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Force Balance Reconstruction of the Orbicularis Oris in Secondary Unilateral Cleft Lip Deformity

  • Original Articles
  • Facial Skeleton
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Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Secondary unilateral cleft lip deformities are commonly observed in patients with cleft lip and traditional surgical methods can’t completely tackle this problem. The purpose of this study was to evaluate the outcomes of a novel surgical technique using force balance reconstruction of the orbicularis oris.

Methods

53 patients with secondary unilateral cleft lip deformity were included in this study, in which the orbicularis oris muscle was reconstructed symmetrically to achieve optimal force balance. Photometric 2d indexes were employed to evaluate the outcome of 27 patients, and 3d indexes for the remaining 26 patients. Aesthetic evaluation and parent-patient satisfaction surveys were also recorded.

Results

Significant differences were found in the following: (1) LH (the lip height), LW (the lip width), D1(the vertical distance from the white roll to the vermilion bottom at the christa philtra points) and D2(the vertical distance from the christa philtra points to the facial midline) when comparing preoperative and postoperative 2D images; (2) LH, LW, D1 and D2 when comparing preoperative and follow-up 2D images; (3) RMS (root mean of square) when comparing preoperative and postoperative 3D images. Aesthetic evaluation in the follow-up period was a mean of 4.29, while parent-patient satisfaction of the overall appearance was a mean of 4.41.

Conclusions

The results suggest this new muscle reconstruction technique can significantly improve the surgical outcome of secondary unilateral cleft lip deformities.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.”

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References

  1. Allori AC, Mulliken JB (2017) Evidence-based medicine: secondary correction of cleft lip nasal deformity. Plast Reconstr Surg 140:166e–176e

    Article  CAS  PubMed  Google Scholar 

  2. Monson LA, Khechoyan DY, Buchanan EP, Hollier LH (2014) Secondary lip and palate surgery. Clin Plast Surg 41:301–309

    Article  PubMed  Google Scholar 

  3. Cho BC (2004) New technique for correction of the microform cleft lip using vertical interdigitation of the orbicularis oris muscle through the intraoral incision. Plast Reconstr Surg 114:1032–1041

    Article  PubMed  Google Scholar 

  4. Naidoo S, Bütow KW (2019) Philtrum reconstruction in unilateral cleft lip repair. Int J Oral Maxillofac Surg 48:716–719

    Article  CAS  PubMed  Google Scholar 

  5. Li L, Xie F, Ma T, Zhang Z (2015) Reconstruction of philtrum using partial splitting and folding of orbicularis oris muscle in secondary unilateral cleft lip. Plast Reconstr Surg 136:1274–1278

    Article  CAS  PubMed  Google Scholar 

  6. Huang H, Han Y, Akinade T, Li J, Shi B, Li C (2020) Force balance reconstruction of the orbicularis oris in unilateral incomplete cleft lip. J Plast Reconstr Aesthet Surg 73:1717–1722

    Article  PubMed  Google Scholar 

  7. Li C, Shi B (2019) Advances in reconstruction of nasolabial symmetry in cleft lip. Chin J Med Aesth Cosmet 25:530–531

    Google Scholar 

  8. Li C, Han Y, Shi B (2019) Clinical results of the new rotational advancement method for reconstruction of nasolabial symmetry. Chin J Med Aesth Cosmet 447–451

  9. Garcia de Mitchell CA, Pessa JE, Schaverien MV, Rohrich RJ (2008) The philtrum: anatomical observations from a new perspective. Plast Reconstr Surg 122:1756–1760

    Article  CAS  PubMed  Google Scholar 

  10. Verhoeven TJ, Coppen C, Barkhuysen R, Bronkhorst EM, Merkx MA, Bergé SJ, Maal TJ (2013) Three dimensional evaluation of facial asymmetry after mandibular reconstruction: validation of a new method using stereophotogrammetry. Int J Oral Maxillofac Surg 42:19–25

    Article  CAS  PubMed  Google Scholar 

  11. Desmedt DJ, Maal TJ, Kuijpers MA, Bronkhorst EM, Kuijpers-Jagtman AM, Fudalej PS (2015) Nasolabial symmetry and esthetics in cleft lip and palate: analysis of 3D facial images. Clin Oral Investig 19:1833–1842

    Article  PubMed  Google Scholar 

  12. Asher-McDade C, Roberts C, Shaw WC, Gallager C (1991) Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J 28: 385-390; discussion 390-391.

