CC BY-NC-ND 4.0 · Indian J Plast Surg 2009; 42(S 01): S62-S70
DOI: 10.1055/s-0039-1699378
Review Article
Association of Plastic Surgeons of India

Primary unilateral cleft lip repair

H. S. Adenwalla
Department of Plastic Surgery, Burns, Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies, Jubilee Mission Medical College & Research Institute, Trichur-680 005, Kerala, India
P. V. Narayanan
Department of Plastic Surgery, Burns, Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies, Jubilee Mission Medical College & Research Institute, Trichur-680 005, Kerala, India
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2020 (online)


The unilateral cleft lip is a complex deformity. Surgical correction has evolved from a straight repair through triangular and quadrilateral repairs to the Rotation Advancement Technique of Millard. The latter is the technique followed at our centre for all unilateral cleft lip patients. We operate on these at five to six months of age, do not use pre-surgical orthodontics, and follow a protocol to produce a notch-free vermillion. This is easy to follow even for trainees. We also perform closed alar dissection and extensive primary septoplasty in all these patients. This has improved the overall result and has no long-term deleterious effect on the growth of the nose or of the maxilla. Other refinements have been used for prevention of a high-riding nostril, and correction of the vestibular web.


  • 1 Rose W. On Harelip and Cleft Palate. In: Lewis HK, editor. London: 1891.
  • 2 Thompson JE. An artistic and mathematically accurate method of repairing the defects in cases of harelip. Surg Gynecol Obstet 1912;14:498.
  • 3 Peet E. The Oxford technique of cleft palate repair. Plast Reconstr Surg Transplant Bull 1961;28:282-94.
  • 4 Mirault G. Deux lettres sur l'operation du bec-de-lievre. J Chir Paris 1844;2:257.
  • 5 Blair VP, Brown JB. Mirault operation for single harelip. Surg Gynecol Obstet 1930;51:81.
  • 6 Brown JB, McDowell F. Simplified design for repair of single cleft lips. Surg Gynecol Obstet 1945;80:12-26.
  • 7 LeMesurier AB. A method of cutting and suturing the lip in the treatment of complete unilateral clefts. Plast Reconstr Surg 1949;4:1.
  • 8 Hagedorn W. Uber eine Modifikation der Hasenschartenoperation. Zentralbl Chir 1884;11:756.
  • 9 Hagedorn W. Die Operation der Hasenscharte mit Zickzacknarbe. Zentralbl Chir 1892;19:281.
  • 10 Tennison CW. The repair of unilateral cleft lip by the stencil method. Plast Reconstr Surg 1952;9:115-20.
  • 11 Randall P. A triangular flap operation for the primary repair of unilateral clefts of the lip. Plast Reconstr Surg 1959;23:331-47.
  • 12 Sawhney CP. Geometry of single cleft lip repair. Plast Reconstr Surg 1972;49:518-21.
  • 13 Millard DR Jr. A primary camouflage of the unilateral harelip. In: Transactions of the First International Congress of Plastic Surgery. Stockholm: 1957. p. 160-6.
  • 14 Millard DR Jr. Cleft Craft: The Evolution of its Surgery. Vol.1. Page 182. The Unilateral Deformity. Boston: Little, Brown and Co; 1976.
  • 15 Gillies, H. And Millard DR. The Principles and Art of Plastic Surgery. Vol. 1. Boston: Little Brown and Company; p. 51.
  • 16 Wilhelmsen HR, Musgrave, RH. Complications of cleft lip surgery. Cleft Palate J 1966;3:223.
  • 17 Latham RA. Orthopedic advancement of the cleft maxillary segment: a preliminary report. Cleft Palate J 1980;17:227-33.
  • 18 Latham RA, Kusy RP, Georgiade NG. An extraorally activated expansion appliance for cleft palate infants. Cleft Palate J 1976;13:253-61.
  • 19 Grayson B, Santiago P, Brecht L. Presurgical orthopedics for cleft lip and palate. In: Aston S, Beasley C, Thorne C, editors. Grabb and Smith's Plastic Surgery. Philadelphia: Lippincott-Raven; 1997. p. 237-44.
  • 20 Pai BC, Ko EW, Huang CS, Liou EJ. Symmetry of the nose after presurgical nasoalveolar molding in infants with unilateral cleft lip and palate: a preliminary study. Cleft Palate Craniofac J 2005;42:658-63.
  • 21 Noordhoff MS, Chen YR, Chen KT, et al. The surgical technique for the complete unilateral cleft lip-nasal deformity. Operative Techniques Plast Reconstr Surg 1995;2:167-74.
  • 22 Narayanan PV, Adenwalla HS. Notch-free vermillion after unilateral cleft lip repair: The Charles Pinto Centre Protocol. Indian Journal of Plastic Surgery 2008;41:167-71.
  • 23 McComb H. Primary correction of unilateral cleft lip nasal deformity: a 10-year review. Plast Reconstr Surg 1985;75:791-9.
  • 24 Berkeley WT. The cleft lip nose. Plast Reconstr Surg 1959;23: 567OE75.
  • 25 Salyer KE. Primary correction of the unilateral cleft lip nose: a 15-year experience. Plast Reconstr Surg 1986;77:558OE66.
  • 26 Trott JA, Mohan N. A preliminary report on open tip rhinoplasty at the time of lip repair in unilateral cleft lip and palate: The Alor Setqr experience. Br J Plast Surg 1993;46:363.
  • 27 Thomas C, Mishra P. Open tip rhinoplasty alongwith the repair of cleft lip in cleft lip and palate cases. Br J Plast Surg 2000;53:1.
  • 28 Huffmann WC, Lierle DM. Studies on the pathologic anatomy of the unilateral hare-lip nose. Plast Reconstr Surg 1949;4:225.
  • 29 Gillies H, Millard DR. The Principles and Art of Plastic Surgery. Vol. 2. Boston: Little Brown and Company; p. 327.
  • 30 Smahel Z, Müllerovñ Z, Nejedlý A. Effect of Primary Repositioning of the nasal septum on facial growth in unilateral cleft lip and palate. Cleft Palate Craniofac J 1999;36:310-4.
  • 31 Anderl H, Hussl H, Ninkovic M. Primary simultaneous lip and nose repair in the unilateral cleft lip and palate. Plast Reconstr Surg 2008;121:959-70.
  • 32 Jackson IT. In: Plastic Surgery in Infancy and Childhood. Edited by Mustarde JC. Jackson IT, editor. 3rd ed. Churchill Livingstone; 1988.
  • 33 Lehmann JA Jr, Artz JS. The minimal Cleft Lip. Plast Reconstr Surg 1976;58:306.
  • 34 Thomson HG. Clinical Evaluation of Microform Cleft Lip Surgery. Plast Reconstr Surg 1985;75:800-3.
  • 35 Charles Pinto. Personal communication with the senior author.
  • 36 Ariyan S, Krizek TJ. A simplified technique for correction of the cleft lip nasal deformity. Ann Plast Surg 1978;1:568.
  • 37 Tajima S, Maruyama M. Reverse-U incision for secondary repair of cleft lip nose. Plast Reconstr Surg. 1977 Aug;60(2):256-61.