Unilateral cleft lip repair: Standardized key steps for Cupid's bow reconstruction

Chuanqi Qin; Yuting Wang; Jian Li; Huixi Jin; Quanmei Yan; Yuchuan Fu; Xiazhou Fu

doi:10.1016/j.jcms.2025.05.018

Unilateral cleft lip repair: Standardized key steps for Cupid's bow reconstruction

J Craniomaxillofac Surg. 2025 Jun 27:S1010-5182(25)00183-0. doi: 10.1016/j.jcms.2025.05.018. Online ahead of print.

Authors

Chuanqi Qin¹, Yuting Wang², Jian Li¹, Huixi Jin¹, Quanmei Yan¹, Yuchuan Fu¹, Xiazhou Fu³

Affiliations

¹ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
² State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
³ State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China. Electronic address: fuxiazhou@whu.edu.cn.

PMID: 40581493
DOI: 10.1016/j.jcms.2025.05.018

Abstract

Cleft lip repair is a complex and technically demanding surgery, performed by skilled surgeons. Improving surgical outcomes in cleft lip repair offers substantial benefits to patients, yet it remains a persistent challenge for surgical teams. To address this challenge, we developed a systematic protocol based on 40 years of refinements in 7400 cases. By deconstructing the procedure into defined steps, this framework aims to reduce procedural variability while preserving flexibility for case-specific adaptations. The stepwise approach was applied to establish a surgical procedure for Cupid's bow reconstruction in unilateral cleft lip repair, providing quantified, predictable, and repeatable steps for both surgeons and surgical teams. Five empirically refined steps were defined: landmarking; descending of Cupid's peak; correction of the Cupid's bow midline; reconstruction of subanatomical structure and the white roll of Cupid's bow; and restore the symmetry and coordination of Cupid's bow. Both immediate and long-term outcomes demonstrated good and stable results in Cupid's bow reconstruction in unilateral cleft lip repair. This protocol synthesizes four decades of surgical expertise into a reproducible framework, emphasizing adaptability to anatomical diversity while reducing reliance on subjective intraoperative decisions.

Keywords: Aesthetics; Cleft lip; Cupid's bow; Unilateral cleft lip repair.