What is the recommended surgical intervention for managing an incomplete cleft lip?

Surgical Management of Incomplete Cleft Lip

Cheiloplasty is the recommended surgical intervention for managing an incomplete cleft lip, with the procedure typically performed around 1 year of age to achieve optimal functional and aesthetic outcomes. 1

Diagnosis and Initial Assessment

• Diagnosis of cleft lip is strictly clinical and does not require radiographic imaging for initial identification 1
• A comprehensive palatal examination and speech/language assessment by cleft/craniofacial specialists should be performed at diagnosis 1
• Speech/language assessments should begin at 6-18 months of age and continue routinely thereafter 1
• CT examination is only indicated for treatment planning purposes, not for routine diagnosis 1

Surgical Timing and Approach

• Overt cleft lip and palate are typically repaired around age 1 year, as this allows for adequate development while minimizing speech and feeding issues 1, 2
• For incomplete cleft lip specifically, the surgical approach should focus on:
  • Repair of the median tubercle using lateral labial elements 3
  • Restoration of normal lip contour and function 4
  • Creation of a symmetrical Cupid's bow and philtral columns 3

Surgical Technique Considerations

• The surgical technique should address:

  • Proper alignment of the vermilion border 4
  • Restoration of the orbicularis oris muscle continuity 4
  • Creation of adequate philtral height and vermillion fullness 3
  • Formation of a well-shaped Cupid's bow 3

• Key aesthetic checkpoints for successful repair include:

  • Philtrum length, shape, and depth 5
  • Vermilion thickness and border definition 5
  • Cupid's bow peak formation 5
  • Nostril shape symmetry (if nasal involvement) 5

Post-Surgical Management

• Lubricate lips with lip balm or lip cream to promote healing 6
• Maintain good oral hygiene with a soft toothbrush and mild fluoride-containing toothpaste 6
• Avoid irritants that may delay healing, including spicy foods, hot foods and drinks, and citrus fruits 6
• Regular follow-up with the cleft team is essential to monitor healing and functional outcomes 1

Special Considerations

• For children with associated syndromes (e.g., 22q11.2 deletion syndrome), additional factors affecting speech development require more intensive monitoring 2, 1
• Early implementation of augmentative communication (e.g., sign language) may be recommended to promote language use and help avoid frustration in children with speech difficulties 2, 1
• Continued monitoring for otitis media with effusion and hearing loss should continue throughout childhood 1

Potential Complications and Follow-up

• Common complications requiring revision surgery include:
  • Widened philtral scars 7
  • Lateral vermilion bulging 7
  • Asymmetry of the lip 7
• Long-term follow-up is essential, as patients with cleft lip may require multiple interventions throughout development 8
• Revision lip/nose surgery may be needed during growing age (approximately 20-30% of cases) or after skeletal maturity (50-70% of cases) 8

Emerging Approaches

• Some centers are exploring early cleft lip repair (before 3 months of age) to take advantage of the high degree of plasticity within the nasal cartilage and maxilla 9
• This approach has shown promising results with a low complication rate (2%) and improvements in anthropomorphic measurements 9
• However, the standard approach of repair around 1 year remains the most widely accepted practice 1