Unilateral Cleft Lip Repair: Reproducibility, Accessibility, and Durability.

Abstract

Unilateral cleft lip (UCL) repair has evolved significantly over the past decades. In certain areas of the world, barriers such as limited surgical expertise, lack of equipment, and restricted access to general anesthesia make cleft care challenging. Simplified, reliable, reproducible, and time-tested techniques are essential to ensure equitable outcomes and reduce the need for revision surgeries. With over 4 decades of refinement, the technique described in this chapter incorporates key maneuvers that yield consistent results. It is easy to teach and applicable to all cleft severities, including wide clefts, and across healthcare settings. This technique empowers providers and promotes long-term, sustainable primary UCL repair through reproducibility, accessibility, and durability. Key maneuvers described in this chapter include the following: (1) simplified and effective surgical markings, (2) the Hamdan Sliding V-Cheiloplasty for appropriate orbicularis muscle repair, and (3) the cartilage-sparing rhinoplasty, using an alar base flap and suspending suture (ABFSS), double interdomal sutures, transverse crural and alar crease transfixion sutures, and soft triangle suspending sutures.