Professional Documents
Culture Documents
Mo`men Mohmed
Bakr
History of the Procedure
repair, which preserved the Cupid's bow in 1952. The geometry of the
triangular flap was described by Randall, who popularized this method of lip
repair. Millard described the technique of rotating the medial segment and
advancing the lateral flap; thus, preserving the Cupid's bow with the
repair
Epidemiology and genetics
A. Incidence of cleft lip and of cleft lip and palate
2. The ratio of left (L) to right (R) to bilateral (B) clefts (L:R:B):
6:3:1.
a. Medications:
N.B. Most cases are sporadic (and multifactorial), but may be X-linked,
autosomal
a. Nasal alae.
b. Columella.
c. Philtral columns.
f. Tubercle.
g. Cupid's bow.
h. Wet-dry border: The vermilion-mucosa junction is the border between keratinized and
nonkeratinized mucosa.
2. Musculature.
a. Orbicularis oris.
(3)Inserts into the dermis at the vermilion border and the lower edge of
the
philtral columns.
c. Nasalis or depressor septi nasi muscle: The fibers run from the alveolar
bone into the medial crural footplates, skin of the columella and the tip of
3. Normal measurements.
5. Sensory innervation: The trigeminal nerve, cranial nerve (CN) V, maxillary division (V2).
6. Motor innervation: The facial nerve, CN VII, zygomatic and buccal branches.
B. Cleft lip anatomy.
b. Fibers insert into the alar base on the cleft (lateral) segment and into
the columella in the noncleft (medial) segment, as well as
intradermally.
c. Incomplete clefts.
(1)Simonart's band consists of a skin bridge across the nasal sill. It does not
usually contain any significant muscle mass.
(2) Some fibers may cross the cleft, if the cleft is less than two-thirds of lip
height.
d. Bilateral complete clefts: No muscle tissue is present in the prolabium.
2. Vertical lip length is decreased: Cupid's bow and the lip are rotated on both the
4. The alveolus and nostril floor are open in a complete cleft lip.
5. The premaxilla is rotated and protruding, especially in bilateral cleft lip, often
with
C. Alveolar segments
(1) The child may need special nipples or bottles (e.g., cross-cut nipple).
d. Otolaryngology: Children with cleft lip and palate have a high incidence
(4) If untreated, repeat otitis may affect hearing and speech development.
B. Wide clefts (>1 cm)
Additionally, the vertical scar that occupies the philtral column can be subject to
wound contracture. Such contracture can lead to shortening of the lip on the cleft
side with resultant vermilion notching and whistle deformity.
Finally the surgeon needs to be cautious when using the rotation advancement
technique to avoid excessive narrowing of the nostril sill on the cleft side. This can
lead to nasal vestibular stenosis as the wound matures.
Markings for unilateral cleft lip
repair with the rotation
advancement technique.
1. Center (low point) of Cupid’s bow
2. Peak of Cupid’s bow lateral,
noncleft side
3. Peak of Cupid’s bow, medial,
noncleft side
4. Alar base, noncleft side.
5. Columellar base noncleft side; X. Back
cut point, noncleft side.
6. Oral c ommissure noncleft
side.
7. Oral comm issure cleft side; 8.
Light scroll, cleft side.
9. Medial tip of advancement flap,
cleft side.
10.Midpoint of alar base cleft side.
11.Lateral alar base, cleft side.
12.Lateral alar base, extent of
E. Bilateral cleft lip repair
1.The premaxillary segment is often a
greater problem than in a unilateral
cleft lip.
2. Consider taping, lip adhesion, or
presurgical orthodontics (see above).
3. Most common techniques
a.Dissect the prolabium to maintain a
central skin flap to resemble the
philtrum.
b.Deepithelialize the remainder of the
prolabium.
c. Use the prolabial vermilion to