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Rare Median Cleft-Lip Repair With Novel Surgical Procedures Using Bilateral Cleft Margin Flaps

Kang, Songsu, MD; Imai, Keisuke, MD; Masuoka, Takeshi, MD; Sakahara, Daisuke, MD; Kawamoto, Koji, MD; Tsumoto, Jumpei, MD

doi: 10.1097/SCS.0000000000004891
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Reports of median cleft lip with nasal anomalies are few, and descriptions of concomitant surgical repair of a median cleft lip and bifid nose deformity are similarly rare. These surgical repair techniques mainly involve the use of normal neighboring structures. Reconstruction of the columella and nasal base is especially important. A new surgical procedure was examined using bilateral cleft margin flaps for patients with a rare median cleft lip. Two patients with a rare median cleft lip were indicated for the procedure. One patient was 3 months old at surgery, and the other patient was 6 months old. These patients underwent single-stage reconstruction of the lip and nose. The new surgical procedure is characterized by the reconstruction of the columella, which involves creating a supportive structure using a cleft margin flap; subsequently, an anterior covering is created using a hinge flap from the nasal tip. Upper lip formation is performed by repair of the orbicularis oris muscle and rotation advancement of a cutaneous and mucosal flap from the lateral segments. The postoperative follow-up period was 4 to 5 years. The postoperative appearance was satisfactory in both patients. Furthermore, no significant complications were observed postoperatively. In conclusion, the surgical procedure with bilateral cleft margin flaps described in this report allows for successful reconstruction of a median cleft lip. This procedure is effectively tissue saving and results in satisfactory outcomes, which are maintained over a long term.

Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, Osaka, Japan.

Address correspondence and reprint requests to Keisuke Imai, MD, Department of Plastic and Reconstructive Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan; E-mail: imai-k@abox3.so-net.ne.jp

Received 21 March, 2018

Accepted 9 July, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.