Clinical efficacy of different operative techniques for reconstruction of vermilion tubercle after primary repair of cleft lip / 中华医学美学美容杂志

Objective To evaluate the clinical repair effects of the reconstruction of different vermilion tubercle after primary cleft lip repair.Methods According to the tight lip deformity and dif ferent degrees of defect of the vermilion tubercle and exposing the gums and the crown of the anterior incisors,178 patients after primary repair of the cleft lip from Department of Oral and Maxillofacial Surgery of Xiangya Hospital,Central South University were classified into the tight lip deformity and four grades of whistling deformities.According to different deformities and defects,the different operative techniques were used as follows:classic Abbé flap and modified Abbé flap were used for tight lip deformity;the bilateral advanced myomucosal flaps of lip were used for the grade Ⅰ;modified Abbé flap was used for repairing the grade Ⅱ and the grade Ⅲ whistling deformities;for grade Ⅳ whistling deformity,we mainly used classic Abbé flap.The follow-up after operation was performed,all patient's Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip were observed.The scarring of the upper lip was also observed.Results The follow-up after operation was performed from six months to ninteen years,all the 187 patient's anatomical structures of the upper lip were nearly normal after recovery.The all patients showed an obvious Cupid's bow,Cupid's bow peak,the vermilion tubercle and the height and width of the upper lip.The relation of the upper lip and lower lip was harmonious.The scarring of the upper lip was not obvious 2 years after operation.Conclusions The different repair methods are chosen to repair different deformity and defect that has an important clinical value.

Configuration of Upper Lip in Newborn

Millard presented the concept of rotation advancement for unilateral cleft lip repair, and today this method of cleft lip closure is acknowledged by most as optimal in principle. However, it has been noted that this procedure occasionally can produce a scar that is symmetrical on the lower two-thirds of philtral column. The scar crosses the upper one third of the philtrum obliquely. The purpose of our study is to determine the configuration of the philtrum. 200 newborn infants were examined from June 1998 to September 1998. Mean gestational ages were 39 weeks and 5 days. Mean birth weight was 3226 gm. Multiple parameters such as philtral shape, nostril sill shape, vermilion shape, curvature of Cupid's bow, mean philtral length, mean white roll length, mean Cupid's bow length, and mean distance between both commissures were applied. An arbitrary classification of the philtrum was established to divide these infants into five groups. As a result, the parallel philtral column from nostril base to vermilion border(Type lla) was found to be the most popular type. Most common vermilion shape was protrusion type. Normal curve of Cupid's was most common. Mean values of philtral length, white roll length, Cupid's length, and distance between commissures were 8.3+/-1.1 mm, 13.9+/-1.3 mm, 5.7+/-1.0 mm, 24.7+/-2.3 mm, respectively. We believe this classification system will be useful for newborn infants evaluation and analysis, systemic planning and application of proper cleft lip repair procedure.