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Current approaches to cleft lip revision

Garland, Katiea; Matic, Damirb

Current Opinion in Otolaryngology & Head and Neck Surgery: August 2019 - Volume 27 - Issue 4 - p 287–293
doi: 10.1097/MOO.0000000000000556
MAXILLOFACIAL SURGERY: Edited by Sherard A. Tatum
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Purpose of review Cleft lip repair requires multidisciplinary follow-up throughout a child's life and often requires lip revision surgery in adolescence to restore function and symmetry of the lip. There is significant variability in the approaches taken for lip repair and therefore a review of current techniques and subsequent guidance to secondary cleft lip repair is warranted.

Recent findings New methods of secondary reconstruction can be divided into superficial or muscle related. Recent suggestions for superficial reconstruction include botulinum toxin injection, silicone gel sheeting, local flap reconstruction, fat grafting, and CO2 laser ablation. Suggestions for muscular reconstruction include pedicled prolabial flaps, modified Abbe flap, and orbicularis oris eversion.

Summary Secondary cleft lip deformities can be classified as superficial or muscle related. Superficial problems require relatively minor treatments such as laser, local scar revisions, small local flaps, mucosal excision, or fat grafting. Muscle deformities generally require total lip revision and rerepair as a first step to achieving longstanding improvements in lip esthetics and function. Cleft lip revision should only be considered in concert with the patient, be based on the patient's concerns and desires, and offered at the appropriate timeline to improve social integration and/or psychosocial wellbeing.

aDivision of Plastic and Reconstructive Surgery, Western University, St. Joseph's Health Care

bDivision of Plastic and Reconstructive Surgery, London Health Sciences Centre, Victoria Hospital Campus, London, Ontario, Canada

Correspondence to Damir Matic, MD, MSc, FRCSC, Associate Professor, Plastic and Reconstructive Surgery, London Health Sciences Centre, Victoria Hospital Campus, Room E2-646, 800 Commissioners Rd E, London, ON, Canada. Tel: +1 519 685 8557; e-mail: Damir.matic@lhsc.on.ca

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