PROLABIUN UPPER

AS THE FULL

LENGTH OF THE
CLOSURE

LZ

IN

STRAIGHTLINE

BILATERAL

CLEFTS

WITHOUT PREMAXILLARY
TO

PROTRUSION
FOR THE

IT

DOES NOT
IT
IS

TAKE
SITTING THREE

MUCH

IMAGINATION

THINK

LIP

PROLABIUM
TO JOIN

DEMURELY BETWEEN THE

SEEMS QUITE LOGICAL

LATERAL

ELEMENTS AND

THE

IF THE PREMAXILLA

PROTRUDES IN
FARTHER

FRONT OF

THE MAXILLARY
ITS

ELEMENTS CARRYING THE PROLABIUM

THE SOLUTION PROJECTING WITH
TO
IS

AWAY FROM

LATERAL COUNTERPARTS
IS

NOT SO OBVIOUS
OFF THE TIP

AND WHEN

THE

ACTUALLY TO
IT

OF THE FLATTENED

NOSE

IT

IS

EASY USED

SYMPATHIZE
AS

THOSE SATISF

SURGEONS THE

WHO
JOINED

IN

DESPERATION WILLING

COLUMELLA

NOSE AND WERE

TO

TO PULL

LIKE

HELL

TO GET THE LATERAL

ELEMENTS

EACH OVER THE PREMAXILLA

OF

COURSE THE

EARLY

SURGEONS

MERELY

CHOPPED
LIP

OFF

THE

PRE

MAXILLARY

KNOB

IN

AN EXPEDIENT
IN

RUSE

TO FACILITATE

CLOSURE THIS HE HAD THE

TO

WAS FRANCOS APPROACH

INGENUITY
RATE THE TO

THE SIXTEENTH THE LATERAL

LIP

CENTURY BUT
ELEMENTS

UNDERMINE
IN

AND

INCORPO

PROLABIUM

THE LIP OF THE ROYAL OBTAINED

GEORGES DE WHOSE
MEDICAL
TION PORTRAIT

LA FAYE

ACADEMY
BY

OF SURGERY PARIS THE

HIS

HAS BEEN
IN

COURTESY OF

BOSTON OPERA

LIBRARY

THE
CLEFT FOR

COUNTWAY LIBRARY
LIP IN

WROTE ABOUT
OF HIS

FOR BILATERAL

1743

TRANSLATION
IN PLASTIC

WORK BY

MARY MCDOWELL
TIVE

THE

CLASSIC THAT

REPRINT HIS

AND RECONSTRUC WAS MORE

SURGERY

1976

INDICATES

SECOND OPERATION

CLASSICAL

DESIGN

INCORPORATING

THE PROLABIUM AS THE CENTER OF THE

RECONSTRUCTED LIP
DID NOT

HE

NOTED
GEORGES DE
LA

REMOVE ANY OF THE JAW BECAUSE NONE PROJECTED

TO ATTACH THE LATERAL TRANSFIX LIP ELEMENTS TO THE SIDES

FAYE

AND PROCEEDED PROLABIUM

OF THE
SILK

AND

THEM

WITH

PINS

WRAPPED WITH

IN

107

FIGUREOFEIGHT

FASHION

AND REINFORCED WITH LINEN

SEVERAL

BANDAGE

HE

BLED THE BOY POSTOPERATIVELY TWENTY DAYS

LATER

TIMES

FOR FEVER

AND REPORTED
THE SHAPE OF

THE LIP WAS

ALL

AY

PERFECTLY

HEALED THE

SCAR

WAS IN

THE ACCOMPANYING COMMENTARY BY

ALWAYS WAS INTERESTING BY DE
STREETS IA

EDITOR FRANK

MCDOWELL

AS

FAYES

TIME

SURGERY

EVEN PLASTIC

SURGERY

HAD COME
SUITABLE

IN FOR

OUR OF THE

AND BECOME

RESPECTABLE

OCCUPATIONONE

GENTLEMEN

WHO WORE POWDERED WIGS AND

ELITE

TRUFFLES AS

AND HAD PORTRAITS MADE MOREOVER THE AND ON OCCASION

THEY WATCHED ONE

KNEW

EACH

OTHER THEN

NOW

ANOTHER OPERATE

IN

1842

IN

NEW YORK

MARION

SIMS

ALSO

REMOVED THE
OF

PREMAXILLA THE LIP

LIP

BUT

PRESERVED THE PROLABIUM FOR THE CENTRAL PORTION

FIVE

AT

SECOND OPERATION

WEEKS
ALL

LATER

HE PARED THE LATERAL TOGETHER

AND

PROLABIAL

EDGES BROUGHT
SINGLE

ELEMENTS

AND

FIXED

THEM
CLEFT

FOR

ONE WEEK WITH

STABILIZED

INTERRUPTED

SUTURE ACROSS NEEDLE

EACH

FURTHER

WITH
OF

THROUGHANDTHROUGH
PHILADELPHIA
FULL

IN
FOR

1844

JOSEPH PANCOAST

EXPRESSED PREFERENCE OF THE LIP

USE OF THE PROLABIUM

AS THE

LENGTH

JOSEPH PANCOAST

THE

IS TO BE SEATED IN GOOD LIGHT WITH THE ARMS AND FEET WELL AND THE HEAD PRESSED SECURED AGAINST THE CHEST OF AN ASSISTANT WHO WITH HIS

