Primary Functional Cheilorhinoplasty in Unilateral Cleft Patients

The primary closure of the cleft lip palate is a challenging procedure. There is no consensus about which surgical technique provides the best outcome from a functional and aesthetic perspective. As cleft lip palate biology is the biology of displacement and not defect, a biological strategy should consider tissue adaption and restoration rather than defect filling. The objective of cheilorhinoplasty is to restore the anatomy of the nose and lip in a physiological manner by ensuring that the correct repositioning of the various structures (particularly those of the nose) is the consequence of two principles: the release of the dislocated structures (above all the alar cartilage) and the careful reconstruction of the nasolabial muscles. There is some debate about the kind of skin incisions. In general, skin line incision varies depending on the extent of retraction, elasticity of the skin, and the characteristics of the mucocutaneous rim (white roll). The skin incision approaches can be divided into a straight closure technique, a curved closure technique, or a triangular technique. There are no direct margins between these skin incision techniques, so a lot of approaches use a combination of these principles. There is becoming more consensus that the functional repair of cleft lip as described by Delaire, adhering to the principle of “Embryological surgery” in which the situation that existed at birth is recreated, is more important for the success of surgery than the kind of skin incision. The technique presented here is based on the approach invented by Delaire.