Teaching Unilateral Cleft Lip Repair Using a Standardized Geometric Landmark-Based Method: A 10-Year Educational Cohort Study

Abstract

Background: Accurate marking is a fundamental component of unilateral cleft lip repair. The Tennison–Randall technique uses predetermined anatomical landmarks and geometric relationships to design a triangular flap and restore lip height. Although the geometric nature of the technique provides a structured framework for operative planning, there is limited literature describing standardised methods for teaching this technique to plastic surgery residents.

We describe a 10-year educational experience using a standardised, landmark- and measurement-based method to teach unilateral cleft lip marking and repair to plastic surgery residents.

Methods: This retrospective educational cohort study included plastic surgery residents who received direct instruction in the Tennison–Randall technique at King Fahad Medical City Riyadh, Kingdom of Saudi Arabia, and during resident rotations over 10 years. The teaching method used a sequential series of fixed anatomical landmarks, bilateral measurements, measurement transfer, and geometric construction to reproduce the cleft-side Cupid’s bow and construct the Randall–Tennison triangular flap.

Residents were required to perform the marking themselves and subsequently perform unilateral cleft lip repairs under direct faculty supervision. Approximately 40 residents underwent training and collectively participated in approximately 400 unilateral cleft lip repairs involving complete and incomplete unilateral clefts.

Immediately following training, residents completed a three-item assessment addressing ease of cleft lip marking, understanding of the marking and operative procedure, and ability to demonstrate the technique to others. Each item was rated on a 5-point scale.

Results: Forty residents received training during the study period. All residents were able to demonstrate the standardised marking technique under direct faculty supervision and subsequently participated in operative repair under supervision.

Approximately 400 unilateral cleft lip repairs were performed by trained residents during the study period.

Thirty-six of the 40 residents completed the post-training assessment, giving a response rate of 90%. All respondents (36/36, 100%) rated each of the three educational domains 5/5.

Conclusions: A standardised landmark- and measurement-based approach provided a reproducible framework for teaching the geometric principles of the Tennison–Randall unilateral cleft lip repair. In this 10-year educational experience, 40 residents acquired the marking technique sufficiently to demonstrate it under supervision, and all questionnaire respondents reported the highest level of perceived learning across three educational domains. Prospective studies using objective technical-skill assessments are warranted to determine whether this approach reduces the learning curve for unilateral cleft lip repair.