PATIENT

HANDS

COMPRESSES THE

THE FACIAL PUSHES

ARTERY

OF EACH SIDE IN

UNDER THE EDGES OF THE JAW

THE MIDLINE
AS IF
IT

AND WITH

THUMB

THE CHEEK
LARGER

TOWARD
IT

THE
WILL

INTERMEDIATE

SUBSTANCE BE IN

DIMENSION

MUST BE PRESERVED

BE OF GREAT IMPORTANCE

THE RECONSTRUCTION BY DETACHING EXCISING

OF THE LIP

THE

OPERATION THE EDGES

MAY

BE COMPLETED

AT

ONCE

THE FRENULUM PARING OF THE TWO LATERAL

OF THE MIDDLE

PORTION

THE MARGINS

PORTIONS

AND INTRODUCING
CAUSING

THE PINS SO AS TO BRING FAIRLY

TRAVERSE

TOGETHER THE FOUR RAW SURFACES

ONE OR MORE OF THEM TO

THE MIDDLE PORTION

IN
SCRIBED

1877

FRANCIS

MASON

OF GROSVENOR SQUARE

LONDON DE

THE METHOD

OF SEDILLOT

WHICH

AIDED

BY REMOVAL OF THE
IN

PREMAXILLA OF THE

INCORPORATED

THE PROLABIUM AS ONLY THE

THE FULL

LENGTH
LIP

UPPER LIP

BRINGING

MUCOSA OF THE ROSE

STATED

LATERAL IN

ELEMENTS

TOGETHER IN

THE MIDLINE

WILLIAM

1891
BY

CANNOT
THIS

BUT THINK

THAT THE NASAL DISTORTION

IS

LESS

EASILY

REMEDIED

PLAN

JO

IT REQUIRED

BOTH

INSIGHT

AND COURAGE AND

STILL

FOR EARLY

SURGEONS TO SAVE THE PROLABIUM

THE OBSTRUCRING INTO IN THE CENTRAL 1897 JULIUS

LIP

PREMAXILLA PORTION

INCORPORATE

OF THE LIP
REALIZED

WOLFF

THE IMPORTANCE

OF PRESSURE FROM
ALSO ADVOCATED

THE UNITED

TO RERROPOSE THE PREMAXILLA

HE

USE

OF THE ENTIRE IN 1844

PROLABIUM

FOR THE FULL LENGTH OF THE CENTRAL

UPPER LIP

JOSEPHFRAN
WHICH WAS
AS PORTRAIT AS CLASSIC

MALGAIGNE

OF PARIS

WROTE

DU

BEC
IVY

DELI
SURGERY

TRANSLATED

FROM THE FRENCH BY ROBERT

FOR PLASTIC

AND PUBLISHED HIS

REPRINT

AND
HISTORY

RECONSTRUCTIVE

FROM

GARRISONS

OF MEDICINE

JULIUS

WOLFF

SHOWS HIM

YOUNG

MAN
OF HIS
TO

USING THE STANDARD APPROACH

EDGES OF THE CLEFT AND USED PINS BY THE

DAY MALGAIGNE PARED THE

APPROXIMATE THEM BUT WAS NOTCHING

CONSTANTLY DISAPPOINTED

RESULTING

HE

WROTE

FOR

DOUBLE

HARELIP
LIP

THE
IS

ATROPHY

IS

STILL

MORE STRIKING
OTHER SECTIONS

GENERALLY

THE

MEDIAN LOBE OF THE

CONTRIBUTE THEREFORE

SHORTER THAN OF THE

IN

THE

AND

IT

CANNOT IS

TO RECONSTRUCTION

LABIAL

