Oribicularis Oris Muscle Defects in Philtral Deformities in the Repaired Cleft Lip.

Kim, Suk Wha; Jeong, Yeon Woo; Cheon, Jung Eun; Park, Chan Young; Oh, Myung June; Kim, Jung Hong; Choi, Tae Hyun

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(4):427-432.
Published online July 1, 2010.

Oribicularis Oris Muscle Defects in Philtral Deformities in the Repaired Cleft Lip.

Suk Wha Kim, Yeon Woo Jeong, Jung Eun Cheon, Chan Young Park, Myung June Oh, Jung Hong Kim, Tae Hyun Choi

¹Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, Seoul, Korea. kimsw@snu.ac.kr
²Division of Pediatric Radiology, Seoul National University Children's Hospital, Seoul, Korea.

Abstract

PURPOSE
The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. METHODS: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist.
RESULTS
The philtral ridge eminence scored 2.79+/-0.54 and 1.40+/-0.53 at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored 1.44+/-0.53 and 2.27+/-0.66 at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be 3.78+/-2.14mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant(p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker(p=0.815) using Spearman's rank correlation.
CONCLUSION
Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.

Keywords: Cleft lip; Muscle defect; Ultrasonography; Philtral deformity

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