CONSCIENTIOUS

OBJECTORS

YEAR SENSE

BEFORE

WAS BORN GEORGE

OF STICKING

BROWN HAD

THE

GOOD
AND
IN

TO OBJECT TO THE PRINCIPLE

LATERAL FLAPS OF SKIN

VERMILION 1918
THAT

BELOW THE
INCISIONS

INFERIOR

EDGE OF THE PROLABIUM BY

HE

NOTED

AS ADVOCATED

VON

LANGENBECK

MIRAULT

MAAS AND OTHERS WERE UNDESIRABLE

THIS

METHOD OF OPERATION

CREATES

AN UGLY DEFORMITY

BY MAKING

THE LIP

TOO

LONG AND SHOULD BE AVOIDED

AT

LEAST HE

HAD THE COURAGE

TO SPEAK OUT

THAT AGAINST METHODS SPITE

WERE POPULAR STAND THIS

AMONG

SURGEONS

OF HIS

DAY IN

OF HIS

EARLY

PRINCIPLE

CONTINUES EVEN

TO HAVE SPORADIC

POPULARITY

AMONG

THE UNENLIGHTENED

OF TODAY

ANOTHER
THEN
HIS IN

HEATED
IN

DISSENTER
FIERY

CHICAGO

1951

THE

MILTON ADAMS OF MEMPHIS

IN

INIMITABLE

STYLE

PULLED

THE PIN

ON

GRENADE

LABELED
CLEFT

THE
AND

MISUSE TOSSED

OF THE PROLABIUM IN
IT

THE REPAIR

OF BILATERAL

LIP

INTO

THE MEETING OF THE AMERICAN

BLAST

ASSOCIATION

OF PLASTIC
AT PRIMARY

SURGEONS THE MAIN

SURGICAL

OF THE EXPLOSION

WAS AIMED
IS

PROCEDURES WHEREIN THE PROLABIUM

SHIFTED

UP
IN

TO BUILD PART

THE COLUMELLA

AND THE UPPER

LABIAL

LIP

IS

FORMED WHOLLY OR
IN

BY

SUTURE OF THE LATERAL

SEGMENTS

THE

MIDLINEOR

MAAS
MILTON

ROSE THOMPSON AND HAGEDORN UNSCATHED WERE THE METHODS OF BROWN VAUGHAN AXHAUSEN AND WARREN

ADAMS

K6NIG

DAVIS
VERTICAL

WHEREIN
LIP

THE

PROLABIUM

ALONE

IS

UTILIZED

FOR

THE

TOTAL

THIS PRESENTATION

COAUTHORED BY THE ADAMS BROTHERS

135

TH
MILTON AND LORENZO FROM TENNESSEE WAS PUBLISHED BECAME MILTON
SHIFTED CLASSIC IN

1953

AND

ADAMS
INFANTS

ADMITTED

THAT

14

YEARS

EARLIER

HE
TO

HAD
AVOID

FIRST

AN

PROLABIUM INTO

THE

COLUMELLA
TO SIDE

THE

FLATTIPPED

NOSE AND HAD CLOSED THE LIP SIDE

FIREBALL

BENEATH IT
THIS TRAP

THE
HIS

MEMPHIS
HAPPIER

BLAMED

BEING

TEMPTED INTO
IN

ON

EXPERIENCES
TO HIS TO

WITH THE SAME PRINCIPLE

ADULT CASES

TRUE
TO DO

MOTTOES

IT

IS

OFTEN AS NECESSARY TO

KNOW WHAT
SURGEON

NOT

AS

KNOW WHAT

TO

DO
CRITIC

AND

GOOD

SHOULD
HIS

ALWAYS BE HIS

OWN SEVEREST

MILTON POINTED

OUT

FIND

INGS
IT
IS

DIFFICULT

TO EXPLAIN

WHY THE

UPPER LIP

OF AN ADULT REPAIRED BY SUTURE OF WILL REMAIN AS CONSTRUCTED WHILE TWICE THE NORMAL LENGTHENING

THE LATERAL SEGMENTS TOGETHER IN THE MIDLINE IN AN INFANT

