Unilateral Cleft Lip Repair: An Anatomical Subunit Approximation Technique

BACKGROUND: A technique of unilateral cleft lip repair is described. The repair draws from a variety of previously described repairs and adheres to a concept of anatomical subunits of the lip. Cases from within the spectrum of the deformity have been chosen from a series of 144 consecutive cases to demonstrate the applicability of the technique in all forms of unilateral cleft lip. METHODS: Incisions cross the lip perpendicular to the cutaneous roll at the cleft side peak of Cupid's bow of the medial lip and at the base of the philtral column of the lateral lip. Above this level, incisions ascend the lip to allow for approximation along a line symmetrical with the non-cleft-side philtral column. Incisions then ascend superolaterally bordering the lip columellar crease to the point of closure in the nostril sill. A Rose-Thompson lengthening effect occurs just above the level of the cutaneous roll. If necessary, a small triangle positioned just above the cutaneous roll is often used. Any central vermilion deficiency is augmented by a laterally based triangular vermilion flap from the lateral lip element. RESULTS: Since January of 2000, this technique has been used in 144 consecutive unilateral cleft lip repairs. The inferior triangle is small (average, 1.24 mm; range, 0 to 2 mm). The technique can be applied to all degrees of unilateral cleft lip. CONCLUSIONS: A technique of unilateral cleft lip repair is described. The repair allows for a repair line that ascends the lip at the seams of anatomical subunits.