Primary Unilateral Cleft Lip Repair: A Deformity-Based Approach

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Outcomes of primary unilateral cleft lip repair vary despite surgical advancements.
• Long-term results are influenced by growth, deformity severity, and surgical decision-making.
• These influencing factors receive less attention in current literature.

Purpose of the Study:

• To describe and illustrate a deformity-based decision-making approach for primary unilateral cleft lip repair.
• To examine how specific deformity characteristics inform surgical planning and outcomes.
• To provide a structured framework for reproducible surgical decision-making.

Main Methods:

• Retrospective review of a consecutive single-surgeon cohort.
• Descriptive analysis of clinical records and standardized photographs.
• Evaluation of how deformity characteristics influenced operative planning, postoperative management, and early outcomes.

Main Results:

• Deformity-based repair achieved balanced early lip-nasal relationships with near-symmetric lip height and nasal base alignment.
• Early symmetry did not predict later growth-related changes.
• Secondary procedures were more frequent in severe clefts, indicating revision patterns relate to deformity severity.

Conclusions:

• Primary unilateral cleft lip repair should be viewed as deformity-guided longitudinal planning, not immediate aesthetic perfection.
• A component-based approach integrates preoperative assessment with growth expectations.
• This strategy supports structured and reproducible surgical decision-making for cleft lip repair.