Comparative 3-Dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair Enhanced with Muscle-to-Subdermis Suture.

BACKGROUND

Recreating the philtral ridge and restoring orbicularis oris muscle (OOM) continuity in patients with cleft is a challenging task. The muscle-to-subdermis technique introduces an effective method for achieving the desired philtral ridge reconstruction.

METHODS

From August of 2015 to July of 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-subdermis sutures. Measurements of philtral projection were taken at 2 distinct points: one above Cupid's bow and the other at the midphiltral level. In the comparative analysis of philtral ridges between the cleft and noncleft sides, the root mean square projection value was assessed. In addition, an analysis of the restoration of the OOM included the use of color mapping from the midsagittal plane and covered 7 different points across 3 distinct horizontal planes: below subnasale, at the midphiltral level, and above Cupid's bow.

RESULTS

A total of 134 patients were included, with a 37.8-month follow-up (SD 9.4). Philtral side projection was well maintained, measuring -0.36 (0.43) mm, -0.24 (0.49) mm in the classic group versus 0.23 (0.29) mm, 0.20 (0.21) mm in the muscle-to-subdermis group ( P = 0.001). The root mean square projection value was 0.57 (0.46) versus 0.14 (0.046), indicating greater symmetry in the muscle-to-subdermis group, with no difference in sagittal vector analysis of the OOM between normal and cleft sides.

CONCLUSIONS

A suturing technique using muscle-to-subdermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of subdermis and fewer muscle sutures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.