Research Of Reconstructing The Anatomic Subunits Of The Lip And Nose In Primary Bilateral Cleft Lip By Modified Millard Method

Objective:This study was to explore the surgical method and clinical effect for bilateral cleft lip with modified Millard operation. Consequently,appropriate individualized therapeutic schemes are designed for the patients with bilateral cleft lip.Methods:From Jun 2012 to May 2015 at the First Affiliated Hospital of Fujian Medical University, clinical and image data from 13 patients with bilateral cleft lip who were under the modified Millard operation were retrospectively analyzed. The operation include the principles of :(1)completely releasing orbicularis muscle to make it anatomic and functional repair,(2)reconstructing cupid bow and vermilion tubercle,(3)reproducting philtral column,(4) adequating the tip,(5)deepening labiogingival groove,(6)releasing and suspending alar cartilage,(7)adducting bilateral lateral nasal alar,(8)separating the oral vestibular from the nasal vestibular to make the ectopic tissue as possible back to normal position and reproduct the anatomic subunits of the nose and lip. The patients were followed up in the ways of home visiting, emailing photos or returning hospital.Results:Compared with the pre-operation, in all the 13 patients who were followed up from 3 to 18 months, the shape of nose and lip was improved. The bilateral clefts in the upper lip were completely closed. The vermilion tubercle and the reconstructed philtral columns were presented apparently. The cupid bow was smooth and upturn slightly from the ventral side. The lip peaks were apparent. The bilateral lateral nasal alar were adducted. The nasal sill were presented in the floor of the nose.The tip was adequated. The oral vestibular was separated from the nasal vestibular; the labiogingival groove was deepened. The anatomic subunits of the nose and lip were evident. The patients were satisfied with the outcome.Conclusions:The key point of repairing bilateral cleft lip is to release the orbicularis muscle which is attached to alar cartilage, and reduce the tension which is produced by suturing accurately in front of premaxilla. It offers the important way to reconstruct anatomy subunits of the lip, such as cupid bow, vermilion tubercle, philtral columns, labiogingival groove,by the method of retenting the white roll on the prolabium and fully usage of red lip elements from the cleft. It reduces the secondary nasal deformity of bilateral cleft lip and makes the secondary operation easy by the way of release and suspension of alar cartilage to restore the tip, columella, alar lateral crura, and nasal sill.