Advancements in Postoperative Cleft Lip Scar Management: Current and Emerging Techniques, a scientific review

Cleft lip with or without palate is the most common orofacial malformation. Cleft lip has a general incidence of 1/700 live birth. The rate of incidence, as well as the rate of developing secondary complications related to improper healing and hypertrophic scarring varies with ethnicity and population. Cleft lip can be either unilateral or bilateral. It can be either part of a syndrome or isolated. Isolated unilateral cleft lip is the most common subtype, especially among males. The exact aetiology of isolated cleft lip is not known, but it is believed to be a mix between both genetic and environmental factors. Almost Every cleft lip baby that is born is subjected to surgical primary repair. Which is the initial surgery performed around the 3rd of month of life that aims to fix the functional and aesthetical comorbidity of the cleft. Unfortunately, every surgery ultimately leads to the formation of a scar. The scar is aesthetically unpleasing, especially if it is hypertrophic. Scarring in the orofacial carries many functional, as well as psychological problems to the affected individual. Such as deformed philtrum, Cupid's bow asymmetry, tight upper lip, and whistle deformity. The philtrum is a crucial and sensitive part of the orofacial area, a scar in the philtrum can affect both the nose and the upper lip. Leaving the individual vulnerable to social stigma that might cause them to have low self-esteem and overall insatisfaction with their external appearance. Thus, it is mandatory to acknowledge the significance of the problem of post-surgical scarring in cleft lip patients. This thesis will collect scientific literature data about the methodologies that have currently attempted and used in order to treat cleft lip scarring. Some of the methodologies used are preventive; meaning that they were used during the surgery or straight after in order to facilitate the formation of a more aesthetically pleasing scar when compared to the control population. Botulinum toxin A injections, IPL, and silicone gel taping are examples of such methodologies. On the other hand, other methodologies have focused on the surgical approach, treating the scar as a secondary complication of cleft lip. Attempts to improve the scarring surgically include fat grafting with cutaneous flaps, microdermal flaps, advancement flaps, orbicularis oris reconstruction, etc… Both of the methodologies described above have been proven to be effective in producing a more aesthetically pleasing and functioning scar according to data collecting from patients that have been evaluated with the VSS (Vancouver Scar Scale)/ VAS (Visual Analogue Scale), or with scar width measurements - where specific measuring points within the cleft upper lip scar were indicated. There is currently not enough data to establish the best effective treatment regarding upper cleft lip scar management. But with the current data, it is possible to perform some sort of comparison using the values obtained from the different scar measurement scales in different studies. In order to allow the patient to live their life with the best aesthetic and functional results possible, it is important to establish a cleft lip scar protocol that would focus on prevention of hypertrophic scarring with specific methods that will be described in this thesis. The protocol should also focus on patients that already are dealing with the secondary deformities related to cleft lip scarring, Offering them surgical solutions that aim to attenuate the burden of the scar. In conclusion, post-surgical cleft lip scarring comes with a heavy burden to the patient, the current most commonly used methodology to produce better scarring is the use of silicone gel and creams. But according to the data in different studies, it is possible to potentially achieve better results using other methodologies, such is IPL Laser accompanied by fractional co2 laser or Botulinum toxin A injections.