BORDER THE
CASES

MEDIAN

NOTCH

MUCH

DEEPER

THAN

UNILATERAL

HE

WAS FIRST

TO CONCEIVE THESE

AND PUBLISH

THE CUTTING OF FLAPS OFF THE

EDGES AND USING

TO PREVENT

NOTCHING
JOSEPH FRANTOIS AL ALGAIGNE

AS HE SAID

IN

WORD THE

FRESHENING

OF THE HARELIP SHOULD ONLY BE DONE BY CUTTING

IT IS

FROM THE SKIN

FEW PARINGSAND

THE UTILIZATION

OF THESE LOST CUTTINGS THAT

THAT CONSTITUTES THE THE HARELIP TRANSFORMED

NEW METHOD
WHICH
IS

SAY METHOD WITH THE UNDERSTANDING

CLASSIFIED AS

OPERATION THAT
IT

NOW

CHIELORTHAPHY CHEILOPLASRY

BECOMES SO
INSTEAD OF

ENTERS THE ADDS PIECE

CLASSIFICATION IF

OF

ECOMING
ARELIP
IT IS

SEAM
EASILY

IT

ONE WERE DEALING

FOR THE
FLAPS

WITH

DOUBLE

UNDERSTANDABLE

HOW ONE COULD

FLOATING

CREATION OF

MEDIAN RUBERCLE TAKE ADVANTAGE OF THESE TWO

OFFER

WHICH WILL ALWAYS

MOTE THAN THE NECESSARY AMOUNT OF SUBSTANCE

IT

LATER

WAS BROUGHT

TO

MALGAIGNES

ATTENTION
TO

BY

ROUX

THAT

CLEMONT OF ROCHEFORT HAD DESCRIBED

HIM

SIMILAR

OPERATION

AS

EXPLAINED
IN

BY EDITOR

FRANK MCDOWELL
CLASSIC ARTICLE

THERE HAD BEEN NO

ILLUSTRATION

MALGAIGNES

AND THE DIAGRAM SHOWN

LATER

HERE LABELED
IN

CLEMONTMALGAIGNE PROCEDURE WAS PUBLISHED

BOOK BY BROCA

109

BROWN VERSUS
TWO
CHAMPIONS
IN

FEDERSPIEL
GENERAL PRINCIPLE OF INCORPORATING THE

OF THE

PROLABIUM

THE FULL VERTICAL

LENGTH OF THE UPPER LIP WERE GEORGE

VAN INGEN BROWN AND MATTHEW FEDERSPIEL

BOTH HELD
IN

MD AND
MILWAU
AT

DDS
KEE

DEGREES BOTH WROTE BOOKS BOTH WORKED CHILDRENS FREE HOSPITAL

THE

AREABROWN AT

AND FEDERSPIEL

MARQUETTE UNIVERSITY
OUSLY GUARDING HIS BARRING
GEORGE BROWN

THEY WERE KEENLY COMPETITIVE

IN

EACH JEAL

OWNVARIATIONS

TECHNIQUE

TO THE

EXTREME OF

THE OTHER FROM HIS

OPERATING

ROOM
TO

BROWNS AIR
REFER TO

OF POMPOSITY LED FOLLOWERS OF FEDERSPIEL VAINLY IMITATES 1918

THAT

HIM

AS

GOD
LIP

BROWN HE
MAINTAINED
ITS

DESIGNED THE
ENTIRE

SIMPLE
VERTICAL

BILATERAL

CLOSURE IN THE

LENGTH
IT

OF INTO

PROLABIUM INCLUDING
UPPER LIP

VERMILION

AND

INCORPORATED

THE CENTRAL

IN

1927

MATTHEW
THE ENTIRE

FEDERSPIEL

PUBLISHED

HIS