IT

WILL BE FOLLOWED BY PRACTICALLY

OF THE LIP

THE ADAMS

BOYS

CONJECTURED
IN

PERHAPS THE EXTRA LENGTH

THE LIP LIP

THE INFANT

IS

DEVELOPED

BY REPEATED DRAWING OF THE TEETH SUPPORT THE

DOWN OVER

THE PREMAXILLA

WHEREAS IN THE ADULT

THEY ADMITTED
THE PROLABIUM
IS

OFTEN

SMALL

EVEN

RUDIMENTARY

AND ONE MAY THUS

BE

TEMPTED

BUT THEY HASTENED

INDEED
IS

TO

REASSURE

THE DEVELOPMENT WHICH TAKES PLACE IN

EVEN

RUDIMENTARY

PROLABIUM

AMAZING

THEY

ADVISED

STAGING

THE

REPAIR

RATHER

THAN

SECTIONING
AFTER

THE THE

VOMER AND
CHILD

ADVOCATED

CORRECTION OF THE NASAL

FACIES

DEFORMITY

ACQUIRED

AN ADULT

IN
THEIR

1973 MORE
PREVIOUS

THAN 20 YEARS LATER

LORENZO ADAMS RECONFIRMED

STAND NOW
THAT THE INFORMATION IN THE ARTICLE

IT

IS

MY

IMPRESSION

PRESENTED
CLEFT CLEFT

BY
LIP LIP

MILTON AND
IN INFANCY
IS

ME ON THE MISUSE
VALID
IT
IS

OF THE PROLABIUM IN IMPRESSION THAT IN

REPAIR OF DOUBLE CASES OF DOUBLE

NOW MY

AND PALATE
FLAPS

AFTER

ATTAINING
LATERAL

MATURITY

OF THE FACIAL

FEATURES IN ABOVE

POSTADOLESCENCE OR BENEATH THE

FROM THE

SEGMENTS

MAY

BE

UTILIZED

LOR

ADAMS

136

PROLABIUM

WITHOUT RESULTING
THIS
IS

IN

EXCESSIVE ELONGATION

IN

THE VERTICAL

DIMEN

SION OF THE LIP INFANCY

IN

CONTRAST TO THE RESULTS

OF THE SAME PROCEDURES IN

CHECK
WHETHER THIS
PREVIOUS BEGINNING 1951
IT

ADAMS

STAND STARTED
TO THE FORE
IS

TREND OR PUT

BRAKE ON

TRENDS

BROUGHT HERE

WHAT MANY SURGEONS WERE

IN

TO REALIZE

AN EXAMPLE

19541955

WHILE STEN
IN

WAS

AT

MED
OF

WITH

THE FIRST

US
HE

MARINE DIVISION
AT

KOREA
HOSPITAL

STENSTROM

SWEDEN WAS DOWN

HIS

THE

SWEDISH

PUSAN
LATERAL

DURING
FLAP TO

TIME

THERE SKIN

USED

THE LEMESURIER
TISSUE

QUADRI
THE
HIS

INTRODUCE

AND MUCOSAL
CLEFT

BENEATH
STATED IN

ORIENTAL PROLABIUM ON 18 1957 PRELIMINARY REPORT

BILATERAL

CASES

HE

ONLY BY LONG OBSERVATION

CAN THE

PROCEDURE BE FULLY

EVALUATED

WHEREUPON BROMLEY FREEMAN 1958

ABOUT SEVEN YEARS AGO
SMALL NUMBER OF PATIENTS
TRIED THIS

OF

HOUSTON TEXAS

RESPONDED

IN

COMBINED
LIP

LEMESURIER

TECHNIQUE

ON

AYC

DOLVT
II

FOR BILATERAL

REPAIR AND HAVE BEEN ABLE TO FOLLOW HAVE

THEM
ENTIRELY

LITTLE

LONGER THAN

DR

STENSTROM

FOUND THAT THE

LIP

GROWS WAS

TOO LONG AS TYPICAL SECONDARY REPAIR

IT

OF THE OLDER METHODS OF REPAIR OCCURRED TO

