Introduction

Clefts of the lip and palate are one of the most common congenital facial malformations described in humans. They remain, however, poorly understood and present a significant challenge for reconstruction.

Early records of successful repairs of clefts of the lip exist in Eastern texts and the earliest recorded case of a successful repair of a cleft lip appears to be around ad 390 in China. Over the centuries, many techniques have been reported to disguise the visible deformities of cleft lip or the occlusion with cleft lip and palate, as well as surgical techniques for their repair.

Surgeons dealing with clefts of the lip and palate today must recognise that although significant advances have been made in surgical and anaesthetic technology, the techniques of repair are far from perfect and remain an area of immense controversy and intense debate.

An understanding of the management of cleft deformities requires a knowledge of the embryology of the face and the classification of cleft deformity. The structural abnormalities that comprise the cleft deformity dictate the patient management and, in particular, the surgical procedures employed. These will be discussed in turn (Table 16.1).

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