Application of vermilion flap and functional reposition of orbicularis oris in reconstruction of unilateral cleft lip

Objective To investigate the clinical effect of vermilion flap and functional repair of orbicularis oris in reconstruction of unilateral cleft lip by using the vermilion flap and functional reposition of orbicularis oris based on the design of Millard technique. Methods From September,2010 to December,2015,76 cases of congenital unilateral cleft lip underwent orbicularis oris degloving anatomy,functional reposition,reconstruction of nasal basal and muscle remodeling,and vermilion flap.For the upper lip,Millard technique was conducted on flexible use of the"4","7" fixed point method to effectively decrease the height of the affected lip,and to reset the anatomy of the upper lip tissue;For vermilion zone,the vermilion-mucosal junction (red line) of Noordhoff technique was used to embed and align vermilion flap and obtain a plump appearance;For function repair,orbicularis oris muscle degloving anatomical technique was used to reconstruct nasal basal and upper lip orbicularis oculi muscle,thus to achieve functional recovery. Results All 76 patients were achieved primary healing.Fifty-seven cases were followed up for 3 months to 30 months.Fifty-four cases at static state were with satisfactory upper lip shape,neat lip to lip,aligned and symmetrical peaks on both sides,plump lip beads,obvious philtrum ridge in the affected lip and aligned with the normal side,not obvious scar in upper lip;At the dynamic state,without obvious ectopic stretch,deformation and local depression formation in upper lip due to muscular movement.Three cases were with upper lip scar hyperplasia,slightly local skin red and hard,slightly protruding the surface of the skin,the repaired lip slightly shorter than the contralateral lip,ipsilateral lips appear sunken at the dynamic state. Conclusion The modified Millard technique can effectively reduce the upper lip,when combined with vermilion flap and orbicularis oris functional reconstruction,a satisfactory repair for congenital unilateral cleft lip can be obtained both in anatomy and function.The design is simple and flexible,which is worthy of promoting in clinic.