Patient Characteristics and Surgical Techniques for Midline/Median Cleft Lip: A Scoping Review

ObjectiveWhile median cleft lip (MCL) remains rare, improvements in prenatal and postnatal care have improved survival past the neonatal period and thus have increased consideration of surgical repair. MCL is also anatomically distinct from unilateral and bilateral cleft lips and is associated with underlying genetically based syndromes. There is a lack of aggregated data on MCL, and this study provides an overview of the literature, characterizes associated phenotypes, and synthesizes surgical and follow-up management.DesignFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, PubMed, EMBASE, Web of Science, and Cochrane were queried using search terms related to cleft and surgical management.Patients and ParticipantsPatients born with MCL.Main Outcome MeasuresNumber of MCL articles published, along with the description of patient presentation, surgical technique, and postoperative management.ResultsIn total, 3454 articles were screened, with 85 articles meeting the inclusion criteria. Published articles have increased each decade since 1970. A total of 158 patients were included (35.4% male, 44.9% female, 19.6% unspecified). Isolated MCLs occurred in 16.5% of patients, and the remaining patients presented with conditions such as holoprosencephaly (18%), hypertelorism (18.4%), and frontonasal dysplasia (3.8%). Repair of MCLs included the straight-line technique (40.5%), use of rotational flaps (3.8%), and use of grafts (2.5%). Surgical complications were evaluated, with a postoperative mortality of 2.5%.ConclusionsThe increasing published numbers of MCL cases reflect prolonged survival of patients and thus rising surgical repair consideration. Furthermore, patients with MCL demonstrate a wide range of complex clinical presentations necessitating different surgical management strategies. This review provides an evidence-based foundation for MCL management.