The role of scar massage in cleft lip surgery

Introduction: Despite advances in surgical technique for cleft lip, minimal evidence exists for methods of scar management, particularly scar massage. Some parents express concern that lip massage creates pain and distress to their children. This study aims to determine whether scar massage has enough cosmetic advantage to justify its use. Method: We reviewed 33 unilateral complete cleft lip repairs performed at our institution. Information on repair technique, suture material and scar management were recorded. Parent questionnaires and clinical photography were used with a panel of eight trained blinded observers asked to assess photos taken 24 months postoperatively. Scars were graded using a scale of 1 (very poor) to 5 (excellent). Twenty patients were included. Ethics approval was obtained from The Royal Children’s Hospital Melbourne Research Ethics and Governance office with HREC reference number QA/60562/RCHM-2019. Results: Frequency of scar massage was not associated with a better scar score (p= 0.36). Both the technique of repair and type of suture material used had greater effect on scar grading than massage therapy. Discussion: Problematic scarring following cleft lip surgery is a challenging outcome. This is the first study aiming to explore the effect of scar massage following cleft lip surgery. Conclusion: We found no conclusive evidence to support the use of scar massage in the postoperative care of cleft lip patients. Limitations include the retrospective nature of the study, low patient numbers and heterogeneity of surgical techniques. Nevertheless, there was no correlation seen between the frequency of massage and scar quality. Lip scar massage can cause significant pain to patients and distress to their family, warranting further studies to justify its use.