This video shows a pediatric patient with Van der Woude syndrome. He has lip pits that are classic for this syndrome and his family desired surgical correction. This video outlines and shows the steps of the modified simple excision technique as well as discussing tips for a successful surgery.
General anesthesia is induced and the patient is orotracheally intubated. The endotracheal tube is taped to the upper lip. The lower lip is injected with 1% lidocaine with epinephrine 1:100000. The patient is prepped and draped in standard sterile fashion. A lacrimal probe is used to assess the length of the tract of the pits. A single incision is marked to include both lip pits. A 15 blade scalpel is used to make the initial incision. This is carried deeply with monopolar electrocautery. Lacrimal probes can be used to make the tracts more easily visible as a combination of blunt and sharp dissection is used to dissect out the tracts. Once the end of the tracts are identified, the specimen is amputated and sent for permanent pathology. The wound is irrigated and hemostasis is achieved with monopolar cautery. The wound is closed in layers with absorbable sutures.
-lower lip pits
Relative contraindications include
-comorbidities that increase anesthetic risk
-general anesthesia with orotracheal intubation
-inject local anesthetic with a vasoconstrictive agent
-prep and drape in standard sterile fashion
-mark a single incision that includes both pits
Preoperative workup includes a detailed history and physical exam. History should address any history of craniofacial abnormalities, any history of prior surgery, prior infections, drainage from the pits, and growth or changes of the pits amongst other issues. Physical exam should include a full head and neck exam with particular attention to the lips and oral cavity. Preoperative imaging is generally not indicated.
Key landmarks to this procedure are the surface landmarks of the lip.
Advantages of this procedure are primarily cosmetic. If the child is bothered by drainage from the pits, resolution of ths would also be a possible advantage. Disadvantages include procedural risks delineated in the complications section.
Possible complications of lip pit excision include bleeding, infection, scarring, and pain. There is also a risk of incomplete excision which can necessitate additional procedures.
We have no conflicts to disclose.
Peralta-Mamani M, Terrero-Pérez Á, Dalben G, Rubira CMF, Honório HM, Rubira-Bullen IF. Treatment of lower lip pits in Van der Woude syndrome: a systematic review. Int J Oral Maxillofac Surg. 2018;47(4):421-427. doi:10.1016/j.ijom.2017.10.002
Richardson S, Khandeparker RV. Management of Lip Pits in Van der Woude Syndrome: A Clinical Classification With Difficulty Index. J Oral Maxillofac Surg. 2016;74(9):1849.e1-1849.e10. doi:10.1016/j.joms.2016.05.023