Primary Goals of Cheiloplasty (Cleft Lip Repair)
The primary goals of cheiloplasty are to restore normal anatomy and functionality of the lip, achieve optimal aesthetic appearance, and establish proper muscular continuity to support normal facial growth and development. 1, 2, 3
Functional Goals (Priority)
The functional objectives directly impact morbidity and quality of life and must be prioritized:
Restore muscular continuity across the cleft by properly realigning the orbicularis oris muscle, which is essential for normal lip function including feeding, speech articulation, and facial expression 1, 4
Establish proper lip seal to enable normal feeding mechanics and prevent oral incompetence, which can affect nutrition and speech development 2, 5
Create adequate lip length by utilizing rotation-advancement techniques that address the inherent vertical deficiency on the cleft side 4, 3
Preserve nasal function through primary septal repositioning, which provides stability for balanced nasal growth and prevents progressive deformity 4
Aesthetic Goals
While secondary to functional outcomes, aesthetic restoration significantly impacts psychosocial development:
Achieve symmetrical cupid's bow with proper positioning of the philtral peaks to restore normal lip contour 3
Minimize visible scarring by placing incisions along natural aesthetic boundaries and avoiding vertical tension on closure 4
Restore normal vermillion architecture including the white roll and vermillion-cutaneous junction 3
Correct nasal deformity including alar base positioning and columellar length, though definitive rhinoplasty is typically deferred 1, 4
Timing Considerations
Optimal timing for primary cheiloplasty is typically 3-6 months of age when the infant has adequate weight gain and anesthetic risk is acceptable, though this must be balanced against the "rule of 10s" (10 weeks, 10 pounds, hemoglobin 10 g/dL). 2
Early repair (before 6 months) facilitates normal bonding between parent and child and reduces psychological impact on the family 2
Palatoplasty should be prioritized over secondary lip revision when both are needed, as palate repair around 1 year of age is critical for speech development and middle ear function 2
Common Pitfalls to Avoid
Inadequate muscle dissection and realignment leads to persistent functional deficits and poor aesthetic outcomes requiring secondary revision 6, 5
Excessive tension on closure results in vertical scar contracture, lip notching, and widening of the scar over time 4
Neglecting primary nasal correction allows progressive deformity as the child grows, making secondary correction more difficult 4
Failing to address the entire deformity in bilateral cases, particularly premaxillary positioning, compromises both function and aesthetics 7
Special Considerations for Adult Patients
When performing primary cheiloplasty in adults with previously unrepaired clefts, expectations must be adjusted:
Functional improvement is achievable but anatomical distortions from years of abnormal growth limit aesthetic outcomes 5
Premaxillary repositioning may be required in bilateral cases and can be performed simultaneously with lip repair in adults 7
Psychosocial benefit justifies intervention despite less-than-perfect results, as even modest improvement significantly impacts quality of life 5