METHOD WHICH
OF THE UPPER THE PROLABIAL

INCORPORATED LIP

PROLABIUM INTO THE

THE

CENTER

ALSO

HE MODIFIED

METHOD BY DISCARDING
VERMILION

VERMILION

AND TRANSPOSED
TO

LATERAL

FLAPS ACROSS

UNDER THE
THESE FLAPS

PROLABIUM
IN
A4ATTHEW
FEDERSPIEL

FORM THE
TO CREATE

FREE

BORDER

HE

INTERDIGITATED

AN

ATTEMPT

CUPIDS

BOW

TOO FEW METHOD

FEDERSPIEL

CASES

WERE PUBLISHED

TO

ALLOW

EVALUATION IN

OF

HIS

BUT THE PRINCIPLE

OF HIS VARIATION

HAS MERIT

THE PAST

HAS BEEN MALIGNED UNJUSTLY BY SOME SURGEONS INCLUD

IT

ING MYSELF AS

HAD BEEN TAUGHT

THAT

HE WAS

PRIME ADVOCATE OF

110

THE MISERABLE BENEATH

PRINCIPLE

OF INTRODUCING

LATERAL

FLAPS INCLUDING

SKIN FLAPS THIS

THE INFERIOR

BORDER OF THE PROLABIUM

IS

ACTUALLY
OFFERED

HIS FOR

AND AN APOLOGY WERE ONLY MUCOSA

HEREWITH

VEAU
DURING

III
HIS

TIME

VICTOR

VEAU

HAD

GREATER

INFLUENCE

ON

LIP

AND PALATE

BEFORE SURGERY THAN ANY SURGEON THE SURGEONS

VERTICAL

HIM HE

WAS THE THIG

NAME AMONG
LABIUM
1938

WHO INCORPORATED

THE ENTIRE IN

PRO
HIS

AS THE CENTRAL

COMPONENT OF THE UPPER LIP

IN DETAIL

BOOK

BECDELI

VEAU DESCRIBED
BILATERAL

THE APPLICATION THE INCOMPLETE PLUS

OF HIS

UNILATERAL CLEFT

CLOSURE IN

CLEFTS

IN

HE MAINTAINED ON

THE MUCOCUTANEOUS JUNCTION THE INFERIOR

FLAPS

SMALL CUFF

OF VERMILION
LATERAL

BORDER OF THE PROLABIUM

AND BROUGHT

VERMILION

TOGETHER BELOW IT

HE

USED

OF EACH LATERAL LIP WIRE RETENTION SUTURE TO ENCOMPASS THE MUSCLE

ELEMENT PASSING
POSTERIORLY

IT

THROUGH THE MUSCLELESS PROLABIUM AND TYING

FREEING

IT

WITHOUT

DIC

PROLABIUM OR BRINGING

THE

MUS

DES

TOGETHER

INCORPORATION
NASAL TIP TO BE

OF THE DRAGGED

TOTAL

PROLABIUM

IN

THE

LIP

CAUSED

THE

DOWN BY

THE SHORT

LL

II

IN
FIVE

COMPLETE

BILATERAL

CLEFTS

VEAU OPERATED
SIDE AT THAT

FIRST

AT

FROM TWO

TO

MONTHS OF AGE AND CLOSED ONE

PALATE CLEFT

TIME INCLUDING
INVOLVED TURNING

THE

ANTERIOR

WITH

HIS

METHOD

THIS

111

FLAP OFF THE FREED

VOMER LIKE

THE LEAF OF

BOOK AND SUTURING

THIS

IT

TO

THE

MUCOSA OF THE

LATERAL FLAP

EDGE THEN OVERLAPPING

