Basket-weave Muscle Reconstruction: An Effective Technique for Bilateral Cleft Lip Repair.

BACKGROUND

The complexity of bilateral cleft lip deformities and the delicate interrelation between muscular arrangement and external lip features require a comprehensive approach for proper management. The principles developed by Mulliken for cleft repair have been a cornerstone in cleft management. In this study, the operative principles for bilateral cleft lip repair described by Mulliken are applied, with functional muscle reconstruction in the form of interlacing orbicularis oris muscle fibers using the basket-weave technique.

METHODS

Eighty patients underwent surgery using modifications of the technique described by Mulliken for bilateral cleft lip repair, involving skin tailoring, lateral flap size, and basket-weave muscle repair, with a mean follow-up period of 1 year and 2 months.

RESULTS

The overall results were extremely satisfactory regarding function and appearance, with no major complications. A full central segment with prominent philtral ridges, an adequate white roll, and a thick vermilion with a seam-like median tubercle were obtained. Based on the 10 parameters for assessment and scoring, 32 (40%) patients had excellent results, 36 (45%) patients had very good results, 8 (10%) patients had good results, and 4 (5%) patients had fair results.

CONCLUSIONS

A basket-weave muscle reconstruction technique for bilateral cleft lip patients is presented, along with the major sites of distortion in the lip, sulcus, and nasal floor addressed during the primary surgery. This technique has shown improved dynamics and 3-dimensional configurations of the repaired lip both at rest and in function.