Construction of the upper lip, columella and orbicularis muscle in bilateral clefts

Summary A concept for repair of double clefts is described. In the primary operations at the age of six months on the first side, and six weeks later on the other, it is important to supply the prolabial mucosa by muscular vermilion flaps from the lateral sides, crossing the midline. Thus a muscular ring in the vermilion is obtained. At the age of 3–4 years both remaining muscular halves of the lip are united. This is achieved together with lengthening of the columella, using broad prolabial forked flaps and reducing the broadened prolabium to a natural looking philtrum. Lips repaired this way are satisfying with regard to both appearance and function.