Clieilorrhuphv is the surgical correction of the cleft lip deformity; this term is derived from   junction by a seam or suture. It is usually the earliest
operative procedure used to correct cleft deformities and is undertaken as soon as medically possible. The cleft of the upper lip disrupts the important circumoral orbicularis oris musculature. The lack of continuity  of this muscle allows the developing parts of the maxilla to grow in an uncoordinated manner so that the cleft in the alveolus is accentuated. At birth the alveolar process on the unaffected side may appear to protrude from the mouth. The lack of sphincteric muscle control from the orbicularis oris will cause a bilateral cleft lip to exhibit a premaxilla that protrudes from the base of the nose and produces an unsightly appearance. Thus restoration of this muscular sphincter with lip repair has a favorable
effect on the developing alveolar segments. Ohicctivcs. The objectives of cheilorrhaphy are twofold: (1) functional and (2) esthetic. The cheilorrhaphy should  restore the functional arrangement of the orbicularis oris musculature to reestablish the normal- function of the upper lip. If muscle continuity is not restored across the area of the cleft, an esthetically unpleasing depression will result when the lip is brought into function. The second objective of cheilorrhaphy is to produce a lip that displays
normal anatomic structures, such as a vermilion tubercle, cupid’s bow, and philtrum. The lip must be symmetric, well contoured, soft, and supple, and the scars must be  Another esthetic necessity is to correct (at least
partially) the nasal deformity resulting from the cleft lip. Despite the skill of the’ surgeon, these ideal objectives are rarely achieved. H indrances are the poor quality of tissues in. the cleft margins and the distortion of structures
before surgical intervention. Several’ surgical techniques reproduce normal appearance immediately but do not maintain this appearance with growth. However, with care~l selection of surgical technique, satisfactory results
are obtainable.  appearence. As each :cleft is unique, so must be the surgical procedure. Countless techniques can be used for cheilorrhaphy, each designed to elongate the cleft margins to facilitate closure (Figs. 27-8 and 27-9). In , unilateral cases the unaffected side serves as a guide for
lip length and symmetry. A key point in design is to break up lines of the scar so to at with fibrosis and contracture, deformity of the lip will be minimized. In lips closed in a . linear fashion, scar contracture causes a characteristic notching of the upper lip. Attention to reorienting and
reuniting the musculature of the lip is of paramount importance if normal function is to be established. Cheilorrhaphy procedures serve to restore symmetry not only to the lip but also to, the nasal tip. With the cleft extending through the floor of the nose, the continuity of the nasal apparatus is disrupted: Without the bony . foundation for the alar cartilage, a collapse of the lateral aspect of the nose occurs, When the lip is closed, itis necessary to a(1’v’ar:ce.this laterally displaced tissue toward the midline. Thus cheiJorrhaphy is the first and one of the IPO~t important steps in correcting the nasal  comman  cleft patients.

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