WHILE
THIS

DOING

ME THAT

SHOULD BRING

TO YOUR IN

ATTENTION INFORMAL WITH

SO THAT THE YOUNGER DISCUSSION WITH

SEVERAL

MEN
OF

COULD

BE APPRISED FIND

OF THE FACT

MY COLLEAGUES

THAT THEY HAVE MET

SIMILAR

DIFFICULTY

MASTERS
LEMESURIER TREATMENT
FLAPS REALIZE

SECOND THOUGHTS
HIS

HAD ADAPTED
OF BILATERAL THE
LIP

MODIFICATION

OF HAGEDORN FOR THE

SLIDING

CLEFTS

AND WAS
OF THE
THAT

TWO

QUADRILATERAL

ALONG

LOWER

BORDER

PROLABIUM

HE

BEGAN

TO

FROM FOLLOWUP OBSERVATION

HIS APPROACH

WHEN THE PROLABIUM WAS

LONG PRIMARILY

COULD ONLY PRODUCE LONGER UPPER LIPS OUTLINED

HIS SELECTIVE

THUS
IF

IN

HIS

1962

BOOK HE

PLAN

THE PROLABIUM

IS

OF THE LIP OF DECENT LONG ENOUGH TO MAKE THE CENTRAL PART

IS

LENGTH AND IF VERMILION

THERE

ENOUGH MUCOUS MEMBRANE AVAILABLE

TO MAKE

THE

BORDER THICK

ENOUGH IT

IS

PROBABLY

BETTER TO BRING

THE PROLABIUM

137

DOWN AND
DER
IN

USE

ITS

LOWER EDGE TO FOTM THE

CASES LIP IN

CENTRAL PART OF THE LOWET

IS

HOT

BILATERAL

WHICH THE PROLABIUM LONG OT

IF
ITS

TOO SHOTT TO

MAKE THE
IS

CENTRAL PART OF THE EXTREMELY

SUFFICIENTLY

MUCOUS MEMBRANE
BOTH
SIDES

THIN

IT

IS

BETRET TO TURN MIDLINE

DOWN FLAPS FROM

AND SUTURE

THEM TOGETHER

IN

THE

BELOW THE PROLABIUM

THEN HE
BILATERAL LIP

CHARTED
CLEFTS

THE

DESIGN

FOR

EACH

GENERAL

CATEGORY

OF

AND INCLUDED

AN ALTERNATIVE

APPROACH

INCORPO

RATING THE WHOLE LENGTH NENT OF THE LIP

OF THE PROLABIUM AS THE CENTRAL

COMPO

COMPLETE

BILATERAL

CLEFTS

KIFGIA

FG

LEMESURIER

HIS

ALTERNATE

LEMESURIER

IN

TYPICAL

CANDOR STATED

IT

MUST BE ADMITTED
IN

THAT NO MATTER
BILATERAL CLEFT

WHICH OPETATION
OF THE LIP
ARE

IS

DONE

THE RESULTS

OBTAINED

THE COMPLETE

ALWAYS FAR FROM PERFECT

ONE COMPLETE CLEFT ONE

INCOMPLETE

LEMESURIER

HIS

ALTERNATE

BOTH

CLEFTS

INCOMPLETE

LEMESURIER

HIS

ALTERNATE

138

LEMESURIETS
BILATERAL CLEFTS

COMMENT ON WAS
IS

HIS

RESULTS

OF INCOMPLETE

TYPE OF

NO MATTER

WHICH OPERATION

DONE THE

RESULTS

ARE

USUALLY BETTER THAN IN

THE

BILATERAL OTHER TYPES OF

HARELIPS

SALTY
IN 1972

CRITICISM
SALT

BROADBENT AND WOOLF OF METHOD

IN

LAKE CITY EVALUATED THE USE

CLEFTS

OF THE LEMESURIER
PRESSIVE INGLY RESULTS

BILATERAL IN

AND REPORTED

UNIM

WHETHER DONE
FALSE

ONE OR TWO STAGES DISAPPOINT CUPIDS

