Median cleft lip: A case report of rare congenital anomaly
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The present case has been reported in the Journal of Cleft Lip Palate and Craniofacial Anomalies.

A 10-year-old boy reported with deformed upper lip. The child was first the issue of full-term normal vaginal delivery. On examination, the child displayed a midline cleft of the upper lip and philtrum with widening of the base of the columella. The cleft was found to be extending to the alveolus with notching.

Hypertelorism and flattening of the nose with wide ala were also present. The movements of the soft palate were normal. There was a tipping of the maxillary central incisors as well.

The marking of the cleft edges was done in an inverted “V” fashion. The philtral base was marked to be of 8 mm and a columellar base 6 mm. The incisions were marked to a point 2 mm above the vermilion border lateral to the defect, which were then carried medially. Incisions were made as per the markings.

The orbicularis oris was dissected anteriorly and posteriorly from the skin and mucosa to the lateral margin of alar base. The abnormal muscular insertions at the nostril sill and alar margins were released. Closure was then completed in straight line fashion beginning with the labial sulcus.

Sutures of 4–0 vicryl were used to repair the muscle. Special emphasis was given to evert the vermilion to create a midline pout. Skin closure was completed with 6-0 nylon. The postoperative period was uneventful. Sutures were removed on the 5th day with good cosmetic result.

Key takeaways:-
- Craniofacial cleft repair is a complex surgery, and diagnosis of defect should always be made with respect to the morphology of the defect before the treatment.

- In cases of true median cleft lip, re-approximation of orbicularis oris muscle is a key to reconstruction regardless of surgical technique used.

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