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Bilateral cleft lip

2004; Elsevier BV; Volume: 31; Issue: 2 Linguagem: Inglês

10.1016/s0094-1298(03)00130-5

1558-0504

John B. Mulliken,

Craniofacial Disorders and Treatments

You notice at a distance—the child has a repaired bilateral cleft lip. As the child approaches, the nasolabial distortions become more evident. The philtrum is wide, bowed, and undimpled; it is also excessively long and missing a white ridge. The median tubercle is thin, chapped, deficient in vermilion, and flanked by overly long lateral labial elements. The nose is squat, the tip is broad, the nostrils have an oblique axis, and the columella appears short. As the child turns, the snubbed nasal tip and tight upper lip are seen in relief, an abnormal profile made more obvious by the everted lower lip and weak chin. The child struggles to attain bilabial closure over the protruded, elongated, and retroclined premaxilla. As the lips pucker, a muscular bulge appears on each side, and as the child smiles, the upper lip appears tight and the alar bases rise. You know that these stigmata cannot be easily erased by revisions, and yet you cannot help but wonder whether the child's appearance could be improved. Perhaps this child's nasolabial features would have looked better if the primary repair had been executed differently.