Approach Considerations
Perform a thorough physical examination, not limited to the head and neck region, to uncover associated anomalies in the infant presenting with a unilateral cleft lip with or without a palatal cleft. Additional workup is determined by physical findings that suggest involvement of other organ systems.
The child's weight, oral intake, and growth and/or development are of primary concern and must be followed closely. Routine laboratory studies typically are not required, other than a hemoglobin study shortly before the planned lip repair.
Although routine imaging is considered to be unnecessary in a healthy patient with isolated cleft lip, a study by Tse et al demonstrated the efficacy of three-dimensional (3D) stereophotogrammetry for anthropometric evaluation of the unilateral cleft lip in preoperative planning, to better assess outcomes in the nasolabial form. [15] A study by Mercan et al also demonstrated the usefulness of preoperative 3D stereophotogrammetry in predicting postoperative outcomes, in patients with unilateral cleft lip nasal deformity. [16]
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Figure illustrates important anatomic landmarks used in all cleft lip repairs. Measurements of various distances are used to guide the surgeon in creating a symmetric lip.
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The Rose-Thompson repair involves curved or angled paring of the cleft margins to lengthen the lip as a straight-line closure.
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Hagedorn-LeMesurier repair. The medial lip element is lengthened by introducing a quadrilateral flap developed from the lateral lip element.
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Tennison-Randall repair. The medial lip element is lengthened by introducing a triangular flap from the inferior portion of the lateral lip element.
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Skoog repair. The medial lip element is lengthened by introducing two small triangular flaps developed from the lateral lip element.
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Millard repair. The medial lip element [R] is rotated inferiorly and the lateral lip element [A] is advanced into the resulting upper lip defect. The columellar flap [C] is then used to create the nasal sill (see text for details).
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Millard repair. Two of the most common variations described with utilization of the C Flap to correct the hemi-columellar deficiency (Millard II] and the nasal sill alar base region [Millard I]
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Millard repair. With maximal rotation of the R flap, any residual lip length discrepancy can be corrected with an inferior Z-plasty or a triangular flap. In a secondary correction, further rotation of the R flap can be considered.
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Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
