PC19. Prolabial Augmentation of Upper Lip (PAUL) Turnover Flap in Bilateral Cleft Lip Repair

PURPOSE: Bilateral cleft lip presents a complex challenge for surgical repair without a universally accepted technique. Secondary deformities of bilateral cleft lip repair include tubercle anomalies, ranging from tubercle deficiency to the well-described whistle deformity. Adequate tubercle is required to create a lip seal while making consonant sounds, fully cover the incisors, and produce balanced projection of the face. METHODS: We propose a novel technique to improve tubercle projection during bilateral cleft lip repair. Here, additional tubercle volume and projection is achieved by making use of tissue that is normally discarded in cleft lip repair. Following harvest of the sulcus flap, a distally-based random pattern fibroadipose flap (Prolabial Augmentation Of Upper Lip turnover flap, the “PAUL” flap) is dissected off of the prolabial skin, keeping a thin layer of fat under the skin. After dissection of the lateral lip elements and inset of the sulcus flap and muscle re-approximation, the PAUL flap is then inset into the submucosal pocket in the midline of the tubercle, as a turnover auto-augmentation flap. The prolabium is then inset superior to the PAUL flap, resulting in improvement in tubercle projection. CONCLUSION: This technique is amenable to use in bilateral cleft lip repairs including traditional Millard-Mulliken and Fisher approaches to augment tubercle volume.