Primary repair of bilateral cleft lip and nasal deformity

Traditional repair of bilateral cleft lip focused on labial closure but acc entuated the nasal deformities, which were addressed later. By the end of t he past century, single staged labial closure had replaced the old multista ged procedures and the technical emphasis had begun to shift from secondary to primary nasal correction. Now, presurgical maxillary orthopedics sets t he bony foundation for synchronous nasolabial repair and for closure of the alveolar clefts. The study of normal nasolabial growth and the typical sti gmata of the conventional methods provides the necessary foreknowledge to g uide surgical sculpture in three dimensions and to anticipate the fourth di mension. The convergence of several forces are changing referral lines for children born with bilateral cleft lip. These include affirmation of center s of excellence, surgeons' self-regulation, prenatal diagnosis, economics o f health-care delivery, and increasing parental sophistication. These press ures are not necessarily in conflict. Care by a sub-specialized plastic sur geon and experienced team is in the best interests of the child and the thi rd-party payer.