Correction of secondary vermilion notching deformity in unilateral cleft lip patients: Complete revision of two errors

Background: Vermilion notching deformity is one of the most common secondary deformities in unilateral cleft lip patients. Two errors during primary cheiloplasty seem to cause notching deformity. The first one is insufficiently lengthened oral lining of the medial lip compared to the cutaneous surface, and the other is medialized marking of the height of cupid's bow on cleft side rather than marking it at the thickest portion of the vermilion. The authors were able to obtain satisfactory results after revising notching deformities by correcting these two errors. Methods: A total of 104 patients (median age: 13) with secondary notching deformity underwent revision surgery from 1987 to 2009. After the new height of cupid's bow on the cleft side was marked on the white roll with the greatest vermilion fullness, the notched vermilion including the cutaneous scar was elevated. For sufficient lengthening of the oral lining, the elevated tissue was interposed as an inferior pedicled flap into a relaxing incision of the central portion of the oral sulcus. Results: The follow-up period ranged from 1 year to 12 years. The patients were satisfied with the aesthetic outcomes. Seven patients experienced lateral vermilion bulging which was easily corrected by an elliptical excision. Conclusion: Complete revision by lengthening the oral lining of the central lip portion, and lateralizing the height of cupid's bow of cleft side to the region where vermilion is thickest, is an effective method for correction of secondary notching deformity. (C) 2010 European Association for Cranio-Maxillo-Facial Surgery.