J Korean Assoc Oral Maxillofac Surg.  2022 Dec;48(6):390-396. 10.5125/jkaoms.2022.48.6.390.

Surgical correction of cleft lip lower-lip deformity: a report of three cases

• Kim CY
• Ha SH
• Choi JY

• KMID: 2537566
• DOI: http://doi.org/10.5125/jkaoms.2022.48.6.390

Abstract

Cleft lip lower-lip deformity is a secondary deformity in patients who underwent primary cheiloplasty of the upper lip, characterized by an enlarged and anteriorly rotated lower lip. In these cases, soft-tissue imbalances remain even after skeletal correction with orthognathic surgery, and additional soft tissue treatment is required for lip harmony and esthetic facial balance in CLP (cleft lip palate) patients. This study describes three cases of transverse myomucosal excision of the lower lip for correction of cleft lip lower-lip deformity to restore facial esthetic balance. Each patient underwent orthognathic surgery, rhinoplasty, or upper lip revision cheiloplasty according to condition. Postoperatively, volume of the lower lip decreased and lip harmony was improved in all three patients. The surgeon should fully understand the anatomical structure around the lips and be able to evaluate overall harmony of the soft tissue. When a lower lip deformity is present, careful surgical planning and execution are important for each patient.

Keyword

Cleft lip lower-lip deformity; Secondary lip deformity; Lip reduction cheiloplasty; Lip harmony; Cleft lip and palate

Figure

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  Fig. 1 Surgical procedure of transverse myomucosal excision. A. Marking of incision lines in the shape of a curved ellipse. B. Excision including the submucosal tissue and part of the underlying orbicularis oris. C. Direct closure.

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  Fig. 2 A case of lower lip reduction using transverse mucosal resection and bimaxillary orthognathic surgery. (Left column) Preoperative clinical photo and lateral cephalogram. (Right column) Postoperative clinical photo and lateral cephalogram.

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  Fig. 3 A case of lower lip reduction using transverse myomucosal excision, upper lip cheiloplasty, and rhinoplasty. (Left column) Preoperative clinical photos and lateral cephalogram. (Right column) Postoperative clinical photos and lateral cephalogram.

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  Fig. 4 Surgical procedures of transverse myomucosal excision of the lower lip and W-plasty of the upper lip. A. Marking of incision lines on the upper lip. B. Excision on the tubercle area and elevation of triangular flaps. C. Transposition and suturing of the flaps. D. Marking of incision lines on the lower lip in the shape of an ellipse. E. Direct closure.

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  Fig. 5 A case of lower lip reduction using transverse myomucosal excision, upper lip cheiloplasty, and rhinoplasty. (Left column) Preoperative clinical photos. (Right column) Postoperative clinical photos.

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  Fig. 6 Surgical procedures of transverse myomucosal excision of both lips and lateral vermilion advancement of the upper lip. A. Marking of incision lines on skin above the white roll. B. Excision and direct closure of skin. C. Marking of incision lines on the upper lip. D. Mucosa, submucosal tissue, and part of the underlying muscle were excised. E. Marking of incision lines on the lower lip in the shape of an ellipse. F. Excision including the submucosal tissue and part of the underlying muscle. G. Direct closure.

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  Fig. 7 Schematic illustrations of transverse myomucosal excision.

Reference

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