LONG LIPS

AND

IRREGULAR

HOW

PROLABIUM AND
FLAT

STILL

ADHERENT TO THE PREMAXILLA

WHISTLING

DEFORMITY

NOSE AND

THE LENGTH OF THE TWO

AT TIMES NORMAL

SIDES

OF THE LIP WERE OFTEN UNEQUAL

SKETCH OF CHRISTMAS
TREE

THE SCAR PATTERN RESEMBLED

PHILTRAL

MORE THAN

RIDGE

OBJECTIONS
TOM CRONIN
AND
RETOLD

FROM TEXAS
JOINED THE

OF

HOUSTON TEXAS

ADAMS SWING

IN

1957

THE STORY
AT

ADAMS AND ADAMS

TEPAIR LIPS FOR

ONE TIME

USED

ALL

OF THE

PROLABIUM

IN

THE INITIAL YEAR SUCH TENDENCY

LENGTHENING

THE COLUMELLA
ENTIRELY

BUT THEY FOUND THAT WITHIN

VERTICALLY

WERE

BECOMING
WITH

TOO LONG

AND THAT

THIS

CONTINUED
THIS

THE GROWTH OF THE CHILD

THEY NOW STRONGLY ADVISE AGAINST

PROCEDURE

AND

AGREE WITH

THEM COMPLETELY

IN THE

REFERENCE LATERAL

TO PREVIOUS LIP

METHODS WHICH TURNED

BENEATH THE

FLAPS TO

OF SKIN FROM
II

ELEMENTS

PROLABIUM

INCREASE

ITS
II

VERTICAL

LENGTH CRONIN EXPLAINED

HAS OBVIOUSLY ARISEN BECAUSE THE

II

THIS

PRACTICE

PROLABIUM APPEARS
IN THEIR

TO BE

SHORTER THAN THE LIP POSITION LIP IN

FRAGMENTS

ON EACH SIDE

ALL PROLABIA

ISOLATED IN THE
LIP

APPEAR SMALLER THAN THEIR ACTUAL POTENTIAL THE

FIRST

WHEN INCORPORATED
THAN

PLACE

THE PROLABIUM
AS

ACTUALLY

IS

THINNER

THE LATERAL

TISSUE

AND
IT

SECONDLY

THERE ARE NO ATTACHMENTS THE

TO STRETCH THE PROLABIUM

OUR

SHRINKS

DOWN TO

SMALLEST AREA POSSIBLE

CRONIN WENT ON
SIMPLE
BILATERAL

TO DESCRIBE LIP

HIS

PREMAXILLARY

SETBACK AND

RATHER

BFR

CLOSURE IN ONE STAGE WITH THE PROLABIUM USED

139

TO

FORM THE

FULL

VERTICAL
LEFT

LENGTH

OF THE MIDDLE

OF THE LIP
NASAL HIS

THIS
TIP LATER

LQ

PROCEDURE DEPRESSED COLUMELLA

OF COURSE

THE COLUMELLA
SET

SHORT AND THE

FOR

AND

MERELY

THE

LIP

GROUNDWORK

LENGTHENING CRONIN WAS EVEN MORE AND EVEN

FIRED LATERAL DECISIVE

BY

1971

AGAINST OF THE

INFERIOR

SKIN

BOLSTERING

INTERDIGITATIONS

PROLABIUM

WITH

PENOFF HE
II

SOME BROADSIDE
IS

SHOTS

THE VEAU
LIP

OR BARSKY
IS

TYPE OPERATION
VERTICALLY

AN OBSOLETE PROCEDURE RESULTING

SIDE

IN

WHICH

TOO LONG TO

AND TOO SHORT FROM AND

LINGUAL
TILTING
ALL

TO SIDE THE

THE

TIGHTNESS TEETH VERMILION

CONTRIBUTES

RETRUSION

OF OF THE

INCISOR

THE

BARRETT

BROWN PROCEDURE REMOVES

OF THE
LATERAL

PROLABIUM
THE

BRINGING

THE VERMILION
TO LIP

