Median cleft of the lower lip:: Report of two new cases and review of the literature

Median clefts of the lower lip and mandible are rare craniofacial clefts. Couronne in 1819 was the first to describe the condition. The midline cleft of the lower lip was classified by Tessier as a type 30 craniofacial cleft. Recently, the total number of the reported cases had increased to about 66 in the world literature. In addition, 2 more patients are presented here. The first case involves only a small notch in the vermilion; the deformity was treated by Z-plasty. In the second case, a midline incomplete cleft of the lower lip, a sublingual abnormal frenulum, a complete cleft in the mandible, a bifid sternum, a presternal skin tag, and a ventricular septal defect in the heart were present. At operation, Z-plasty of the lingual frenulum released the normal-sized tongue. The lip cleft was corrected by a simple V excision followed by closure in 3 layers. The mandibular segments were "vitalized" with a bone rongeur and immobilized in the predetermined position with an interosseous stainless steel wire. Because the bone fusion was complete, the stainless steel wire was taken out after 3 months so that it would not prevent mandibular development. Our treatment methods and others are discussed.