Two Decades of Midline Cleft Lip Management: Insights from a Single Institution on a Rare Anomaly

BackgroundThe purpose of this study is to characterize the clinical features, associated anomalies, and surgical outcomes of patients with midline cleft lip (MCL).DesignRetrospective cohort study.SettingSingle tertiary craniofacial referral center.Patients, ParticipantsPediatric patients evaluated by the Plastic and Maxillofacial Surgery Division for repair of MCL between 2004 and 2024.InterventionsSurgical repair of MCL using wedge excision, straight-line closure ± triangular flaps, and/or release of aberrant orbicularis oris attachments.Main Outcome Measure(s)Surgical safety, postoperative complications, revision rate, and improvement in midline facial symmetry quantified by horizontal deviation of key landmarks from the facial midline using ImageJ software.ResultsTwenty patients were included; 60% had cleft lip and palate, and 40% had isolated cleft lip. Central nervous system anomalies were present in 65% of patients. One patient expired preoperatively. Median age at repair was 6.4 months, with a mean follow-up of 10.4 years. Surgical techniques included wedge excision, straight-line closure ± triangular flaps, and release of aberrant orbicularis oris attachments. No intraoperative complications occurred; two patients had major postoperative complications. Revisions were performed in 20% of patients. Image analysis showed a mean reduction in midline deviation for subnasale, labiale superius, and left crista philtri, indicating significantly improved symmetry for these landmarks.ConclusionsMCL is a rare anomaly often associated with central nervous system comorbidities. Repair was safe and resulted in improved midline symmetry confirmed by image analysis. The 20% revision rate highlights the need for continued refinement of surgical techniques and long-term management strategies.