Analysis of Philtral Unit Anatomy and Method of Philtral Column Formation in Unilateral Cleft Lip Repair

Uhm, Ki Il

Abstract

The philtral unit plays a key role in the appearance of the upper lip. And making the philtral column is extremely important in unilateral cleft lip repair for natural looking lip. Previously, we have been satisfied with the well matched white line & cupid bow, even though that is flat lip. But symmetrical upper lip and symmetrical philtral unit is necessitated So author analysed philtral column anatomy and cleft lip anatomy to make a symmetrical philtral unit, Ipsilateral orbicularis oris fiber attached to the philtral column, labial levator muscles including levator labii superioris and thickened dermis of philtral column area have the major role to make a philtral column. And in the cleft lip anatomy, deviation of septum and lateral muscle bulge were the obstacles to make a philtral cloumn in primary cleft lip repair. Author tried to make a philtral column in secondary cleft lip with several methods and concluded that it is not easy to get a satisfactory result. Based on upper trial and experience, author hypothesized two considerable points(prerequisites) in making a philtal column. 1) Relief of tension 2) Skin excess over the repaired muscle of the lip. To relieve tension, author used intraoral orthopedic appliance to narrow alveolar gap. The deviated septum was dislocated and fixed to the midline point and cinching was done. Supraperiosteal dissection near the pyriform apperture was also done. Above mentioned techniques are the solving way to fill the two prerequites. In the primary cleft lip repair, to get symmetrical philtral unit, author tried weakening of non-cleft side philtral column and formation of cleft side philtral column. To weaken the prominent philtral column, septum transfer to midline and cinching were performed. To prevent making nostril sill depression, the author performed lengthening technique of nasal lining flap of nostril sill area for reconstruction of the philtral column. lengthening of nostril sill area. Regarding lateral muscle bulge, spreading of muscle suturing are needed. Supraperiosteal dissection to release of insertion of labial elevator muscles and beveled incision of vertical incision has the effect of philtral column formation. We performed 462 cases of unilateral cleft lip repair from 1990 to 1999. In most cases, we did not get flat lip in the repaired cases and we could get good appearing of philtral unit. Author think primary repair is the optimal time and Millard technique and above mentioned methods are the method of choice to make a philtral column.