Our Summary

This research paper discusses the evolution of understanding and surgical techniques for repairing cleft lip, a condition where a baby’s lip does not form completely during pregnancy. In the past, the methods used to fix this were quite basic and didn’t yield great results. However, over time, doctors have developed more sophisticated techniques that consider the many different ways cleft lip can appear.

Before the 19th century, the results of surgery to fix cleft lips were not very good. But then, doctors started using curved cuts and moving skin around (also known as ‘advancement flaps’) which improved results.

In the 1900s, more techniques were introduced like making straight lines, quadrilateral flaps, and triangular flaps during surgery. These methods helped to reduce visible scarring after surgery, increased the length of the repaired lip, and restored the symmetry of the Cupid’s bow (the double curve at the center of the upper lip).

Later in the century, the use of rotation-advancement principles (a way of moving and rotating tissue) further improved how well the repaired lip worked, and how it looked.

Looking ahead, doctors are aiming to improve even further. They want to achieve better symmetry for both the lip and nose, ensure the muscles work well, hide scars more effectively, and make patients happier with the results. They are also looking to apply these improvements to a wider range of cleft lip appearances and as the patient grows over time.

FAQs

  1. How has the understanding of cleft lip etiology and surgical repair evolved over time?
  2. What are some of the improvements made in the 20th century to mitigate post-repair surgical scarring and restore symmetry of the Cupid’s bow after cleft lip repair?
  3. What are the future goals for technical improvements in cleft lip repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cleft lip repair is to follow post-operative care instructions carefully to ensure proper healing and minimize scarring. This may include keeping the surgical site clean, avoiding certain foods or activities that could disrupt healing, and attending follow-up appointments for monitoring and adjustments as needed. It’s also important to communicate any concerns or changes in the healing process to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for cleft lip repair include infants and children born with cleft lip deformities. These patients may have unilateral or bilateral cleft lip, with or without cleft palate. The decision to undergo cleft lip repair is typically made by a multidisciplinary team, including plastic surgeons, pediatricians, otolaryngologists, speech therapists, and orthodontists. The timing of cleft lip repair may vary depending on the individual patient’s needs and overall health, but it is generally recommended to be performed within the first few months of life to optimize outcomes and minimize potential complications. Overall, cleft lip repair is recommended for patients who are seeking improved facial aesthetics, speech development, and overall quality of life.

Timeline

Before cleft lip repair:

  • Prenatal diagnosis of cleft lip through ultrasound or other imaging techniques
  • Birth of the baby with a visible cleft lip
  • Evaluation by a multidisciplinary cleft care team, including plastic surgeons, otolaryngologists, speech therapists, and social workers
  • Counseling for the parents on the surgical options and potential outcomes
  • Pre-operative assessments and preparation for surgery

After cleft lip repair:

  • Surgery is performed, usually within the first few months of life
  • Post-operative recovery period, including pain management and monitoring for complications
  • Follow-up appointments with the cleft care team to monitor healing and address any concerns
  • Speech therapy and other interventions as needed to address any functional issues related to the cleft lip
  • Long-term follow-up to monitor growth and development of the repaired lip and address any potential secondary surgeries or aesthetic concerns.

What to Ask Your Doctor

  1. What is the recommended age for cleft lip repair surgery?
  2. What are the potential risks and complications associated with cleft lip repair surgery?
  3. How many cleft lip repair surgeries have you performed, and what is your success rate?
  4. What is the expected recovery time and post-operative care for cleft lip repair surgery?
  5. Will there be any visible scarring after the surgery, and how can it be minimized?
  6. Will additional surgeries or procedures be necessary in the future for optimal results?
  7. What are the long-term effects of cleft lip repair surgery on speech and facial development?
  8. Are there any alternative treatments or techniques available for cleft lip repair?
  9. How should I prepare for cleft lip repair surgery in terms of diet, medication, and lifestyle changes?
  10. Can you provide me with before and after photos of previous cleft lip repair surgeries you have performed?

Reference

Authors: Raghuram AC, Jacob L, Wlodarczyk JR, Munabi NCO, Tomaro M, Nagengast E, Chong DK, Yao CA, Magee WP 3rd. Journal: J Craniofac Surg. 2021 Sep 1;32(6):2068-2073. doi: 10.1097/SCS.0000000000007635. PMID: 33770042