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Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(7):1338-1346.
Published online October 1, 1998.
Correction of bilateral cleft lip, alveolus, and nose with modified mulliken method.
No authors listed
The authors had been operating on bilateral cleft lip, alveolus, and nose by the mulliken method to correct the synchronous nasolabial repair without producing a fork flap, but found several problems with this method when applied to oriental infants. To create a more appropriate surgical technique for Korean infants, we made several modifications in the Mulliken method. There are six parts of modified method. First, the dislocated alar cartilages were approached through the base of prolabial flap instead of alar rim and vertical tip incisions. Second, we made short incision of lateral lip segments between both alae. Third, the dissection of the orbicularis oris muscle was conservatively. Fourth, we sutured the alar cartilages to one another and suspended them to the upper lateral cartilage by means of cinching. Fifth, the prolabial flap was made larger than suggested by Mulliken. Sixth, we sutured the prolabial flap to lateral lip segments, lower by as much as 1 mm. We corrected bilateral cleft of 8 males and 6 females aged between 3 and 6 months(mean 4.4 months) with modified Mulliken method. A technique for primary lip and nasal correction are detailed. An aesthetically almost definitive lip and nose were obtained in all cases after an average follow-up period of 25.5 months.The nasal length, nasal tip projection, and columella width were appropriate, median vermillion tubercle was well formed, and the shape of the philtrum was natural. However, the tip of the nose pointed cranially so that it made the nasolabial angle large, and the interalar base distance had the tendency to become wider with time.
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