Surgical Correction of a Median Cleft of the Upper Lip Associated with Enlarged Frenulum and Palatal Masses

정중 상구순열의 수술적 교정 치험례

  • Hahn, Hyung-Min (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Kim, Ji-Ye (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Min, Hee-Joon (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine) ;
  • Kim, Sug-Won (Department of Plastic and Reconstructive Surgery, Yonsei University Wonju College of Medicine)
  • 한형민 (연세대학교 원주의과대학 성형외과학교실) ;
  • 김지예 (연세대학교 원주의과대학 성형외과학교실) ;
  • 민희준 (연세대학교 원주의과대학 성형외과학교실) ;
  • 김석원 (연세대학교 원주의과대학 성형외과학교실)
  • Received : 2011.03.15
  • Accepted : 2011.05.23
  • Published : 2011.07.10

Abstract

Purpose: Median cleft of upper lip is defined as any congenital vertical cleft through the midline of the upper lip. It is uncommon, its embryological pathogenesis remains unexplained to date. The authors hereby report a rare case of median cleft of the upper lip associated with enlarged frenulum and palatal mass. This case offers some understanding of the possible embryologic development of this anomaly. Methods: A 10-month-old boy born by normal vaginal delivery at full-term had a notch in the midline of the upper lip with widened philtrum along with enlarged median frenulum, alveolar cleft, and mass of the hard palate. We performed en bloc resection of the enlarged frenulum and palatal mass and cheiloplasty under general anesthesia. Results: Histological examination revealed that the frenulum and palatal mass was consisted of fibrous tissue with normal mucous membrane. The postoperative course was satisfactory. Conclusion: A rare case of median cleft of the upper lip with associated enlarged frenulum and palatal mass was presented with proper surgical management. The surgical technique includes marginal excision of the clefted epithelium and reconstruction of orbicularis oris muscle, in addition to en bloc resection of the palatal mass and frenulotomy.

Keywords

References

  1. Tessier P: Anatomical classification of facial, cranio-facial and latero-facial clefts. J Maxillofac Surg 4: 69, 1976 https://doi.org/10.1016/S0301-0503(76)80013-6
  2. Kawamoto HK Jr: The Kaleidoscopic world of rare craniofacial clefts: order out of chaos (Tessier classification). Clin Plast Surg 3: 529, 1976
  3. Kawamoto HK Jr: Rare craniofacial clefts. In McCarthy JG (eds): Plastic Surgery. Philadelphia, WB Saunders, 1990, p 2922
  4. Asada K, Ishibashi K, Usui H, Hirano Y: A rare case of median cleft of the upper lip associated with enlarged frenulum and palatal masses. Plast Reconstr Surg 109: 1464, 2002 https://doi.org/10.1097/00006534-200204010-00050
  5. Millard DR Jr, Williams S: Median lip clefts of the upper lip. Plast Reconstr Surg 42: 4, 1968 https://doi.org/10.1097/00006534-196842010-00002
  6. Braithwaite F, Watson J: A report on three unusual cleft lips. Br J Plast Surg 2: 38, 1949 https://doi.org/10.1016/S0007-1226(49)80007-5
  7. Wiemer DR, Hardy SB, Spira M: Anatomical findings in median cleft of upper lip. Plast Reconstr Surg 62: 866, 1978 https://doi.org/10.1097/00006534-197812000-00006
  8. DeMyer W: The median cleft face syndrome. Differential diagnosis of cranium bifidum occultum, hypertelorism, and median cleft nose, lip, and palate. Neurology 17: 961, 1967 https://doi.org/10.1212/WNL.17.10.961
  9. Millard DR: Median cleft lip with hypertelotism. In Millard DR: Cleft Craft. Boston, Little Brown & Co., 1976, p 745