ABSTRACT

Secondary cleft surgery can present a reconstructive challenge significantly greater than that of the initial deformity. The surgeon is frequently managing postsurgical deformities after having little or nothing to do with the primary procedure as teams and protocols evolve over time and surgeons move. The appearance and function of the mended cleft lip are greatly impacted by the initial repair at infancy. When the ala is left behind in the initial surgery, regardless of attempted soft-tissue correction and camouflaging techniques, facial harmony can only be accomplished when the hard tissue problems have been addressed. A complete takedown of the lip should be considered if there are significant issues with lip height or symmetry, nasal symmetry, substantial vermilion/white roll mismatches or a dehiscent orbicularis oris. Revision palatoplasty in an effort to avoid the morbidity of pharyngoplasty is an attempt to restore functional continuity to the palatal muscles and length to the palate.