Method of Gillies and Millard 1957

A vermilion flap is outlined on the upper or lower lip (Fig. 6.58a) according to the degree of elongation required. A two-layer excision is made at the commissure, sparing the mucosa on the inner aspect of the lower lip, which is raised as a flap (Fig. 6.58b, c). That flap is sutured to a de-epithelialized area to reconstruct the vermilion of the lower lip (Fig. 6.58d). The vermilion flap is rotated laterally to restore the upper vermilion at the commissure. The mucosal flap may have to be mobilized slightly toward the oral vestibule.

Fig. 6.55 Elongation of the oral fissure by the method of Converse (1959). Right side: the epithelium is excised following measurement of lip length. The vermilion is incised and mobilized (see Fig. 6.54). Left side: closure of the defects (D).

Fig. 6.56 Elongation of the oral fissure (Converse 1977). a The lip length is measured. A triangle of epithelium (D) is excised down to the mucosa, which is left intact. The existing commissure is incised ( f). b T-shaped incisions are made in the exposed mucosa. c The three mucosal flaps are turned. d The completed repair. (S = mucosal flaps)

Fig. 6.56 Elongation of the oral fissure (Converse 1977). a The lip length is measured. A triangle of epithelium (D) is excised down to the mucosa, which is left intact. The existing commissure is incised ( f). b T-shaped incisions are made in the exposed mucosa. c The three mucosal flaps are turned. d The completed repair. (S = mucosal flaps)

Fig. 6.57 Elongation of the oral fissure by the Ganzer method.

a An epithelial triangle is excised following measurement of lip length. An incision is made around the vermilion without dividing it.

b The entire vermilion is advanced laterally and sutured into the defect.

Fig. 6.57 Elongation of the oral fissure by the Ganzer method.

a An epithelial triangle is excised following measurement of lip length. An incision is made around the vermilion without dividing it.

b The entire vermilion is advanced laterally and sutured into the defect.

Fig. 6.58 Elongation of the oral fissure by the method of > Gillies and Millard (1957).

a After the necessary elongation is determined, a triangular segment of skin is excised lateral to the rounded commissure, and a vermilion flap is raised from the lower (or upper) lip.

b The vermilion flap is rotated laterally, and the remaining tissue is excised down to the oral mucosa. c The mucosal flap is mobilized to form the vermilion of the lower lip.

d Both flaps are sutured into the upper and lower lip defects

(using 6-0 or 7-0 monofilament). e Two-part mucosal flap from the cheek.

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