You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.
This one is about: Whistle Defect / Abbe Flap
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Whistle Defect/Abbe Flap (Lengthening the lip)
Excerpts from Cleft-Talk -- A parent writes:
Isn't a short upper lip what causes a whistle defect? In our case, a lip revision surgery isn't going to do anything for his whistle defect -- there is no more tissue to work with. The PS noted that our child's cleft is unique in that there was very little tissue to work with. That is why they had to do his lip repair in two parts.
A whistle defect is a pucker in the upper lip that will not allow the upper and lower lips to come together when closed in a relaxed state. It's usually the result of poorly aligned musculature. Joey had almost no tissue to work with at all. (Look at his newborn picture in the gallery). He needed a couple of surgeries to get it closed, in fact. But once it is going in the right direction, over time, it tends to stretch and grow. Anyway, even though Joey started out with almost no tissue at all, he has a nice, full lip now.
What does this mean -- lengthen from top to bottom -- are we talking the vermillion here? Does the Abbe flap make a fuller vermilion, so that more of it shows? I don't understand the purpose of the procedure, I guess, when I think of lengthening the lip - I almost think of making the smile wider -- that is lengthen from end to end or side to side. So could we just clarify what the Abbe Flap is designed to achieve?
An Abbe Flap procedure is contemplated when the upper lip is "short" - meaning too little tissue from side-to-side of the mouth, while there is plenty of tissue in the lower lip. Therefore, the upper lip looks "tight". The doctors will do a graft of tissue, then, from the lower lip to the upper lip, putting more vermillion corner-to-corner in the upper lip. They cut a wedge of flesh from the lower lip, leaving a portion attached for blood flow - they split the upper lip and insert the wedge of tissue,
leaving the upper and lower lips attached for a short time while the tissue graft "takes". After about two weeks, the two lips are then separated, and the result, after healing, is a wider, fuller upper lip with no more tightness. There is also a straight, vertical scar left on the lower lip.
A whistle defect is any time the line of the lip closure does not naturally go together in a relaxed state. Meaning - when the mouth is closed, there is a gap where there should not be one. It is usually at the place where the repair was done. It is generally created when the obicularis tissue is not well aligned. A child can have both a tight upper lip AND a whistle defect at the same time.
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