Secondary bilateral cleft lip repair: An orbicularis oris muscle reorientation technique for philtrum reconstruction

Traditional surgical approaches typically involve end-to-end suturing of the orbicularis oris muscle during cleft lip repair. However, this method often leads to a flattened lip and requires subsequent secondary revision surgery. This retrospective single-arm study aims to evaluate the efficacy and aesthetic improvement of an orbicularis oris muscle reorientation technique for philtrum reconstruction in correcting secondary bilateral cleft lip nasolabial deformities. From October 2020 to January 2024, 34 patients with secondary bilateral cleft lip nasolabial deformities were included, with ages ranging from 16 to 36 years. The orbicularis oris muscle reorientation technique was employed to address nasolabial deformities. In the 34 patients, the nasolabial morphology was significantly improved postoperatively, with successful reconstruction of the vermilion tubercle (Ls-Sto) and the philtrum structure. The Ls-Sto thickness increased from an average preoperative of 7.02 ± 2.63 mm to 11.33 ± 3.04 mm. The extremely large columellar base (CobR-CobL) was reduced by 24.5 %, and the Cupid's peak distance (ChpR-ChpL) was reduced by 18 %. The convexity of the philtral ridge and the concavity of the philtral dimple were significantly enhanced. This study demonstrates that the orbicularis oris muscle reorientation technique is an effective approach for correcting secondary bilateral cleft lip nasolabial deformities. It successfully constructs a three-dimensional philtral ridge and achieves significant morphological improvement with stable outcomes observed during the 7-month follow-up period.