title: Correction of the cleft lip lateral bulge deformity using anatomic muscle repair.
abstract: BACKGROUND
  The lateral bulge deformity may result after primary cleft lip repair. In a pilot study, greater orbicularis oris thickness and levator width underlying the lateral bulge were identified using ultrasound. The purpose of this study was to evaluate postoperative results of anatomic muscle repair for lateral bulge correction.
  
  
  METHODS
  Patients with a lateral bulge after primary unilateral cleft lip repair were prospectively recruited. Oronasal musculature and connective tissue dimensions were measured using ultrasound, preoperatively and postoperatively. Guided by preoperative ultrasound findings in each patient, lateral bulge correction consisted of total lip takedown and anatomic orbicularis oris reapproximation. Within each group, measurements between sides at corresponding landmarks were compared using t-tests. Ratios between sides at corresponding landmarks preoperatively and postoperatively were compared using parametric and nonparametric tests. Repeat measurements were performed to calculate intrarater reliability. Standardized video assessments of dynamic lip function were recorded preoperatively and postoperatively.
  
  
  RESULTS
  Average patient age was 17.4 years. Patients were evaluated preoperatively and postoperatively (n=14) at 7.8 months' mean follow-up. Cleft-side orbicularis thickness and levator width were greater preoperatively versus postoperatively (P=0.003 and P=0.018, respectively). Postoperatively, no differences were seen between sides for both orbicularis thickness (P=0.763) and levator width (P=0.626). All patients demonstrated improved lip contour and symmetry, both static and dynamically, on video assessments.
  
  
  CONCLUSIONS
  Lip contour, function, and aesthetics improved clinically, and lip muscle anatomy normalized postoperatively as assessed using ultrasound. Complete orbicularis oris takedown and anatomic reapproximation effectively addressed the lateral bulge deformity.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Paediatrics, University of Western Ontario, London, Ontario, Canada. damir.matic@lhsc.on.ca
authors.forename: Damir B
authors.initials: DB
authors.lastname: Matic
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Power
mesh_terms: D000293:Adolescent; D002971:Cleft Lip / Q000000981:diagnostic imaging / Q000601:surgery*; D005152:Facial Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014463:Ultrasonography; D014741:Video Recording