Bilateral complete cleft lip repair with augmentation of the central vermilion and use of intraoral palatal appliance

ABSTRACT

Repair of bilateral cleft lip is challenging and many procedures were developed to improve the results and shape of the lip and nose. A presurgical, passive, intraoral orthodontic palatal appliance is used to maintain the arch width to prevent the collapse that occurs with lip repair. The appliance is fitted as soon as possible after the first visit of the patient and removed just before the lip repair. Cheek-to-cheek tape is applied to return back the premaxilla within the palatal arch. Then, the repair reestablishes the skin and muscle continuity after separation of the orbicularis oris muscle from its overlying skin attachment and underlying mucosa. One important feature of the lip is the fullness of the central vermilion which is an important feature in the shape of the upper lip. Augmentation of the central vermilion is done by using a lateral advancement vermilion flap with utilization of the inferior prolabial vermilion for reconstruction of the central part of the vermilion. These studies evaluates the effect of augmentation of the central vermilion by inclusion of the prolabial vermilion in the reconstruction of the central part of the vermilion as regards the final shape of the lip and evaluate the benefit of presurgical intraoral palatal appliance in facilitating lip repair. The study was done on 42 patients. The repair of cleft lip was done at 3-4 months age. Intraoral palatal appliance was applied for all cases from attending the patients up to just prior to lip repair. Cheek to cheek tap for receding back the premaxilla was applied for all patients. Lip repair with orbicularis oris muscle reconstruction and inclusion of the prolabial vermilion in reconstruction of the central part of the vermilion was done 2-4 months following the palatal appliance. The complications as regards appliance application, vermilion thickness or deformity, Cupid's bow feature, dehiscence, incidence of nasolabial fistula, philtrum alignment and palatal expansion or collapse were recorded. Satisfactory results were achieved with this method. The Cupid's bow and the central part of the vermilion appeared more natural with easy lip repair. None of the patients developed dehiscence of the wound or nasolabial fistula. Nine developed noticeable scar and five developed lip discrepancy. Six patients developed contracture of the two lateral philtral scars