Unilateral cleft lip repair treatment outcomes using triangular flap and rotation-advancement techniques: A systematic review

Introduction
Cleft lip and palate is a common congenital facial malformation that significantly impacts deve­lopmental, physical, and psychological aspects of patients and their families. It is essential to measure treatment outcomes in cleft surgery to evaluate cleft management in the era of evidence-based medicine.

Objectives
This review aimed to analyze and compare outcomes of two primary unilateral cleft lip repair techniques, such as triangular flap and rotation-advancement.

Material and methods
Articles were retrieved from PubMed, Medline, Cochrane Library, and ScienceDirect based on PRISMA guidelines, to find relevant articles published between 1990-2021. Two reviewers independently appraised articles in separate rounds. A total of 1,241 articles were retrieved. However, only eight studies were selected based on inclusion criteria.

Results
The rotation-advancement technique group showed better results in the shape of nostril and the length of Cupid’s bow, but with a higher finding of notching and nasal deformities. Meanwhile, the triangular flap technique group showed better results in philtral height, Cupid’s bow shape, vermilion height, lip height, and nasal width, despite having a more significant number of nasal defect formations compared with the rotation group.

Conclusions
The triangular flap and rotation-advancement techniques have their respective advantages and disadvantages. Nevertheless, post-operative deformities can be found in some cases, including asymmetry of Cupid’s bow, flattened philtrum, elongated white lip, tilted columella, and flattened ala nasi. Further systematic review studies should be conducted to analyze treatment outcomes of primary cleft lip surgery in other techniques, according to various measurement methods.