• To reduce procedural variability and enhance predictability and repeatability in cleft lip surgery.
• To provide a framework for consistent and adaptable surgical execution based on extensive clinical experience.

Main Methods:

• Development of a systematic protocol based on 40 years of refinements and 7400 cases.
• Deconstruction of the cleft lip repair procedure into defined, adaptable steps.
• Empirical refinement and definition of five key steps for Cupid's bow reconstruction: landmarking, peak descent, midline correction, structure/white roll reconstruction, and symmetry restoration.

Main Results:

• The protocol successfully established quantified, predictable, and repeatable steps for Cupid's bow reconstruction.
• Application of the protocol demonstrated good and stable immediate and long-term outcomes.
• The stepwise approach reduced reliance on subjective intraoperative decisions while allowing for case-specific adaptations.

Conclusions:

• The developed protocol synthesizes decades of surgical expertise into a reproducible framework for unilateral cleft lip repair.
• This systematic approach enhances consistency and improves outcomes in Cupid's bow reconstruction.
• The protocol emphasizes adaptability to anatomical diversity, offering a valuable tool for surgeons and surgical teams.