FOR PARTIAL

CLOSURE

WITH MONTHS
HIS FREE

MUCOPERIOSTEAL
LATER

SECOND LAYER

THREE
IN

HE CLOSED THE SECOND SIDE OTHER POINTS OF

THAT

INTEREST

METHOD WERE
THE

HE DID

NOT SECTION

THE

VOMER

HE DID

NOT GREAT

PROLABIUM

FROM THE PREMAXILLA

SUTURE PICKED

AND HE

PLACED

EMPHASIS

ON

HIS

MALLIQUE
PREMAXILLA THE

MUSCULAIRE

WHICH PASSED

OVER THE ANTERIOR

UP

THE LATERAL LIP MUSCLE CLOSURE

AND
THE
HIS

WHEN

TIED

RELIEVED HIS CASES

TENSION
FANTASTIC LIP

OF THE

OF

COURSE

VOLUME OF

WAS

AND THE WITH

AN

RESULTS

SHOWN IN

BOOK REVEALED

REASONABLE

OCCASIONAL

LL

DEFORMITY YET
AN EXTREMELY

INVARIABLY
NASAL

THE SHORT COLUMELLA TIP

HAD

RESULTED

IN

DEPRESSED

WHEN
TIONS

VISITED

HIM

IN

1948

CONFIRMED

THESE

SAME OBSERVA

HERE
MILIVOJ MARGARET
NASAL

IS

SIMILAR

CASE

TREATED FIRST

ALONG

THE

SAME WAS

PRINCIPLE INSTITUTED AREA

BY BY AND

PERKO

OF ZURICH

ORTHODONTIA ADHESION

HOTZ THEN

CELESNIK

OF THE ALVEOLAR

FLOORS

WAS FOLLOWED BY

SECONDSTAGE

VEAUTYPE

LIP

CLOSURE

112
IF

AVOIDING

IA

XHAUS EN
ABOUT
THE SAME TIME
IN

1941

THE GREAT

GERMAN SURGEON GEORG

FOR THE CENTER OF THE LIP

AXHAUSEN

ALSO USED THE ENTIRE

PROLABIUM

AFTER SECTIONING CLOSED THE

CLOSURE
II

THE VOMER AND RETROPOSING

THE PREMAXILLA

HE

IN

ONE OR TWO STAGES HIS

FLOOR

TECHNIQUE

EMPHASIZED

OF THE
FREEING

NASAL

AND CONSTRUCTED NO UPPER SULCUS BY

THE PROLABIUM FROM THE PREMAXILLA

HE MAIN
FROM
AS

TAI

NED THE

INFERIOR

PROLABIUM VERMILION

AND

IN

VARIATION

WELL THE LATERAL PROLABIAL OTHER METHODS CONSERVED AS

FLAPS BASED DISTALLY

VERMILION

WHICH HE USED

TO BOLSTER

THE LATERAL SEGMENTS

IN CERTAIN PARTS

THIS

BILATERAL

OPERATION GAINED

SOME POPULARITY

OF

GEORG

AXHAUSEN

EUROPE

113

IT

IS

INTERESTING

THAT

THE

FIRST

TO DESCRIBE

THIS

LATERAL

TRANSPOSI

DON

OF MUCOSA FROM THE PROLABIUM IN THE

WAS AN ENGLISHMAN
LANCET

NAMED
PRE

SMITH
SENTED

DECEMBER 28
FOR BILATERAL SIDES

1867

THOMAS SMITH
IN

METHOD
FLAPS

CLEFTS OF THE LIP

WHICH HE PARED
INFERIORLY

MUCOSAL
INSERTED LIP

FROM THE

OF THE PROLABIUM BASED

