eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Reconstructive Surgery

Cleft Lip: Follow-up

Author: Jagajan Karmacharya, MBBS, FRCS, Research Fellow, Department of General Surgery, Division of Plastic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania
Contributor Information and Disclosures

Updated: May 21, 2009

Outcome and Prognosis

Outcome assessment after cleft lip repair is based on lip contour and symmetry, facial growth, and psychological well-being. Major revisional surgery is not usually needed after cleft lip repair. Minor revisions of the vermilion or scar revision may be needed. The most challenging aspect of cleft lip surgery is correction of nasal deformity. Secondary surgery to improve nasal contour and symmetry is commonly required.

Future and Controversies

Recombinant DNA technology has revolutionized the ability to detect molecular defects at the protein and gene level; however, a clear understanding of the molecular basis of clefts has yet to be discovered. Some studies have suggested that several genes may be involved, including transforming growth factor–alpha, retinoic acid receptor–alpha, BCL3, and MSX-1. Future advances in molecular technology and understanding may ultimately lead to improvements in the diagnosis and management of orofacial clefts.

The experimental finding that fetal wounds made early in gestation heal without scar formation sparked an interest in intrauterine repair of the cleft lip. In animal models, evidence supports the fact that surgically created cleft lip and palates heal without scar formation. The molecular basis of such scarless healing is not well understood and remains the subject of intense investigation. At the present time, the risk of preterm labor and fetal loss is too high to justify the use of fetal surgery for the correction of cleft lip.

Neonatal lip repair is controversial. Proponents of neonatal repair cite the potential psychological benefits of bringing home a child with normal appearance; however, this assertion remains unproven. Such early repair may be associated with an increase in perioperative risk.

Controversy exists regarding the use of presurgical orthopedics or lip adhesion. Lip adhesion may be indicated for wide unilateral complete clefts. Those that oppose this technique argue that the scar introduced in the adhesion may interfere with subsequent cheiloplasty. A well-planned and executed lip adhesion may facilitate cleft repair while introducing a fine scar.2

 


More on Cleft Lip

Overview: Cleft Lip
Workup: Cleft Lip
Treatment: Cleft Lip
Follow-up: Cleft Lip
Multimedia: Cleft Lip
References
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References

  1. Millard DR. Cleft lip. In: McCarthy JG, May JW, Littler JW, eds. Plastic Surgery. Philadelphia, Pa:. WB Saunders Co;1990.

  2. Ruotolo RA, Fearon JA. Cleft lip repair: a unique sutureless skin closure technique. Plast Reconstr Surg. Mar 2009;123(3):109e-111e. [Medline].

  3. Burt JD, Byrd HS. Cleft lip: unilateral primary deformities. Plast Reconstr Surg. Mar 2000;105(3):1043-55; quiz 1056-7. [Medline].

  4. Ciminello FS, Morin RJ, Nguyen TJ, Wolfe SA. Cleft lip and palate: review. Compr Ther. Spring 2009;35(1):37-43. [Medline].

  5. Habel A, Sell D, Mars M. Management of cleft lip and palate. Arch Dis Child. Apr 1996;74(4):360-6. [Medline].

  6. Kirschner RE, LaRossa D. Cleft lip and palate. Otolaryngol Clin North Am. Dec 2000;33(6):1191-215, v-vi. [Medline].

  7. La Rossa D. Unilateral cleft lip repair. In: Bentz M,. Pediatric Plastic Surgery. Appleton & Lange:1998.

  8. Stal S, Brown RH, Higuera S, Hollier LH Jr, Byrd HS, Cutting CB, et al. Fifty years of the Millard rotation-advancement: looking back and moving forward. Plast Reconstr Surg. Apr 2009;123(4):1364-77. [Medline].

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Further Reading

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Keywords

cleft lip, harelip, hare lip, cleft palate, lip surgery, cosmetic lip surgery, Van der Woude syndrome, cleft lip deformity, bilateral cleft lip repair

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Contributor Information and Disclosures

Author

Jagajan Karmacharya, MBBS, FRCS, Research Fellow, Department of General Surgery, Division of Plastic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania
Jagajan Karmacharya, MBBS, FRCS is a member of the following medical societies: American Cleft Palate/Craniofacial Association and American Society of Gene Therapy
Disclosure: Nothing to disclose.

Medical Editor

Mark K Wax, MD, Professor and Program Director, Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University; Service Chief, Department of Surgery, Section of Otolaryngology, Veterans Affairs Medical Center
Mark K Wax, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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