Two-stage primary repair of bilateral cleft lip incorporating 'prolabial sulcoplasty'

Primary prolabial sulcus reconstruction is an essential step of bilateral cleft lip repair. Prolabial sulcoplasty was routinely done by the author on 52 patients, as a part of two staged "primary" repair of bilateral cleft lip using the Tennison Randal technique, from January 1986 to December 1996 at the Plastic Surgery Department of Kasturba Medical College, Manipal, India. The author's technique deepens the prolabial sulcus utilising the whole of existing prolabial-mucosa to form the "gingival" surface and lateral-lip-mucosa for the "labial" surface of the reconstructed gingivobuccal sulcus of the central upper lip. The advantage of this technique is that it provides mucosal lining to the entire deepened prolabial sulcus without disturbing the pre-maxillary periosteum. It also overcomes the various disadvantages of other techniques described earlier mainly for " secondary" sulcoplasty: leaving the premaxilla exposed for re-epithelialisation; leaving redundant mucosa at the prolabial sulcus region; the requirement of an appliance for maintaining the reconstructed sulcus post-operatively. The only disadvantage of this technique is the fact that it could be technically demanding to carry out prolabial mucosal dissection and to apply tacking sutures over the premaxilla.