RELEASING INCISIONS THIS

AND

THEM INTO MUCOSAL

ALONG THE
IN

LATERAL

ELEMENTS ROSE COMMENTED ON

IT

APPROACH
TISSUES

1891

EVIDENTLY

CAN ONLY BE OF USE WHERE THE

SOFT

ARE ABUNDANT

VAUGHAN
HAROLD
SCOTIA SCHOOL
IN

VAUGHAN WHO CAME

1889
PRECEDED IVY
AT

TO THE UNITED THE UNIVERSITY RECEIVED

STATES

FROM NOVA

OF PENNSYLVANIA

OF DENTISTRY

BY TWO YEARS

HIS

MD FROM
UNIVERSITY

THE

COLLEGE OF PHYSICIANS
LIVED FOR

AND SURGEONS OF COLUMBIA

93 YEARS
IS

AND

AN

ACTIVE

NOTE

TO

IVY

FROM VAUGHANS

GRANDDAUGHTER CATHERINE
GRANDAD WAS

ENLIGHTENING
ECLECTIC

MAN

OF GENIUS

AND

INTERESTS

RUGGED INDIVIDUALIST
AT

AND NOVA SCOTIAN UNDERTOOK

HAROLD VAUGHAN FINANCE OF PAINTING

THROUGH AND THROUGH HE

ETCHING HORTICULTURE THE

SUCCEEDED THE STUDY

WHATEVER BUSINESS

HE

OF

AND

HE UNDERSTOOD

PROFOUNDLY

HUMAN

CHARACTER

HIS SENSE
DID

HUMOR WAS SUBTLE AND

IN IDLE

EXTREMELY

TEASING VERY

HE

LOVED ARGUING

NOR BELIEVE

FLATTERY

HUMAN HUMAN BEING

UNIVERSITY
IN HIS

THIS

HAROLD VAUGHAN OF COLUMBIA

1940

BOOK AGREED WITH

PHIA
THAT

BROWN AND WARREN DAVIS

SHOULD

OF PHILADEL
CENTRAL

THE LOWER PROLABIUM VERMILION

FORM THE

BORDER OF THE LIP MILION

IN PART
IS

HIS

METHOD

INCORPORATED
LATERAL

THE PROLABIUM
TO
FILL

VER
THE

BUT

OVERLAPPED

VERMILION
IS STILL

OUT
IN

TUBERCLE THIS
CLINICS

GENERAL APPROACH THAT

POPULAR

MANY

TODAY

CQAA

114

TJ
AN

NO VS KY
SURGEON
INCLUDED

EARLY RUSSIAN

TERNOVSKY
THE SMALL

IN

THE SPIRIT
ITS

OF

VEAU

BROWN AND VAUGHAN

MUCOCUTANEOUS JUNCTION
CENTRAL PORTION LIP

PROLABIUM
CUFF

INFERIOR AS

AND

OF VCIMILION

THE

OF THE LIP

HE
THE

BROUGHT THE VERMILION

MIDLINE

OF THE LATERAL OF

ELEMENTS

TOGETHER IN

BELOW THE FRINGE

PRO

LABIUM VERMILION

IL

THROUGLIANDTHROUGH

STRAIGHT
IN
ALL

CLOSURE
CLEFTS IN

OF THESE
TO

EARLY

BILATERAL

WHICH THE PROLABIUM

WAS

USED

FORM THE

FULL

LENGTH

OF THE UPPER LIP

THROUGHAND THE
FOR SCARS ARE

THROUGH STRAIGHTLINE UNIMAGINATIVE

CLOSURE

WAS USED
PARTLY

BILATERALLY

UNNATURAL

AND

RESPONSIBLE
CLEFTS

SOME

OF THE

WELLKNOWN SECONDARY
EARLY

STIGMA

OF BILATERAL

