eMedicine Specialties > Plastic Surgery > Craniofacial

Craniofacial, Unilateral Cleft Lip Repair: Follow-up

Author: Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Coauthor(s): Raja Ramaswamy, MS, The Chicago Medical School; Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery; David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children
Contributor Information and Disclosures

Updated: Jun 19, 2009

Outcome and Prognosis

Careful preoperative assessment of the cleft lip deformity and attention to detail in the reconstruction typically results in an excellent repair that achieves many characteristics of the natural lip. Realistically, many variables are involved beyond the technical aspects of a particular repair. Ultimately, the outcome depends on the natural course of uncomplicated healing of the initial repair, alignment of the skeletal framework on which the lip rests, and the differential effect of normal growth and development on the operated lip.

While a poor initial result is unlikely to improve with time, do not assume that an excellent initial result will not require some revisional procedure because of uncontrolled variables. Moreover, while the lip repair may be acceptable, additional procedures required to achieve nasal symmetry are not uncommon, despite the initial primary nasal surgery incorporated as an integral part of lip repair.

Future and Controversies

Cleft lip surgery has evolved from a geometrically defined "cookie-cutter" type approach to a more adaptable repair using the principles outlined by Millard's elegant rotation advancement technique.9,11 Skin flap design has led to a better understanding of the underlying musculature that is disrupted by the cleft and the importance of realignment of the individual bundles to create a functional repair. With a better understanding of the underlying anatomy, cleft surgery currently results in an excellent lip repair but is marred by a residual cleft nasal deformity.

Adjunct treatment. including early presurgical alveolar and nasal molding with a palatal appliance. may improve the long-term outcome, with the ultimate intent to remove the accompanying cleft nasal deformity, which is the most common stigmata of a facial cleft.

Only close long-term follow-up care and an honest assessment of the results can establish these improvements in outcome.1 Advances in the treatment of children with clefts will come only from a team-based approach in which close cooperation of multiple disciplines can address all the child's needs. Such children deserve to be cared for at major centers where an interdisciplinary approach is possible and substantial experience is available.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Kara K Criswell MD, Bryan K Criswell MD, and Mimis Cohen, MD, FACS, FAAP to the development and writing of this article.



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References
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References

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Further Reading

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Keywords

cleft lip, cleft lip repair, cleft palate, cleft palate repair, unilateral cleft lip repair, unilateral cleft lip, cleft lip and palate, facial cleft, cleft, lip, palate, congenital deformities, Kernahan, Kernahan classification, Millard technique, Millard repair, Millard cleft repair, face embryology, facial development, facial defect, embryonic development

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Contributor Information and Disclosures

Author

Pravin K Patel, MD, Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS, The Chicago Medical School
Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Mitchell F Grasseschi, MD, Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery
Disclosure: Nothing to disclose.

David E Morris, MD, Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children
David E Morris, MD is a member of the following medical societies: Chicago Medical Society and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Larry Hollier, Jr, MD, Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine
Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

R Edward Newsome, MD, Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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