CC BY-NC 4.0 · Arch Plast Surg 2017; 44(03): 210-216
DOI: 10.5999/aps.2017.44.3.210
Original Article

Correction of Minor-Form and Microform Cleft Lip Using Modified Muscle Overlapping with a Minimal Skin Incision

Min Chul Kim
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
,
Dong Hun Choi
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
,
Sung Gun Bae
BL Plastic Surgery Clinic, Daegu, Korea
,
Byung Chae Cho
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
› Institutsangaben

Background In treating minor-form or microform cleft lip, obtaining an optimal result is a challenge because of the visible scarring caused by traditional surgery. We present a refined method using muscle overlapping with a minimal skin incision in patients younger than 3 years, a group characterized by thin muscle.

Methods The surgical technique involves restoration of the notched vermillion using Z-plasty, formation of the philtral column using overlapping of an orbicularis oris muscle flap through an intraoral incision, and correction of the cleft lip nasal deformity using a reverse-U incision and V-Y plasty. A single radiologist evaluated ultrasonographic images of the upper lip.

Results Sixty patients were treated between September 2008 and June 2014. The age at the time of operation ranged from 6 to 36 months (mean, 26 months). The follow-up period ranged from 8 to 38 months (mean, 20 months) in minor-form cases and from 14 to 64 months (mean, 37 months) in microform cases. A notched cupid's bow was corrected in 10 minor-form cases and 50 microform cases. Ultrasonographic images were obtained from 3 patients with minor-form cleft lip and 9 patients with microform cleft lip 12 months after surgery. The average muscle thickness was 4.5 mm on the affected side and 4.1 mm on the unaffected side.

Conclusions The advantages of the proposed procedure include the creation of an anatomically natural philtrum with minimal scarring. This method also preserves the continuity and function of the muscle and provides sufficient augmentation of the philtral column and nostril sill.



Publikationsverlauf

Eingereicht: 29. März 2017

Angenommen: 10. Mai 2017

Artikel online veröffentlicht:
20. April 2022

© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 Yuzuriha S, Mulliken JB. Minor-form, microform, and mini-microform cleft lip: anatomical features, operative techniques, and revisions. Plast Reconstr Surg 2008; 122: 1485-1493
  • 2 Cho BC. New technique for correction of the microform cleft lip using vertical interdigitation of the orbicularis oris muscle through the intraoral incision. Plast Reconstr Surg 2004; 114: 1032-1041
  • 3 Cho BC. Refined new technique for correction of the minor-form, microform cleft lip and minor-form bilateral cleft lip through the intraoral incision and long-term results. Plast Reconstr Surg 2011; 127: 781-783
  • 4 Mulliken JB. Double unilimb Z-plastic repair of microform cleft lip. Plast Reconstr Surg 2005; 116: 1623-1632
  • 5 Onizuka T, Hosaka Y, Aoyama R. et al. Operations for microforms of cleft lip. Cleft Palate Craniofac J 1991; 28: 293-300
  • 6 Desrosiers 3rd AE, Kawamoto HK, Katchikian HV. et al. Microform cleft lip repair with intraoral muscle interdigitation. Ann Plast Surg 2009; 62: 640-644
  • 7 Oyama A, Funayama E, Furukawa H. et al. Minor-form/microform cleft lip repair: the importance of identification and utilization of Cupid bow peak on the lateral lip. Ann Plast Surg 2014; 72: 47-49
  • 8 Cosman B, Crikelair GF. The minimal cleft lip. Plast Reconstr Surg 1966; 37: 334-340
  • 9 Sigler A, Ontiveros DS. Nasal deformity and microform cleft lip in parents of patients with cleft lip. Cleft Palate Craniofac J 1999; 36: 139-143
  • 10 Koh KS, Hwang CH, Kim EK. Modified design of Cupid's bow in the repair of unilateral microform cleft lip: in case of deficient distance between the midline and the cleft side Cupid's bow peak. J Craniofac Surg 2009; 20: 1367-1369
  • 11 Schlezinger NS. A study of the oral (orbicularis oris) reflex. Psychiatr Q 1938; 12: 629-649
  • 12 Millard DR. Cleft craft: the evolution of its Surgery. Vol I: the unilateral deformity. Boston: Little Brown; 1976
  • 13 Tajima S, Maruyama M. Reverse-U incision for secondary repair of cleft lip nose. Plast Reconstr Surg 1977; 60: 256-261
  • 14 Cronin TD. Lengthening columella by use of skin from nasal floor and alae. Plast Reconstr Surg Transplant Bull 1958; 21: 417-426
  • 15 Cho BC, Baik BS. Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty. Br J Plast Surg 2001; 54: 588-596
  • 16 Fara M. Anatomy and arteriography of cleft lips in stillborn children. Plast Reconstr Surg 1968; 42: 29-36
  • 17 Thaller SR, Lee TJ. Microform cleft lip associated with a complete cleft palate. Cleft Palate Craniofac J 1995; 32: 247-250
  • 18 Lee TJ. Clinical manifestation of microform cleft lip (Abstract). Korean Cleft Palate-Craniofacial Association Symposium 2003 Apr 19 Kwangju, Korea:
  • 19 Cho BC, Park JW, Baik BS. Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review. Ann Plast Surg 2002; 48: 131-137
  • 20 Cho BC. Correction of unilateral cleft lip nasal deformity in preschool and school-aged children with refined reverse-U incision and V-Y plasty: long-term follow-up results. Plast Reconstr Surg 2007; 119: 267-275
  • 21 van Hees NJ, Thijssen JM, Huyskens RW. et al. Quantitative ultrasound imaging of healthy and reconstructed cleft lip: a feasibility study. Cleft Palate Craniofac J 2007; 44: 261-268
  • 22 Kim SW, Jeong YW, Cheon JE. et al. Oribicularis oris muscle defects in philtral deformities in the repaired cleft lip. J Korean Soc Plast Reconstr Surg 2010; 37: 427-432