Chung Jeehyeok, Lim Joonho, Kim Sukwha, Koo Yountaek
From the Department of Plastic and Reconstructive Surgery, Myongji Hospital, Gyeonggi-do, Korea.
Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Korea.
Ann Plast Surg. 2019 Dec;83(6):655-659. doi: 10.1097/SAP.0000000000002012.
There are various methods to correct the whistle deformity in bilateral cleft lip. In case of the central deficiency with concomitant lateral excess, local tissue rearrangement can be used to reposition the lateral tissue. We designed bilateral lateral advancement flap with reinforcement of the orbicularis oris muscle.
Thirteen bilateral cleft lip patients with whistling lip deformity from July 2009 to February 2017 underwent our method of tubercle formation. Vertical upper lip measurements of upper lip were recorded. Augmentation percentage was documented using follow-up measurements compared with preoperative measurements. The average follow-up period was 16.2 months (range, 9-26 months). The axis of the flap and central incision were placed on the red line (wet-dry vermilion border). Dissection was performed through the submucosal plane. After entire dissection, inter-orbicularis oris muscle suture on both medial edge of the flap was performed. In case it was necessary, back-cutting incision on both curvature of the central orbicularis oris could facilitate central augmentation. Elevated superior and inferior trap-door flaps were trimmed to make natural central lip line along with the lateral mucosal flaps. Both lateral parts of vermilions were closed in V-Y advancement fashion.
The vertical height of central tubercle (T) had a mean increase of 136.9%, which was significantly different from preoperative measurement (P < 0.05). There were no surgical complications.
Our surgical method is safe, useful, and effective to correct the whistle deformity of the central deficiency with concomitant lateral excess.
双侧唇裂口哨畸形有多种矫正方法。对于中央组织缺损伴外侧组织过多的情况，可采用局部组织重排来重新定位外侧组织。我们设计了双侧外侧推进瓣并加强口轮匝肌。
2009年7月至2017年2月，13例患有口哨样唇畸形的双侧唇裂患者接受了我们的结节形成方法。记录上唇垂直高度的测量值。与术前测量值相比，使用随访测量记录增大百分比。平均随访期为16.2个月（范围9 - 26个月）。瓣的轴线和中央切口位于红线（干湿唇红缘）上。通过黏膜下层平面进行解剖。完全解剖后，在瓣的两侧内侧边缘进行口轮匝肌缝合。如有必要，在中央口轮匝肌的两个弯曲处进行回切切口可促进中央隆起。修剪抬高的上、下活板瓣，使其与外侧黏膜瓣一起形成自然的中央唇线。唇红的两侧部分以V - Y推进方式缝合。
中央结节（T）的垂直高度平均增加了136.9%，与术前测量值有显著差异（P < 0.05）。无手术并发症。
我们的手术方法对于矫正中央缺损伴外侧过多的口哨畸形是安全、有用且有效的。
