Cleft Lip Revision: A Proven Classification for Surgical Precision and Resource Optimization

Secondary cleft lip deformities (SCLD) are common, diverse, and individually unique due to their multifactorial etiology and varied clinical presentation. They are the result of postoperative complications of primary cleft lip repair, such as lip dehiscence, delayed wound healing, hematoma, infection, trauma, suture abscesses, poor operative planning, and inadequate surgical technique. The broad spectrum of these deformities and the absence of a standardized stratification framework necessitated the development of a comprehensive and universally applicable classification system. This system was designed to provide a simplified, consistent approach to identifying and categorizing residual cleft deformities. By doing so, it enhances communication among cleft care providers and facilitates the planning and execution of appropriate corrective procedures. The proposed classification organizes SCLD into 5 types (type I to V) based on the anatomic structures involved: skin, mucosa, orbicularis oris muscle, nose, and premaxilla. Each type corresponds to a specific pattern of tissue involvement and is associated with a tailored surgical approach described in this chapter. A careful preoperative assessment using this classification system significantly improves surgical planning, guides anesthetic considerations, ensures more accurate time and resource allocation, and promotes effective interdisciplinary communication.