SEGMENTS

TOGETHER IN
CIRCULAR

MIDLINE
AS

THEREBY TENDING

CONSTRICT THE PROLABIAL SKIN IN

BIT

MANNER
ONLY ONE

WELL AS

MAKING
OF THE

THE

TIGHT

FROM SIDE TO SIDE WAS DONE

THIS

ADAPTATION

LEMESURIER TENDED

OPERATION
IN

PROCEDURE

WAS

WASREFUL OF TISSUE SCARS

TO RESULT

SIDE TO SIDE TIGHTNESS AND NOTICEABLE

THE
LIP
ERNEST

VERSUS GROWTH OBJECTION

KAPLAN
LENGTH OF STANFORD OF UNILATERAL MEDICAL
CLEFTS IN

HORIZONTAL

VERTICAL
CENTER THE
ITS

HAS MEASURED

HORIZONTAL

NEWBORN AND THE

ORIGINAL

ADULT AND FOUND THAT THE LIP LENGTH DOUBLES

HORIZONTAL OF
VERTICAL

DIMENSION
PHILTRUM PORTIONAL
VERTICAL

100
HEIGHT
IN

PERCENT

SIMILAR

MEASUREMENTS

THE NEWBORN AND THE ADULT INDICATED

PRO
PERCENT

GROWTH OF THE PROLABIUM

WITH ONLY 50
TO

TO 75

GROWTH POTENTIAL
IN

FROM THE NEWBORN

THE

ADULT

HE

NOTED
ERNEST

1974

KAPLAN

WHEN THE

5075
DIRECTION

VERTICAL

GROWTH
THAT CAN
TISSUE IN

IS

COMPARED TO THE 75
LIP

100
AS

HORIZONTAL
IN

GROWTH WE
HORIZONTAL OPERATIVE RING
IT

CAN APPRECIATE
AS
IT

CLEFT

CAN GROW TWICE DIRECTION

MUCH

THE ANY

THE
THAT
IS

VERTICAL

THEREFORE

PROCEDURE TAKING THE VERTICAL

HORIZONTALLY
FOR

ARRANGTD AND TRANSFER

THIS

IN

DIRECTION

MUST ACCOUNT

POTENTIAL

GROWTH

DIFFERENTIAL REPAIR IN

THIS

WE BELIEVE MUCH ON
LITTLE

EXPLAINS

WHY

THE ASENSIO

AND THE LEMESURIER

IS

CAN GROW TOO

THE CLEFT SIDE

WHEN THE
IS

PROCEDURE

PERFORMED
IS

NEWBORN BUT

OR NO DISCREPANCY

SEEN

WHEN

THE

PROCEDURE

APPLIED

TO YOUNG CHILDREN

AND ADULTS

140

CAUSE

OF
LIP

INCREASED

VERTICAL
ALT

LENGTH
HAVE BEEN CONFINED
TO THE BILATERAL TO THE UNILATERAL CLEFT

HH
OUG ANY

KAPLANS

STUDIES

DEFT OF COURSE THEY

VERTICAL

ALSO APPLY

AND DOUBLY SO NOTED

LIP

FLAPS TRANSPOSED HORIZONTALLY FOR

AS SO OFTEN IN

WILL

BE RESPONSIBLE
IS

ABNORMAL

INCREASE

VERTICAL

YJENGTH
FLAPS

THIS

ANOTHER SOUND

CONTRAINDICATION

TO THE USE OF SUCH

SPITE HALF

OF THESE CENTURY

WISE

WARNINGS BY EXPERIENCED
ARE
STILL

SURGEONS
IN

FOR

OPERATIONS

BEING

DONE

WHICH
14

FLAPS ARE INTRODUCED

BELOW THE PROLABIUM

SEEN IN DURING

THE
CLINICS

INVARIABLY

UNAEPTABLE

RESULTS

BEING

MANY
THEIR

CLEFT

AND THE

DIFFICULTIES

ENCOUNTERED
THESE

SECONDARY CORRECTION

WARRANT STAMP
HAVING
THEIR

ACTIONS

OBSOLETE

AND

DANGEROUS

USE OUTLAWED

II

141