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Functional reconstruction of the philtral ridge and dimple in the repaired cleft lip
Suk Wha Kim1, Myungjune Oh, Jong Lim Park
1Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, Seoul, Korea. kimsw@snu.ac.kr
Insights
This study presents a simple surgical technique for functional philtral ridge reconstruction in children with repaired cleft lip. The method effectively improved philtral ridge and dimple appearance, offering satisfactory aesthetic and functional outcomes.
Area of Science:
- Plastic Surgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Cleft lip repair can result in philtral deformities, including groove and lateral bulging.
- Restoring the philtral ridge and dimple is crucial for facial aesthetics and function after cleft lip repair.
Purpose of the Study:
- To describe a straightforward surgical method for functional reconstruction of the philtral ridge in patients with repaired cleft lip.
- To evaluate the efficacy of this technique in improving philtral ridge and dimple aesthetics.
Main Methods:
- Functional reconstruction of the philtral ridge was performed in 21 children with orbicularis oris dehiscence.
- The technique involved muscle realignment, vertical incision and repair with mattress sutures, and dermal suture for dimple accentuation.
- Postoperative evaluation used visual scales for philtral ridge eminence and dimple depth at rest and during maximal pucker.
Main Results:
- Preoperative philtral ridge was characterized by grooves or flatness.
- Postoperative results showed improved philtral ridge prominence, approaching normal appearance at rest and during pucker.
- Philtral dimple improved from none or slight to slight or prominent.
Conclusions:
- The described functional reconstruction technique yields satisfactory results for philtral ridge and dimple formation in repaired cleft lip patients.
- This method offers a viable solution for addressing philtral deformities, enhancing both form and function.
Abstract:
Our report describes a simple method of functional reconstruction of the philtral ridge in patients with repaired cleft lip. Philtral reconstruction was performed in 21 children with dehiscence of the orbicularis oris in repaired cleft lip. Prominent groove at the philtral column and lateral bulging during maximal "pucker" were the indications. First, the abnormally inserted orbicularis muscle is freed and realigned in a normal horizontal orientation. The muscle is vertically incised and repaired with vertical mattress sutures, spreading out the muscle to increase the thickness of the philtral ridge. The philtral ridge is accentuated by deepening the dimple with a dermal suture at the midline. Postoperative evaluation was performed at 8-18 months (mean; 13.1 months). The philtrum was evaluated by a panel using two visual scales. Eminence of the philtral ridge was scored by a five-point grading scale and the philtral dimple was scored by a three-point grading scale, both at resting and at maximal pucker. Preoperative scores showed the philtral ridge to be from "prominent groove" to "flat" at maximal pucker and at rest, respectively. Postoperative scores showed improvement of the philtral ridge to "less prominent than the normal philtral ridge" both at rest and at maximal pucker. The philtral dimple preoperative scores ranged from "no dimple" to "slight dimple" and postoperative improvement to "slight dimple" to "prominent dimple." This technique of functional reconstruction of the philtrum gave satisfactory results in formation of the philtral ridge and dimple, both at rest and at maximal pucker.