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Musculovascular pattern in the myrtiform area: implications for cleft lip reconstruction
S Gschwindt1, A A Mueller2, B K Benitez2
1Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary.
International Journal of Oral and Maxillofacial Surgery
|March 26, 2026
Summary
This study clarifies the myrtiform muscular system (MMS) in cleft lip repair. Repositioning the MMS origin restores facial anatomy and function, improving cleft lip-nose repair outcomes.
Area of Science:
- Anatomy and surgical reconstruction
- Craniofacial morphology
- Plastic surgery
Background:
- The myrtiform area is crucial for facial aesthetics and function but is poorly understood in cleft lip reconstruction.
- Existing literature lacks detailed documentation of the perioral musculovascular structures relevant to cleft lip repair.
Purpose of the Study:
- To investigate the morphological characteristics of perioral musculovascular relationships.
- To determine the surgical implications of these findings for cleft lip-nose repair.
Main Methods:
- Examination of 21 adult and 3 fetal human specimens.
- Morphological analysis of the myrtiform muscular system (MMS) and associated vasculature.
- Intraoperative observations during cleft lip-nose repair procedures.
Main Results:
- The MMS comprises nasalis, myrtiformis, and depressor septi nasi muscles, with W-type (69.2%) and V-type (30.8%) patterns identified.
- Variations in arterial supply to the alar region were mapped (Types A-D).
- Cleft lip-related displacement distorts muscular vector orientations, despite generally normal muscle attachments.
Conclusions:
- A novel surgical approach involving detaching and repositioning the MMS origin can restore the natural alar-facial groove in cleft lip-nose repair.
- This technique corrects cleft-induced muscular vector distortion and preserves anatomical alar base insertion, enabling realignment with minimal dissection.
