Functional cleft lip repair: a sequential, layered closure with orbicularis muscle realignment.

A lip repair based on anatomic and electric stimulation studies of the orbicularis muscle in unilateral cleft lip has previously been reported by one of the authors. Following some early modifications, this technique has been used on 125 primary lip repairs. The details of the present technique are described here. The advantages of the procedure, in addition to its functional reconstruction of the orbicularis muscle, are in its applicability to clefts of all widths and superior scar formation. The sequential nature of the procedure and freedom from commitment to a fixed, measured pattern at the outset makes the teaching of the method easier and the achievement of a pleasing result more predictable.