Gingival Vestibuloplasty in a Patient With Cleft Lip and Palate Using Birth Tissue
After informed consent was obtained the patient was brought to the operating room and placed in the supine position. The correct patient and procedure were identified and a Time Out was performed. After induction of general anesthesia, patient was intubated transnasally from right nostril. The table was turned to 90 degree and head was extended. 2% xylocaine with 1:100,00 epinephrine was injected over the left side of the maxillary gingivolabial sulcus.
Patient was prepped and draped in usual fashion.
Approximately 3 cm long incision was made along the mucogingival junction on the left side preserving the gingiva at the dental margin. This went from just to the right of the central incisor and over to the left molar. Supraperiosteal dissection was performed till the desired vestibular depth using predominantly a 15 blade. The periosteum was intentionally incised towards the height of the sulcus to promote attachment of the mucosa and maintain a deep sulcus with healing.
In the process of obtaining adequate release towards the intended sulcus depth, a connection to the nasal cavity was noted where the fistula was previously repaired. Tissue manipulation was done around the left nasal fistulous tract to allow for closure and it was then sutured with 5-0 vicryl in intermittent fashion.
Leak test performed showed no leak. Another suture in figure 8 fashion was then also applied over the closure to ensure no leak.
The free cut mucosal edge of the lip tissue was then sutured to the depth of the vestibular sulcus using interrupted 4-0 monocryl sutures. The remaining raw periosteal surface was covered with a 2×2 cm piece of Neox 1K membrane and was secured with intermittent sutures with 4-0 monocryl. Hemostasis was great throughout requiring very little cautery..
A periopak was created that was also mixed with doxycycline powder and applied over the surgical site. Mouth was closed to reshape the Coepack dressing to remove excess material and to prevent chipping off while eating.
Having tolerated the procedure well the patient was turned back over to anesthesia, awakened and transferred to the recovery room in stable condition.
A Gingival vestibuloplasty performed under general anesthesia. The technique includes: infiltration and mucosal incision at the shallow vestibule, mobilization and advancement of mucosal tissue to deepen the vestibule, meticulous hemostasis, placement of processed birth tissue as a biologic dressing and scaffold over the donor/recipient bed, fixation with resorbable sutures.
1. Shallow labial/buccal vestibule or loss of vestibular depth after cleft lip repair that impedes prosthetic rehabilitation, orthodontic tooth movement, or oral hygiene.
2. Shallow labial/buccal vestibule limiting denture retention/stability.
3. Loss of vestibular depth after scarring post traumatic oral injuries.
4. After segmental resection, flap harvest, or grafting where vestibular depth is lost.
5. Correction of post-burn or surgical contracture tethering lip and reducing vestibular depth.
1. Active local infection (untreated acute oral infection/abscess) or uncontrolled oral inflammatory disease.
2. Inadequate soft-tissue or vascular supply at the recipient site preventing successful closure/mucosal advancement.
3. Systemic contraindications to elective surgery (unstable medical comorbidity)
4. When combining with birth tissue, severe immunologic concerns/contradictions per product labeling.
Cheek retractor
15 blade scalpel
Dental Spoon
Needle driver
Double pronged skin hook
Senn Retractor
Tenotomy scissors
Gerald tissue forceps
Frazier tip suction #9
1. General anesthesia with orotracheal intubation.
2. Head slightly extended; oral cavity prepped and draped.
3. Standard periodontal/ENT instrument set: mucosal elevators, scalpel (15-blade), fine scissors, needle drivers, suction, bipolar cautery for hemostasis.
4. Resorbable sutures (4-0 / 5-0 Vicryl or similar).
5. Processed human birth tissue (amnion/chorion membrane or equivalent sterile allograft) sized to defect.
6. Optional: intraoral stent/splint or periodontal dressing to protect graft and maintain vestibular depth.
1. Full medical history and examination (bleeding diathesis, diabetes control, smoking status for adults).
2. Dental/orthodontic charting and panoramic radiograph (and CBCT if alveolar defects or bone graft planning).
3. Review prior cleft repairs, scars, and any prior grafts or bone grafts.
4. Informed consent discussing use of birth tissue allograft, alternatives (autogenous grafts such as free gingival graft or mucosal advancement alone), risks and expected recovery.
5. Review birth-tissue product information (donor screening, sterilization, storage instructions) and institutional tissue-use policies.
6. Preoperative mouth rinse (chlorhexidine) and perioperative antibiotic plan per institutional protocol.
1. Labial/buccal vestibule: region between alveolar ridge/attached gingiva and internal surface of lip/cheek.
2. Attached gingiva and mucogingival junction. Identify transition between keratinized attached gingiva and non-keratinized mucosa.
3. Mental nerve branches (anterior mandibular vestibule) and infraorbital nerve distribution (maxillary vestibule). Try to avoid deep vertical dissection in nerve areas.
4. Scar bands from previous cleft lip repair and alveolar cleft margins. These determine direction and extent of release.
1. Early: bleeding, hematoma, wound dehiscence, infection.
2. Graft-related: partial graft loss or sloughing, delayed epithelialization.
3. Long-term: insufficient vestibular depth recurrence due to contracture, scar formation, mucosal tethering affecting lip mobility, persistent sensitivity or mucosal discomfort.
4. Rare: immune reaction (very rare with properly screened/processed allografts), this must be disclosed per product labeling and institutional policy.
All the authors declare no conflict of interest related to this surgical video submission.
1. Dawiec, G.; Niemczyk, W.; Wiench, R.; Niemczyk, S.; Skaba, D. Introduction to Amniotic Membranes in Maxillofacial Surgery—A Scoping Review. Medicina 2024, 60, 663. https://doi.org/10.3390/medicina60040663
2. Sabbatini, M.; Boffano, P.; Ferrillo, M.; Migliario, M.; Renò, F. The Human Amniotic Membrane: A Rediscovered Tool to Improve Wound Healing in Oral Surgery. Int. J. Mol. Sci. 2025, 26, 8470. https://doi.org/10.3390/ijms26178470
3. Kothari CR, Goudar G, Hallur N, Sikkerimath B, Gudi S, Kothari MC. Use of amnion as a graft material in vestibuloplasty: a clinical study. Br J Oral Maxillofac Surg. 2012 Sep;50(6):545-9. doi: 10.1016/j.bjoms.2011.09.022. Epub 2011 Oct 24. PMID: 22024106.
4. Sikkerimath BC, Dandagi S, Gudi SS, Jayapalan D. Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark's technique with and without amnion as graft material. Ann Maxillofac Surg. 2012 Jan;2(1):30-5. doi: 10.4103/2231-0746.95313. PMID: 23482953; PMCID: PMC3591084.
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