Two-staged tubercle plasty using a banked prolabial vermilion island flap for bilateral cleft lip

We evaluated the effectiveness of a novel two-staged tubercle plasty method utilizing banked vermilion tissue of the prolabium to reconstruct a natural and esthetically pleasing median tubercle in patients with bilateral cleft lip.

A retrospective observational study was conducted on 20 patients (13 boys and 7 girls) with bilateral cleft lip who underwent primary cheiloplasty with oral-side banking of the prolabial vermilion at our institution between 2009 and 2024. At preschool age (5-6 years), a second-stage tubercle plasty was performed in conjunction with secondary alveolar bone grafting. Anthropometric measurements (philtral height, vermilion height of the upper lip, and total labial height) were assessed pre- and postoperatively and compared with age-matched normal controls. The morphology of the upper lip and degree of wet vermilion exposure were evaluated on a four-point scale (excellent, good, fair, and poor) before and after the revision surgery.

All patients underwent successful procedures without complications. The vermilion and total labial heights were significantly increased (both p=0.031), while philtral height remained unchanged. At 6-131 months of follow-up, lip morphology was significantly improved (p=0.021) and wet vermilion exposure was reduced (p=0.008).

Two-staged tubercle plasty using banked vermilion tissue of the prolabium is an effective technique for correcting an upward convex deformity of the upper lip in patients with bilateral cleft lip. This method preserves native lip tissue during the primary repair and allows for natural median tubercle construction at a later stage. Additional studies with larger cohorts and long-term follow-up are warranted to validate these findings.