Columella lengthening in bilateral cleft lip patients. Experience with the forked flap procedure.

All patients with bilateral complete clefts of the lip and some patients with incomplete clefts have a short or almost non-existing columella. This is a characteristic deformity which can only be corrected by surgical lengthening of the columella. Among the numerous methods which have been used for this purpose, the forked falp method as described by Millard (1958) has certain advantages: 1. Sufficient donor tissue is available in the lateral parts of the prolabium to produce full lengthening of the columella and adequate projection of the tip of the nose. 2. Most patients with bilateral clefts need secondary correction of the lip scars and a narrowing of the nostrils after the primary operation. Both of these objectives are achieved as a part of the forked flap procedure. 3. Access is gained both to the lip muscles and to the alar cartilages at the tip of the nose. 4. Narrowing of the lip in the upper part results in a natural eversion of the lower part, and a short lip can be lengthened by letting the remaining central part of the prolabium go down during suturing. 5. The scars left in the upper lip are in an unobtrusive position corresponding to the philtral ridges. During the period 1965-77, 87 patients with bilateral cleft lip have had a columella lengthening performed according to the forked flap method. Our experience with this method has been very favourable. No serious complications have ensued, and the cosmetic results have been most satisfactory in the majority of cases.