A Prospective comparative Study of Vermilion repair by Modified V-advancement Vermilion Flap in Unilateral Cleft Lip Patients.

Abstract

Orofacial clefts include a wide range of congenital deformities, the commonest of which is cleft lip with or without cleft palate (CLP) or isolated cleft palate. The incidence of oral clefts in any form occurs in about one in every 700 live births. Cleft lip is consistently more common in males at a 2:1 ratio, in contrast to cleft palate which has a similar ratio in favor of females. Epidemiologic and etiologic features of CLP differ in the syndromic and non-syndromic forms. Non-syndromic forms occur in 70% of cases. The causes are multifactorial and involve genetics, environmental factors, and teratogens. The unilateral cleft typically results in a disruption of Cupid’s bow and the absence of one philtral column. The continuity of the orbicularis oris circumferentially is compromised, with abnormal insertions. In the lateral lip element, the upper part of cutaneous orbicularis (Pars' Superficialis) inserts in the lateral aspect of the alar base and the nasolabial fold, while the lower part inserts into the nostril base periosteum of the pyriform rim. In the medial lip element, the cutaneous orbicularis (pars superficialis) inserts into the anterior nasal spine and columella. The deep orbicularis (pars marginalis) is simply interrupted by the cleft deficiency and results in a diminished vermilion cutaneous ridge at the cleft margin. Anatomical characteristics of unilateral cleft lip include nasal deformities of the tip, columella, nostril, alar base, septum, and skeleton.