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Cleft lip repair is a surgical procedure that may be approached with a wide array of different techniques. The ultimate goal of cleft lip repair is to restore the sphincter function of the orbicularis oris muscle and obtain a cosmetically favorable outcome for the developing child. This activity reviews the most commonly used surgical techniques and highlights the importance of a multidisciplinary team in these complicated patients that include an otolaryngologist, a plastic surgeon, a dentist, an orthodontist, a pediatrician, a geneticist, a nurse, a social worker, and a speech-language pathologist. Objectives: Discuss the goals and timing of cleft lip repair. Identify the surgical considerations for cleft lip repair. Describe the most common surgical techniques for unilateral and bilateral cleft lip repair. Access free multiple choice questions on this topic.

Cleft lip deformity is one of the most common congenital malformations.[1] It may be isolated, or it may be associated with other malformations. Management of the cleft lip patient is centered around a multidisciplinary approach. Ultimately, cleft lip requires surgical intervention for definitive repair for which many surgical techniques have been described. Preoperative and postoperative strategies aid in the successful management of patients with this disorder. The choice of the surgical technique employed depends on many factors such as surgeon preference, the severity of the deformity, and the presence or absence of other deformities. In this discussion, we aim to present the most commonly used surgical techniques for cleft lip repair, their advantages, and their disadvantages.

The complications related to surgical repair are wound dehiscence, scar contracture, scar hypertrophy, and infection. Other complications are related to lip and nasal deformities not resolved during the primary repair, such as vermillion notching, misalignment of the white roll, orbicularis discontinuity, short or excessive length of the lip, short or deviated columella, the horizontal orientation of the nares, abnormalities of nostril size,  and disturbance of alar base position. Avoiding tension at closure and postoperative local wound care will decrease the incidence of wound dehiscence. Careful marking and approximation of the white roll are necessary to avoid its misalignment. Careful orbicularis muscle dissection and suturing are also necessary to avoid orbicularis muscle discontinuity. Prevention is as always therefore the best course of action to avoid complications.

The standard of care for a patient with cleft lip involves a multidisciplinary team that meets multiple times each year to discuss patient management. This team should be comprised of an otolaryngologist, a plastic surgeon, an oral and maxillofacial surgeon, a speech-language pathologist, an orthodontist, a dentist, a pediatrician, a geneticist, an audiologist, nurses, social workers, and a psychologist. Each member of the team provides their expertise to optimize the management of patients that will most likely have disorders associated or due to their cleft lip deformity.[15][16]