Jack-like eversion by splitting the orbicularis oris muscle for reconstruction of the philtral column in secondary cleft lip

The philtrum is an important aesthetic unit that contributes hugely to the characteristics of the human face. From March 2002 to May 2006 inclusive, a total of 16 patients with unilateral cleft lip nose were operated on to form a philtral column and obtain muscular continuity. Six of the patients were female and 12 were male, age range 5 to 30 years old. We used Millard's method, so rotation and advancement flaps were planned. A full thickness incision was made down to the orbicularis oris muscle and mucosa after the scar on the philtral column had been excised. The medial and lateral muscle flaps were exposed and split into two leaves at the coronal plane. The deepest part of the muscle flaps were sutured together to create a jack-like eversion. Skin and mucosa were then closed. The follow-up period ranged from 8 to 18 months (mean 11 months). Two visual analogue scales were used to assess the outcomes. Thirteen of 16 patients were satisfied with their good result. Three had moderate results. The advantages of the technique are: ease of use; the creation of an anatomically-natural philtrum while preserving the continuity and function of the muscle; sufficient augmentation of the philtral column by the jack-like eversion; and no donor-site morbidity.