The anatomy of the philtrum is incompletely understood because it is difficult to analyze three-dimensionally. Previous anatomic studies suggested that the philtral ridges are formed by the dermal insertion of the orbicularis oris muscle and musculis nasalis decussating across the midline, with the philtral dimple an area of few muscular insertions. This theory is inconsistent with the usual finding of a normal-appearing philtrum contralateral to the cleft in patients with unilateral cleft lip. Using a microcomputer and three-dimensional software, we have created a three-dimensional model of the philtrum from digitized images of sequential transverse histological sections from a third-trimester fetus. Our studies demonstrate that the philtral ridges are formed by thickened dermis and dermal appendages. The labial levators are the predominant muscles associated with the philtrum throughout its length; their fibers insert into the dermis lateral to the philtral ridges. Crossing muscle fibers of the orbicularis oris pars marginalis only appear below the vermilion-cutaneous junction, caudal to the philtral ridges.
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