Reconstruction of orbicularis oris and levator labii superioris muscles insecondary repair of unilateral cleft lip

We devised a new method to repair the depression of the nasal floor and inf erolateral displacement of the alar base and to reconstruct the philtrum in the secondary repair of unilateral cleft Lip. Depression of the nasal floo r and inferolateral displacement of the alar base were corrected by advanci ng a lump of the levator labii superioris, the levator labii superioris ala eque nasi, and the upper part of the superficial orbicularis oris muscles t o the anterior nasal spine. When the depression of the nasal floor was too severe to repair using these muscles only, a cranially-based de-epitheliali sed flap of the scar region on the upper lip was inserted under the nasal f loor. The lower, greater part of the superficial orbicularis oris muscle wa s dissected to the nasolabial fold, brought towards the midline, and laid o n the surface of the same muscle on the medial side to be sutured. When the depression of the nasal floor was not severe, the lower, greater part of t he superficial orbicularis oris muscle was passed through a tunnel pierced beneath the de-epithelialised scar tissue and sutured to the corresponding components on the medial side to reinforce the philtral ridge. In both case s, if the deep orbicularis oris muscle in the vermilion had been interrupte d, it was reconstructed by end-to-end anastomosis. Operative results were e valuated in 76 patients using photographs taken preoperatively and postoper atively. Elevation of the nasal floor and correction of the alar base were achieved in most patients, while reconstruction of the philtrum was achieve d in cases in which the skin tension at the suture line was weak.