Muscle reconstruction during the primary surgical management of the cleft lip is a technique which may contribute to the functional and esthetic repair of cleft lips. Aim of this comprehensive review is to present the most contemporary views concerning the anatomy of the nasolabial area and the various surgical techniques for the cleft lip, based on the principles of the muscle reconstruction, as well as to discuss the clinical effectiveness of this technique according to the currently existing literature. Muscle reconstruction is based on the precise knowledge of the normal and pathologic anatomy of the nasolabial area, as well as of the growth pattern of the maxilla. In cleft lip patients, the normal anatomy of the paranasal muscles and the orbicularis oris muscle is disordered. This results to interruption of the anatomic connection between the primary and the secondary growth centers of the face, which leads to the characteristic appearance of the cleft lip. The precise repositioning of all the anatomical elements in their normal positions is feasible to be accomplished with various surgical techniques and it seems that this procedure may have more favorable results concerning the remaining growth of the maxilla. However, further evidence based research is still needed to confirm these results.