  13. Grewal NS, Kawamoto HK, Kumar AR, Correa B, Desrosiers AE, Bradley JP (2009) Correction of secondary cleft lip deformity: the whistle flap procedure. Plast Reconstr Surg 124:1590–1598

    Article  CAS  PubMed  Google Scholar 

  14. Park CG, Ha B (1995) The importance of accurate repair of the orbicularis oris muscle in the correction of unilateral cleft lip. Plast Reconstr Surg 96:780–788

    Article  CAS  PubMed  Google Scholar 

  15. Mulliken JB, Martínez-Pérez D (1999) The principle of rotation advancement for repair of unilateral complete cleft lip and nasal deformity: technical variations and analysis of results. Plast Reconstr Surg 104:1247–1260

    Article  CAS  PubMed  Google Scholar 

  16. Cho BC, Baik BS (2000) Formation of philtral column using vertical interdigitation of orbicularis oris muscle flaps in secondary cleft lip. Plast Reconstr Surg 106:980–986

    Article  CAS  PubMed  Google Scholar 

  17. Rogers CR, Meara JG, Mulliken JB (2014) The philtrum in cleft lip: review of anatomy and techniques for construction. J Craniofac Surg 25:9–13

    Article  PubMed  Google Scholar 

  18. Seagle MB, Furlow LT (2004) Muscle reconstruction in cleft lip repair. Plast Reconstr Surg 113:1537–1547

    Article  PubMed  Google Scholar 

  19. Fan Q, Li Y, Danning Z, Zhang B, Chen S, Wang J (2015) “Three-unit” muscle reconstruction in secondary cleft lip repair. Cleft Palate Craniofac J 52:88–95

    Article  PubMed  Google Scholar 

  20. Jiang C, Zheng Y, Ma H, Yin N (2021) Muscle flap reconstruction based on muscle tension line groups to repair the philtrum of patients with microform cleft lip or secondary cleft lip. J Craniofac Surg. https://doi.org/10.1097/SCS.0000000000008127

    Article  PubMed  Google Scholar 

  21. Lim AA, Allam KA, Taneja R, Kawamoto HK (2012) Construction of the philtral column using palmaris longus tendon. Plast Reconstr Surg 129:374e–375e

    Article  CAS  PubMed  Google Scholar 

  22. Wei J, Zhang J, Herrler T, Zhang Y, Li Q, Hua C, Dai C (2020) Philtrum reconstruction using a triangular-frame conchae cartilage graft in secondary cleft lip deformities. J Craniofac Surg 31:1556–1559

    Article  PubMed  Google Scholar 

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Funding

Research and Develop Program, West China Hospital of Stomatology, Sichuan. LCYJ2019-10 and LCYJ2019-12

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Author notes

  1. Yu Chen and Chong Zhang have contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, Sichuan, People’s Republic of China

    Yu Chen, Chong Zhang, Meilin Yao, Chialing Tsauo, Bing Shi & Chenghao Li

  2. Division of Plastic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    David W. Low

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  1. Yu Chen
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  2. Chong Zhang
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  4. Chialing Tsauo
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  5. Bing Shi
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Contributions

YC and CZ contributed to conception, design, data acquisition, analysis, and interpretation, drafted the manuscript; MY and CT contributed to data acquisition, analysis; BS and DWL contributed to conception and data interpretation; CL contributed to conception, design, data interpretation, drafted and critically revised the manuscript. All authors have approved the manuscript and agree with submission to Aesthetic Plastic Surgery.

Corresponding author

Correspondence to Chenghao Li.

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Our research has got the review and approval of medical ethics committee of West China Stomatology Hospital of Sichuan University, and the IRB number is WCHSIRB-D-2017-143.

Informed Consent

Informed consent was obtained from all participants in this study.

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Supplementary Information

Below is the link to the electronic supplementary material.

266_2024_4110_MOESM1_ESM.jpg

Supplementary file1 Supplemental Figure 1. Surgical Procedure. a. Markings were made with Bonnie blue ink to indicate the christa philtri, the labrale superioris, the columella base, the subnasale, and the alare; b. An “M” incision was made along the junction of the wet and dry vermillion; c. Central excess muscle on the non-cleft side was split to form a muscle flap, which was rotated toward the vermilion tubercle and secured; d. The deep layer of orbicularis oris muscles was sutured in the midline to ensure the muscle force balance on both sides of the midline; e. The superficial layer of muscles on the non-cleft side, the subcutaneous tissue of the upper lip, the superficial layer of muscles on the cleft side, and the deep muscles were sutured together at the midline; f. The red lip mucosa was sutured gradually from the sides to the middle.

266_2024_4110_MOESM2_ESM.tif

Supplementary file2 Supplemental Figure 2. 2D Photographs Measurement. LH = lip height; LW = lip width; D1 = vertical distance from the white roll to the vermilion bottom at the christa philtri points; D2 = vertical distance from the christa philtri points to the facial midline.

266_2024_4110_MOESM3_ESM.jpg

Supplementary file3 Supplemental Figure 3. 3D photographs measurement. a. The original image was trimmed and corrected for the position of the bilateral points of the endocanthion; b. A mirror image was created using the Symmetry Analysis Tool, which was paired and overlapped with the original image; c. A trapezoidal region was enclosed by the bilateral points of the alare and the chelion; d. A distance map was created and the RMS (root mean of square) of all values were calculated and displayed by the Histogram Tool.

Supplementary file4 Video. The procedure of the force balance reconstruction of orbicularis oris.

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Chen, Y., Zhang, C., Yao, M. et al. Force Balance Reconstruction of the Orbicularis Oris in Secondary Unilateral Cleft Lip Deformity. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04110-1

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