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Rectangular Flap for Horizontal Upper Vermilion Tightness in Secondary Cleft Lip Deformity

Park, Beyoung Yun M.D.; Roh, Tai Suk M.D
Plastic and Reconstructive Surgery: December 1999
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Radical paring of the cleft edge during a primary cleft operation or repeated secondary surgeries can result in tightness of the upper lip. The degree of the resulting side-to-side tension can vary, from mild cases for which improvement is sought through realignment of the misplaced oral sphincter muscle in secondary revision, to severe cases for which the possibility of a lip switch flap must be considered. When the lip tightness accompanies more than three-quarters loss of the Cupid's bow, an Abbé flap is an alternative. However, the lip switch flap is far from ideal, in both artistic and functional perspectives, and should be avoided if at all possible in mild to moderate degrees of lip tightness.

This study presents a method of correcting horizontal cleft upper lip tightness, especially of the vermilion. The method involves local transfer of an inferiorly based rectangular flap from the relatively redundant upper twothirds to the lower one-third of the upper lip and vermilion. Primary indications for the technique include vermilion tightness with half to three-quarters loss of Cupid's bow. The method has the advantage of supplementing the horizontal lip dimension on the cleft side and restoring a natural Cupid's bow, thereby repositioning the shifted philtral column and adding fullness to the lower one-third of the upper lip. Incorporation of the upper lip scar in the rectangular flap removes ugly scars and spares the lower lip from surgical violation. The orbicularis sphincter function, as seen in facial animation, was well regained. Twenty unilateral and three bilateral cases with a maximal follow-up period of 4.5 years are presented. (Plast. Reconstr. Surg. 104: 1976, 1999.)

From the Department of Plastic and Reconstructive Surgery, Yonsei University, College of Medicine, Severance Hospital. Received for publication October 27, 1998; revised April 23, 1999.

Presented at the 55th Annual Meeting of the American Cleft Palate-Craniofacial Association, in Baltimore, Maryland, in April of 1998.

Beyoung Yun Park, M.D.

Department of Plastic Surgery Yonsei University College of Medicine C.P.O. Box 8044 Seoul, Korea

D. Ralph Millard, M.D. 1444 NW 14th Avenue Miami, Fla. 33125

©1999American Society of Plastic Surgeons