On the importance of muscle repair in secondary cleft lip deformity

Generally the evolution of cleft lip repair has included a transition from those methods with primary emphasis on the skin design with intricate flaps, going to further elaborations of carefully designed skin and muscle units but with minimal muscle dissection or intentional reorientation, on to those with greater emphasis on extensive muscle dissection with specific realignment of the orbicularis oris muscle. These latter methods assign to the skin a more complementary role in the plan of correction. This article joins others in which it is now felt that extended dissection and surgical reorientation should be done to include associated involved muscles of the lip, nose, and medial face. In particular, attention to the details of muscle repair as completely as possible, extending to the entire oro-naso-facial complex, seems pertinent in the matter of secondary correction of cleft lip deformities. A review of the anatomy involved, certain surgical philosophy, and examples of illustrated cases are included in this article.