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The Reconstruction of the Central Tubercle in Bilateral Cleft Lips

Bilateral Lateral Mucosal Advancement Flap With Reinforcement of the Orbicularis Oris Muscle

Chung, Jeehyeok MD, PhD*; Lim, Joonho MD; Kim, Sukwha MD, PhD; Koo, Yountaek MD

doi: 10.1097/SAP.0000000000002012
Head and Neck Surgery

Background There are various methods to correct the whistle deformity in bilateral cleft lip. In case of the central deficiency with concomitant lateral excess, local tissue rearrangement can be used to reposition the lateral tissue. We designed bilateral lateral advancement flap with reinforcement of the orbicularis oris muscle.

Method Thirteen bilateral cleft lip patients with whistling lip deformity from July 2009 to February 2017 underwent our method of tubercle formation. Vertical upper lip measurements of upper lip were recorded. Augmentation percentage was documented using follow-up measurements compared with preoperative measurements. The average follow-up period was 16.2 months (range, 9–26 months). The axis of the flap and central incision were placed on the red line (wet-dry vermilion border). Dissection was performed through the submucosal plane. After entire dissection, inter-orbicularis oris muscle suture on both medial edge of the flap was performed. In case it was necessary, back-cutting incision on both curvature of the central orbicularis oris could facilitate central augmentation. Elevated superior and inferior trap-door flaps were trimmed to make natural central lip line along with the lateral mucosal flaps. Both lateral parts of vermilions were closed in V-Y advancement fashion.

Result The vertical height of central tubercle (T) had a mean increase of 136.9%, which was significantly different from preoperative measurement (P < 0.05). There were no surgical complications.

Conclusions Our surgical method is safe, useful, and effective to correct the whistle deformity of the central deficiency with concomitant lateral excess.

From the *Department of Plastic and Reconstructive Surgery, Myongji Hospital, Gyeonggi-do, Korea

Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea

Received February 22, 2019, and accepted for publication, after revision May 6, 2019.

Conflicts of interest and sources of funding: none declared.

Reprints: Yountaek Koo, MD, Department of Plastic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. E-mail:

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Online date: August 8, 2019

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