Principles of Cleft Lip Repair: Conventions, Commonalities, and Controversies

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We read with great interest the article from Marcus et al. entitled “Principles of Cleft Lip Repair: Conventions, Commonalities, and Controversies.”1 The authors describe the evaluation and management of unilateral and bilateral cleft lip (with or without cleft alveolus and with or without cleft palate) in a very comprehensive review.
They underscored the work performed by Mohler regarding the description of the anatomical variants of the philtrum.2 In clinical practice, we also realize that we found many vertical philtrum columns, rather than curvilinear philtrum columns. The philtrum is one of the most important anatomical structures in the preoperative evaluation of the patient. Philtral anatomy is a complex relationship between components of orbicularis oris muscle and overlying dermis. For unilateral cleft lip repair, eversion of orbicularis oris muscle is necessary to build a philtral ridge.3
In our opinion, among the various surgical techniques reviewed by Marcus et al. for the unilateral cleft lip repair, the Fisher technique allows the maximum respect of the philtrum—in particular, the column proximal to the cleft.4 As Fisher reported, the technique derives from a variety of previously described repairs and adheres to a concept of anatomical subunits of the lip. The repair allows for a repair line that ascends the lip at the seams of anatomical subunits, with the almost total respect of the philtrum column.
Another crucial aspect is the reconstruction of alveolus cleft, through periosteoplasty.5 The technique described by Massei guarantees the preservation of vascular supply and the osteogenic activity of the periosteum, with satisfactory new bone production.
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