PMC3800392_01
(a) Normal chelioplasty markings, (b) Markings for chelioplasty of median facial dysplasia
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F1
The most important factor in reconstruction of the cleft lip in cases of MFD is the identification of the surgical reference points of chelioplasty [Figure 1a] which is a cumbersome process as the columella is deformed or poorly defined, hence the aid of adjacent midline structures such as the midpoint of nasal columella can be used as a guide to locate IS (Cupid bow summit point, Point 1), similarly the CPHR (Cleft Philtrum Horizontal Right, Point 2) is traced towards the non-cleft side, an equidistant point is marked as CPHL (Cleft Philtrum Horizontal Left, Point 3) on the cleft side based on the measurement between IS and CPHR. The CPHL' (Point 3') is marked based on the maximum thickness of the vermilion and verified by transferring the measurements of CHR (Cleft Horizontal Right point) -CPHR to CHL (Cleft Horizontal Left point) -CPHL' [Figure 1b].
(a) Pre-operative left unilateral Median facial dysplasia cleft lip, (b) Post-operative view
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F2
The reference points are further used as guide for dissection of the muscles and reorientation with its counterpart on the non-cleft side [Figure 2a and b].