Clinical Features and Management of a Median Cleft Lip

BACKGROUND: Median cleft lip is a rare anomaly consisting of a midline vertical cleft through the upper lip. It can also involve the premaxillary bone, the nasal septum, and the central nervous system. In our current report, we present the clinical features of 6 patients with a median cleft lip and their surgical management according to the accompanying anomalies. METHODS: From December 2010 to January 2014, 6 patients with a median cleft lip were reviewed. Five of these cases underwent surgical correction; alveolar bone grafting was performed in a patient with a median alveolar cleft. The surgical technique included inverted-U excision of the upper lip and repair of the orbicularis oris muscle. The mean follow-up period was 20.4 months (range, 7.4-44.0 months). RESULTS: The study patients presented various anomalous features. Five patients received surgical correction, 4 with repair of the median cleft lip, and one with iliac bone grafting for median alveolar cleft. A patient with basal sphenoethmoidal meningocele was managed with transoral endoscopic surgery for repair of the meningocele. Successful surgical repair was achieved in all cases with no postoperative complications. CONCLUSIONS: Relatively mild forms of median cleft lip can be corrected with inverted-U excision with good aesthetic outcomes. In addition, there is a broad spectrum of clinical features and various anomalies, such as nasal deformity, alveolar cleft, and short upper frenulum, which require close evaluation. The timing of the operation should be decided considering the presence of other anomalies that can threaten patient survival.

Two Cases of the Incomplete Upper Median Cleft Lip: New Classification

A median cleft lip has been broadly defined as any congenital vertical cleft through the center of the upper lip. In the Tessier 0 cleft, the location of the median cleft of the upper lip has a spectrum of dysmorphic gradation. This varies from a simple central vermillion notch to a wide cleft accompanied by a bifid nose and hypertelorism. Despite its extreme variability, the median cleft is quite rare and has a reported incidence amongst cleft patients alone of 0.43 to 0.73%. We experienced two cases of incomplete median cleft lip without other craniofacial anomalies. One of them who had reverse V-shaped defect of upper vermilion and fibrous band in her oral mucosa, was corrected with orbicularis oris muscle union and Z-plasty. The other patient had triangular shaped upper lip and deficiency of vermilion. We reviewed the classifications of median cleft lip and devised new classification, so that it helps understanding of median cleft lip.