Secondary Mucous Membrane Advancement in Bilateral Cleft Lip: A Combined Surgical-Dental Approach

Abstract

A bilateral cleft lip deformity is frequently associated with a deficient labial vestibule. This is the result of the intimate attachment of the pro-labium to the premaxilla. It is impossible to release and resurface this vestibule in a one-stage primary bilateral cleft lip repair. The only effective means of overcoming this in a primary repair is with the utilization of local mucosal flaps in a two-stage repair as described by Bauer, Trusler, and Tondra (1). It is those instances in which the vestibule reconstruction has not been accomplished to which we direct our attention. The lack of a labial vestibule is not only cosmetically undesirable, but can be functionally inhibitory as well. It can also prohibit the orthodontist from inserting appliances needed for major orthodontic treatment. It can prevent the proper protection and lubrication of the maxillary incisor teeth, by the upper lip, and thus promote the premature decay and loss of these vital teeth. To enlarge the labial vestibule presents a sub— stantial rehabilitative challenge. For, while it is quite possible to sur— gically dissect the prolabial area and to create an adequate vestibule, the stability that results is diminished by the healing processes endog-enous to the procedure. That is, while a labial vestibule can be surgically achieved, the secondary contracture following surgery will often deny vestibular stability. As an answer to this problem, skin grafting procedures in the vestibule have been advocated (2). These procedures are not without limitations. Among the limitations are: the graft may contract, the graft may slough, the donor sites may hypertrophy and be unsightly, the graft growth is limited by its fibrous or scarred bed, and hair growth at the graft site is possible. With these factors in mind an alternative was effected, using a com