YET

AS LATE AS THE BILATERAL

1970S

TWO

PLASTIC

SURGERY GIANTS

WITH IMPRESSIVE
CONCLUSIONS

CLEFT TRACK

RECORDS

HAVE

COME

TO

OPPOSITE
IN

TOM
HIS

CRONIN WITH
FOR

PENOFF IN THE

TEXAS
III

1971

EMPHATICALLY CLOSURE

STATED

PREFERENCE

VEAU

OR STRAIGHTLINE

WITH

PRESERVATION
IT

OF THE PROLABIUM CUPIDS

RIDGE

CLAIMING
NOR DIFFICULT TO REVISE

IS

SIMPLE
FOR

FORMS

BOW AND

IS

THERE

IS

TENDENCY

LACK OF PROTRUSION

OF THE VERMILION

BORDER

RAY BROADBENT WITH WOOLF

DISADVANTAGES
ADDITIONAL

IN

UTAH

IN

1972

ENUMERATED THE

OF THE STANDARD STRAIGHTLINE WITH THE STRAIGHT

LINE

CLOSURE
REAFFIRMED THE
FLOOR

EXPERIENCE OF THE

REPAIR

20

CASES

OLD PROBLEMS PRESENTING ADHERENT

STRAIGHT DIRTY

SCAROFTEN ASSOCIATED WITH APPEARANCE

WHISTLING

GROOVED NOSTRIL
DEFORMITY

WITH

NOSE

AN

PROLABIUM

115

AS

LATE

AS

1974

DONALD
TOTAL

KAPETANSKY OF SOUTHFIELD

MICHIGAN
IN

ADVOCATED

SIMPLE

INCORPORATION

OF THE PROLABIUM

THE

CENTER OF THE LIP EDGE PARINGS SUPERIORLY

HIS

ONE MODIFICATION
VERMILION THE

WAS PRESERVATION
AS LATERAL

OF CLEFT

INCLUDING

AND SKIN

FLAPS BASED

DURING

SIDETOSIDE

APPROXIMATION

OF
FLAPS

THE

FRESHENED LATERAL LIP ELEMENTS

TO THE PROLABIUM THESE SIDE

WERE
RELIEVE

INSERTED

BILATERALLY

INTO

MEMBRANOUS SEPTAL

INCISION

TO

TENSION

OF THE UPPER

LIP

KAPETANSKY
TION WILL

IS

NOT CONCERNED

THAT THE RESULT OF SUCH AN OPERA ALAE SPREAD PROLABIUM

PRESENT

SHORT COLUMELLA FLARING

LIP

WITH

BULGING
OF

LATERAL

ELEMENTS

LACK OF

MUSCLE CONTINUITY
OF
BIZARRE

ABSENCE

AN

UPPER

SULCUS

VISIBLE

PRESERVATION

PROLABIUM

VERMILION

AND
UNTIL

WHISTLING
FIVE YEARS

DEFORMITY
OF AGE AT WHICH TIME HE BY
BILATERAL

HE

IS

CONTENT
HIS

TO WAIT

ADVOCATES FOLLOWED

EFFECTIVE

MUSCLE

TRANSFERS

PENDULUMS

WITH MILLARD

COLUMELLALENGRHENING
FLAPS

PROCEDURE
NOSTRIL FLOOR

AND

NOSTRIL

CORRECTION

EITHER

BY

OR BY CRONIN

PEDICLES

THE

AN ANATOMICAL PROLABIUM

ARGUMENT FOR
IN
FIRST

THE
DESCRIBED

LIP
BY RUYSCH IN 1703

THE VOMERONASAL ORGAN WAS

FINALLY IN IT

AND

1811

BY JACOBSON CLAIMED

DANE
THAT

