Philtral Ridge Projection in Repaired Unilateral Cleft Lip: Three-Dimensional Anthropometry

Abstract

Background: Cleft surgeons try to construct a philtral ridge during primary repair of a cleft lip, but rarely document the results. The authors used three-dimensional photogrammetry to measure projection of philtral ridges after closure of the common forms of unilateral labial cleft. Methods: This is a retrospective study of patients with unilateral complete, incomplete (moderate and severe), and microform cleft lip repaired by one surgeon from 2000 to 2013. Cleft type determined the technique for building a philtral ridge. The relative elevation of the ridge on the cleft versus noncleft side was measured on three-dimensional childhood photographs at two locations along the philtrum: just above the Cupid’s bow and at the midlabial level. Results: Thirty-four patients were evaluated at a mean age of 9.25 years. All cleft types exhibited greater projection at the philtral midlabial level compared with the Cupid’s bow level. The authors found a trend toward a more prominent cleft side philtral ridge in microforms. In incomplete cleft lips, there was slightly greater philtral ridge projection in severe forms repaired after a preliminary nasolabial adhesion compared with those repaired in a single stage. There was similar projection of the cleft side ridge in two-stage complete and single-stage repaired incomplete lips. Conclusions: It is possible to construct a philtral ridge that is as prominent as the noncleft side in all types of unilateral cleft lip. Increased muscle thickness may explain the slightly increased philtral ridge projection in patients with an incomplete cleft repaired in two stages compared to one-stage closure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Three-Dimensional Anthropometry for Evaluating Philtrum Contour in Patients With Unilateral Cleft Lip: Comparison Between Photographic Assessment and 3-Dimensional Anthropometry

“…Ganske et al 21 also measured the philtrum heights of patients with unilateral cleft lip using a 3D camera. The anteroposterior philtrum heights from the dimple were assessed in these patients.…”

Modified Unilateral Incomplete Cleft Lip Repair with Primary Nasal Overcorrection: A Muscle-Driven Technique

“…The current muscle-driven technique of unilateral incomplete cleft lip repair 1 is based on the lessons learned from four decades of experience in cleft care, 2 then delivered by Dr. Noordhoff and now by the senior author (L.J.L.). Technical modifications have been introduced over time to enhance surgical outcome and reduce the surgical burden of care, 3 which is in line with the Noordhoff's motto: "You must constantly progress and enhance your surgical techniques and results pursuing the excellence in cleft care!" 2 displacement of the affected nasal alar base.…”

“…In addition, the four-suture technique described in the authors' Figure 4 for muscle reconstruction has crossed the midline of the face, which means that in the process of separation, the relatively normal anatomical structure of the philtrum may have been destroyed, which is rare in previous surgical principles. 3 We hope that the authors will provide a detailed description.…”

Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study

“…1 and 2), displaying the lip height-related measurements, was standardized according to previous studies. 12,13,[41][42][43][44] Cropped two-dimensional frontal before-andafter photographs 45,46 (Fig. 3) were rated for scar quality by two external blinded plastic surgeons using a 10-point visual analogue scale.…”

“…espite efforts to consistently build a normalappearing philtrum during primary cleft lip repair, [1][2][3][4][5][6][7][8][9][10][11][12][13] morphologic abnormality of the philtral ridge could be a point of dissatisfaction for patients and parents, requiring surgical revision. [14][15][16][17][18][19][20][21][22] However, no optimal approach exists to improve philtrum symmetry and projection.…”