Philtral Construction by Composite Skin-Muscle Rotation and Orbicularis Oris Muscle Advancement in Secondary Cleft Lip Deformity

Abstract

The authors describe a method of philtral construction in a secondary cleft lip deformity to achieve better philtral definition and natural lip animation. The operation begins with a skin incision based on the usual design of secondary revision. Subcutaneous undermining is then performed laterally, and medially up to the line of the new philtral ridge, where the lip is divided vertically to the mucosa. A wedge-shaped flap is developed in the medial lip by dissecting from the posterior mucosal wound edge toward the cutaneous midline up to the dermis. The composite skin-muscle flap is thus elevated and rotated 90 deg on the axis of the cutaneous midline to form the philtral ridge. The orbicularis oris muscle is reapproximated in the midline by advancing the lateral orbicularis segment. The wedge-shaped flap is placed over the advanced orbicularis, and the skin is closed. Ten consecutive patients, followed for more than 6 months, were evaluated. In all patients the lip showed a well-defined philtrum with sufficient thickness and smooth continuity. Natural lip animation was also reproduced. Purportedly, the composite skin-muscle rotation provides a well-defined philtrum, and the midline approximation of the orbicularis muscle provides natural lip animation.

Haramoto U, Kamiji T, Takagi S, Kubo T, Yoshioka N, Hosokawa K. Philtral construction by composite skin-muscle rotation and orbicularis oris muscle advancement in secondary cleft lip deformity. Ann Plast Surg 2000;45: 485-490