Definition Distance between the base of the nose and the border of the upper lip, in the midline.
Landmarks Measure from the base of the nose (subnasion) to the superior aspect of the vermilion border of the lip, in the midline (Fig. 7.74).
Instruments Ideally the philtral length is measured with spreading calipers; however, a calibrated transparent ruler could be used.
Position The head should be held (in the resting position) erect with the eyes facing forward. The observer should be lateral to the patient so that the face is in profile.
Figure 7.74 Measuring philtrum length.
Alternative A young infant or child could lie supine with the head held.
Remarks Variation in philtrum length is shown in Figs. 7.75 and 7.76. In some individuals the philtrum is poorly demarcated; in others the cutaneous elevations that mark its lateral borders are clearly discernible. The enclosed area is usually depressed. The philtral margins may be parallel or divergent.
Pitfalls In the newborn with a cleft lip, either unilateral or bilateral, this measurement mat not be reliable. Facial expression, particularly smiling, will alter this measurement. Thus, the patient's facial expression should be neutral.
Philtrum smoothness and upper lip thinness are measured in five-point Likert pictorial scales by holding the lip-philtrum guide next to the patient's face and assigning each feature the Likert rank of the photograph that best matches each feature (Fig. 7.77).
Figure 7.75 Philtrum length, both sexes, at birth. From Merlob et al. (1984), by permission.
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