Operative Correction of Deformities of Upper Lip
When the deformity is either of the first or second degree, one or the other of the operations for the restoration of congenital cleft just considered may be employed. When these are impracticable other methods must be resorted to.
Bruns Method.—Bruns advocates making two lateral flaps from the cheeks, as shown in [Fig. 198]. He preserves the inferior margin of these flaps, which contain a cicatricial border which must take the place of the prolabium. This border can, however, be made up of the vermilion border of the lower lip, as shown later in the performance of stomatoplasty, to establish a better cosmetic effect.
The rectangular cheek flaps are sutured, as in [Fig. 199], leaving two small triangular wounds at either side of the alæ to heal by granulation.
The cheek flaps referred to must be dissected up from the bone, and be rendered as mobile as possible for a successful issue.
Fig. 198. Fig. 199.
Bruns Method.
Dieffenbach Method.—The method of Dieffenbach is very similar to the above. It has been described on page 157. In this the lateral flaps are made by two curved incisions encircling the alæ of the nose. Should these be insufficient, two other curved incisions are added, as shown by the dotted lines in [Fig. 183].