Horizontal trimming of the white lip and pedicled flap for whistle deformity correction in a patient with a bilateral cleft lip: A case report.

INTRODUCTION: Upper lip deformities, such as a whistle deformity, asymmetry, and a disproportionately narrow and tight upper lip, are common challenges in patients with bilateral cleft lip and palate (BCLP). In cases with a hypoplastic prolabium, the vertical length discrepancy between the lateral white lip segments and the central prolabium results in a triangular red lip shape. These deformities cause significant surgical challenges.

PRESENTATION OF CASE: Herein, we present a 22-year-old female patient with incomplete BCLP and an evident whistle deformity. Surgical correction involved spindle-shaped trimming of the lateral white lip and the use of the excised tissue as de-epithelialized pedicled flaps for augmenting the central red lip. The procedure reshaped the triangular vermilion border into a natural contour with adequate red lip height, reduced the whistle deformity, and improved lip closure. Minimal scars and decreased mentalis muscle tension resulted in a natural, balanced lip appearance.

DISCUSSION: For BCLP with mild tissue deficiency but without significant lip imbalance, spindle-shaped trimming of the white lip effectively corrected contour deformities. Augmentation with de-epithelialized pedicled flaps improved the whistle deformity and enhanced central red lip projection. This technique minimizes visible scars and provides a reliable, less invasive alternative to the Abbe flap.

CONCLUSION: Horizontal trimming of the white lip and de-epithelialized pedicled flaps is a reliable, minimally invasive solution for addressing upper lip deformities in patients with BCLP. Further research and extended follow-up are required to validate long-term stability and patient satisfaction with this technique.