The 3-line Algorithm for the Treatment of Bilateral Cleft Lip

Background: The treatment of bilateral cleft lip (BCL) depends on many factors, and the complexity of the repair can be reflected in the resulting complications. The severity of the cleft, along with the orthopedic and surgical treatment, requires coordinated treatment under a proven algorithm to achieve an aesthetically harmonious lip while avoiding complications. This study aimed to design and apply a clear approach to measuring severity and applying a technique that leads to optimal outcomes in BCL repairs. Methods: This study included patients from Operation Smile Ecuador and Guatemala. It consisted of 2 parts: (1) the retrospective part, which studied the clinical histories of patients with BCL from January 2021 to December 2022, correlating photographs, measurements, treatment protocol, surgical technique, and patient evolution; and (2) the prospective part, in which the algorithm was applied to patients treated from January 2023 to December 2024. Results: In the retrospective part, the results of 22 patients were correlated with the case-treatment protocol analysis, as well as the incidence of complications. Using these results, the 3-line algorithm was developed and applied to 21 patients in the prospective portion. Complications were decreased in this cohort, demonstrating the applicability and viability of the algorithm. Conclusions: In cases of BCL, the severity of the cleft is a factor of sine qua non importance, influencing not only the planning of the treatment protocol, but also the prevention of complications. The results of this study showed that the 3-line algorithm reduces complications and improves the function and aesthetic result for patients.