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The cleft lip deformity has always held a central position in the history and practice of plastic surgery. Providing an opportunity for combining the art and practicality of surgical technique, the restoration of such an obvious deformity is extremely satisfying. Despite the presence of this procedure for over 3000 years, surgical management has evolved dramatically only in the past 100 years. This field provides a beautiful example of surgical evolution and multidisciplinary approach, “standing on the shoulders of those before us.” Evidence-based techniques are a challenge in this area because of difficulties in longitudinal follow-up and variations in surgeon techniques. However, many of the recent changes described in this review have been gathered through years of experience and presented through peer-reviewed journals.
From these experiences I have tried to include major changes that have occurred in the management of cleft lip repair over the last 10 years. Included is the increasing acceptance of the need for the “cleft center” with its multispecialty component, especially in the area of early postnatal intervention (e.g., feeding, information gathering).
Nasal reconstruction has become more of a presence in the primary cleft lip repair in both the unilateral and bilateral cleft patient. Orthodontic involvement in the cleft patient has also increased, not only in the area of presurgical manipulation but also in centers that practice bone grafting at the time of the primary repair.
Finally, new approaches to training surgeons both in the United States and abroad are discussed with examples of computer-assisted programs that may allow better standards of care throughout the world.
Without a doubt, this issue is not complete. Controversies remain within the listed topics, and exclusions exist regarding techniques and philosophies of many who practice this craft. However, I hope this review provides some guidance to major shifts that have taken place in the specialty of cleft lip repair. Thanks to all of the outstanding contributors who again challenge the younger generation to continue to strive for “perfection” and never be satisfied.