Occult cleft lip is a more special type of cleft lip, whose main characteristic is the absence of cleft in the white lip skin and mucosa, mainly manifested as red lip cut, white lip stripe-like fibrous tissue and nasal deformities such as nasal wing collapse, wide transverse nostril, and depression of the nasal base on the affected side. As the mildest type of cleft lip, although its upper lip skin is not cleft, its basic pathologic anatomy is the same as that of a completely cleft upper lip. There are breaks and ectopic stops of the orbicularis oris muscle fibers, abnormal nasal cartilage structure, and insufficient skin on the affected side of the nasal columella. Due to the functional abnormal pulling effect of the muscles, untimely treatment may cause aggravation of nasolabial deformity and cause difficulties in later revision. Therefore, the lip and nose deformity of occult cleft lip should be repaired as a whole in order to achieve good results. Often, the deformity itself is not obvious, and the upper lip deformity may only appear as a light scar that is slightly darker than the surrounding skin, as well as a slight nasal deformity with a red lip notch before the patient is seen. Therefore, the parents of such children or the patients themselves are more demanding, and traditional surgical methods are difficult to satisfy the patients and their families.
In the traditional functional repair of cleft lip, due to the presence of tissue loss and displacement, the skin and muscles must be incised to form several lip tissue flaps, and after reconstructing the orbicularis oris muscle, the flaps are combined and transposed and re-sutured to reconstruct the upper lip structure. After such a procedure, upper lip skin incision scarring is inevitable. However, for some types of cleft lip, such as recessive cleft lip and degree I cleft lip, the problem of tissue loss and displacement is mild, and the use of conventional skin incision will leave a scar on the lip that is difficult to eliminate, and once the scar develops hyperplasia or contracture, it may leave the patient with a feeling of “increased deformity”, which is difficult for the patient to accept. According to our questionnaire survey of previous patients, the satisfaction rate after surgery for recessive cleft and I cleft lip is much lower than that of second and third degree cleft lip.
So there is no better way for this type of cleft lip?
After continuous exploration and practice, we have come up with a surgical method that can achieve the effect of Millard-type surgery on the reconstruction of nasal floor and orbicularis oris muscle and at the same time avoid leaving obvious scar on the white lip after surgery – recessive cleft lip repair through small incision at the red lip margin and nasal floor. For the more detailed different types of occult cleft lip, the surgical procedure is divided into three subtypes: single triangular flap method, double triangular flap method, and intraoral linear method. The advantages of this method are: 1. Reconstruction and restoration of the integrity of the orbicularis oris muscle 2. Maintenance of skin integrity, no obvious scar left on the white lip after surgery 3. Reconstruction of the muscle ring of nasal cartilage on the affected side and reshaping of the nasal base nasal canal shape
4.Simultaneously improve the triangular cut pattern of the red lip.
5.Some cases with conditions can form a simulated human middle form.
Surgical method: infraorbital nerve block and local infiltration anesthesia are used. The skin was incised from the nasal floor and the red lip margin incision line respectively, and the orbicularis oris muscle was separated bluntly under the skin on the surface of the orbicularis muscle. A deep incision was made along the nasal floor and the red lip margin to the submucosa, and a blunt separation was made on the deep surface of the orbicularis oris muscle, to the same extent as above. The lateral flap was sutured to the fascia of the anterior nasal crest and the medial flap was sutured to the muscle break at the base of the lateral nasal foot, thus reconstructing the muscle ring of nasal cartilage on the affected side, improving the shape of the nasal floor and nostrils on the affected side, and reshaping the shape of the nasal can. The remaining two broken ends of the muscles were pulled together and externally sutured with mattress sutures to facilitate the formation of the human middle ridge.
After postoperative observation and follow-up of a large number of patients with occult cleft lip repair, it was concluded that the method of occult cleft lip repair through a small incision at the red lip margin and nasal base could not only achieve the effect of Millard-type surgery on the reconstruction of the nasal base and orbicularis oris muscle and avoid the formation of postoperative white lip scar, but also reconstruct the muscle ring of nasal cartilage on the affected side and improve the nasal wing shape, nostril size and the appearance of the nasal base and nasal can. At the same time, the method reconstructs the muscle ring of the affected nasal cartilage, which improves the nasal shape, nostril size and the appearance of the nasal base.
As for the problem of skin sulcus in the lips of some patients, the sulcus in most patients can be improved and the color contrast can be expected to be reduced because of the peeling between the skin and the muscle during the surgery. In some severe cases, this procedure does not completely resolve the developmental marks on the white lip, but we believe that the morphological results are better than the through scar left by the traditional procedure, even if it leaves a mild mark.
Problems: This procedure is difficult to perform and requires a high level of expertise on the part of the surgeon.