FOR

WHOMTHE

ORGAN WAS

NAMED
LOGICALLY

HAS BEEN THE

PHYLOGENETICALLY THE

AND EMBRYO

PROLABIUM
AS

REPRESENTS
IS

JACOBSON
BELONGS
AT

AND
THE

THE LATTER

PART TO

RUDIMENTARY ORGAN OF OF THE NOSE THE PROLABIUM

IN

LOWER

SEPTUM

AID

THE

FORMATION

OF THE

COLUMELLA IN

NEW YORK

STARK AND

EHRMANN PROVED
CLEFT LIP

OTHERWISE

WHEN

THEY

FOUND

OUT OF SIX

EMBRYOS WITH

AND PALATE

116

IN THOSE THREE IT WITH THE ORGAN OF JACOBSON AND EVEN ONLY THREE SURFACE OF THE LIP TO THE CUTANEOUS 15

WAS 10

TO

MM

POSTERIOR

THUS THE CONCLUSION

WAS THAT NEITHER PROLABIUM NOT PREMAXILLA

BILATERAL CLEFTS

IS

WE1L
CT

IN THE SEAT OF JACOBSONS ORGAN

COEXISTENCE

OF

ORGAN

FAR POSTERIOR IN

THE NASAL SEPTUM TO

POSSIBILITY

THE WELIDEFINED

SUCH PROLABIUM PRECLUDES

AND THE

IN ABSENCE OF THE ORGAN

THE PROLABIUM OF EMBRYOS FURTHER VITIATES

THE CLAIM PROLABIUM

IN
IN

1958 THE LIP

STARK WITH

EHRMANN

CONFIRMED

USE OF THE

PROGRAM
STRUCTURE
IT

THE

PROLABIUM
LIP

IS

LIP IN

SHOULD
CLEFT IF

BE LIP

USED IN
IF

ITS

ENTIRETY

AS

THE
IS

CENTRAL

ELEMENT

REPAIR WILL

OF BILATERAL

THE PROLABIUM ALONE

IS

USED

NORMAL PHILTRUM

DEVELOP
WILL

THE PROLABIUM

PLACED ONTO THE WILL

NOSE AS COLUMELLA BEGREARLY

THE COLUMELLA

BE HIRSUTE IN BEREFT OF

THE MALE AND THE LIP

ITS

ELONGATED

AND

WILL

DEVELOP

PHILTRUM

IN

GENERAL PRINCIPLE
IS

USE OF THE PROLABIUM AS THE CENTRAL

AS FAR AS IT

FIGURE

OF THE LIP

SOUND

GOES

AND
IT

IS

THE

BASIS IN
ITS

OF MOST
ENTIRETY VERTICAL

MODERN METHODS TODAY YET AND

ONLY IN

TO INSIST
IT

THAT

BE USED
TOTAL

THE LIP
IS

AND

THAT

FORM THE
EVENTUALLY

CENTRAL

PORTION BE

OF THE LIP

SHORTSIGHTED THE

THE COLUMELLA

MUST WIDE
CAN

LENGTHENED AND
OR AS THE COLUMELLA
IN

PROLABIUM

WHICH

MAY

BE

TOO

ORIGINALLY SHARE ILY IN

BLOB
LENGTHENING

LATER STRETCHED TOO EITHER

WIDE

PRIMARILY
VERTICAL

OR SECONDAR LENGTH OF THE

THEN TOO

ORDER TO FORM THE ENTIRE

INFERIOR

LIP
TION

THE PROLABIUMS

VERMILION

AND MUCOCUTANEOUS JUNC

OFTEN LEAVES

MUST BE PRESERVED

AS SUCH

AND

THIS

MUCH

TO

BE

DESIRED

II

117