Primary Unilateral Cleft Lip Repair: A Deformity-Based Approach

Outcomes after primary unilateral cleft lip repair remain variable despite advances in surgical technique. Beyond operative design, long-term results appear influenced by growth, deformity severity, and surgical decision-making, factors that have received comparatively less attention in the literature.

A deformity-based decision approach to primary unilateral cleft lip repair is described and illustrated through a retrospective review of a consecutive single-surgeon cohort. Clinical records and standardized photographs were reviewed descriptively to examine how deformity characteristics informed operative planning, postoperative management, and early clinical outcomes during available follow-up.

Restoration of continuity across lip and nasal components produced generally balanced early lip-nasal relationships, supported by objective subset-level photogrammetric measurements demonstrating near-symmetric lip height and preserved nasal base alignment. Early postoperative symmetry did not reliably predict subsequent growth-related change. Primary nasal correction focused on alignment and structural support rather than cartilage reshaping, allowing early symmetry while preserving flexibility for later revision. Secondary procedures occurred more often in more severe clefts, suggesting revision patterns were primarily related to deformity severity rather than operative technique. Postoperative scar care and selective nasal conformer use supported scar maturation and contour stability but were not essential for achieving balanced primary repair.

Primary unilateral cleft lip repair may be best viewed as deformity-guided longitudinal planning rather than the pursuit of immediate aesthetic perfection. A component-based approach links preoperative assessment with expected growth and supports structured, reproducible surgical decision-making.