A radical rotation in single harelip

Abstract

S IR Harold Gillies has Iong taught the principle of avoiding routine by treating each patient individually. StimuIated by this principle, chahenged by a stream of harelips in Korean patients and disappointed by my resuIts with standardized methods, I was Iead to contempIate the use of the existing Cupid’s bow and dimpIe in toto. The act of constructing or repairing facia1 features is of its very nature artistic and, as in a11 art, depends on freedom for its vitaIity. No two cases are exactIy aIike; not even two hareIips of seemingly equal degree of cIeft can boast this identity. In generaI, one cIeft lip with its nasal distortion may be reminiscent of another; they may even be similar but never quite identical. Hordes of patients are run through the A,B,C, bIue-dot routine because of the temptation to Iatch on to a reasonabIy satisfactory method and drift merriIy aIong mesmerized by a memorized bIueprint. Yet the simpIe fact that no two lips are identica1 seems to demand a surgica1 soIution for each, with a personaIity al1 its own. A Normal Goal. The ideal normal nose has a straight coIumeIIa, symmetrical nostriIs, alae bases which swing into the Iip with equal flare and a siI1 to each nostri1 floor. The idea1 normal lip has a balanced muscuIar action, a Cupid’s bow with a midline tubercIe of vermiIion, highIighted aIong its upper border by a white rolled edge and two coIumns of the phiItrum embracing a centra1 dimple. CIoser scrutiny reveals that the phiItrum columns run from each peak of the bow with varying degrees of curve toward the sides of the columella. AI1 of these natural landmarks must be taken into account if there is to be any hope of camouff aging the hareIip Iook. Guided by Principles. In the harelip deformity both the Iip and nose have been shortchanged. Not onIy has nature Ieft out a portion but she has aIIowed distortion of what remains. This distortion can be relieved by moving normal tissues into norma position and retaining them there. The norma tissue which is out of position here is the vestige of a Cupid’s bow, with a phiItrum coIumn and dimpIe. This entire unit can be rotated down into normal position and maintained in this position by a IateraI advancement. With tissue actuaIIy missing we must throw away nothing, guarding what IittIe we have jeaIousIy for use to its utmost advantage. The presence of a cIeft necessitates the formation of a scar and this scar, if not hidden, more often than not will give away the secret. It wouId be weI1, if possibIe, to maneuver it into hidden crevices or use it to simuIate natural Iandmarks.