New technical method to correct secondary vermilion deformities with cleft lip

Yotsuyanagi, Takatoshi; Yamashita, Ken; Yamauchi, M.; Sugai, Asuka; Kato, Shinobu; Gonda, Ayako; Kita, Arisa; Kitada, Ayaka

doi:10.1016/j.bjps.2018.07.025

Cited by 8 publications

(3 citation statements)

References 17 publications

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“…By grafting the patients with the Coleman technique, they restored the volume deficiencies of the philtrum and vermillion; however, the uncertainty of fat absorption reduces the reliability of this method. Yotsuyanagi et al 21 present a method to repair the irregular vermillion border with an advanced M-shaped flap; this technique achieved the restoration of the dry-wet lip junction. Nevertheless, how to effectively avoid the generation of dog ears still needs more exploration.…”

Section: Discussionmentioning

confidence: 99%

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity

Wang

Chen

et al. 2023

Journal of Craniofacial Surgery

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Although surgical techniques have developed, the incidence of secondary cleft lip deformities after the primary repair is still high. Asymmetry of Cupid's bow and philtrum is a common presentation and a technical challenge to reconstruct the upper lip. The authors introduce a technique to use the free grafts of the full-thickness scalp for the correction of scars and tissue deficiency in secondary unilateral cleft lip deformity. Thirty-seven patients with a prominent scar, tight upper lip, deformed Cupid's bow and philtrum, and irregular vermillion border were included in this study. The specific points of interest were assessed before and after surgery by independent examiners with both subjective and objective methods. All surgeries were successfully completed, and the assessment results were satisfactory. The rating scores of philtrum improvement was 1.6 ± 0.4, the POSAS result of patient scales was 13.48 ± 3.21, and the observer scale result was 11.98 ± 3.88. The asymmetry of Cupid's bow was corrected (P = 0.004), the central tubercle of vermilion was more natural (P = 0.001), and the irregular vermillion border was improved (P = 0.015). The results presented significant differences before and after surgery. This method could be an optional treatment for repairing scars and tissue deficiency in secondary unilateral cleft lip deformity.

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Section: Discussionmentioning

confidence: 99%

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity

Wang

Chen

et al. 2023

Journal of Craniofacial Surgery

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“… 21 Importantly, exposed mucosa poses not only an aesthetic problem, but it can also lead to discomfort, dryness, crusting, and bleeding. 23 , 24 Noordhoff therefore describes a technique of primary repair that takes vermilion height into account to achieve better symmetry, which involves the addition of a vermilion triangular flap to augment the medial vermilion. 10 Mulliken also incorporated a lateral triangular flap of vermilion into his repair, while Zuker described a similar diamond-shaped flap for the same purpose.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height

Chiang¹,

Zubovic²,

Skolnick³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry. Methods: Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut “poker incision” to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry. Results: Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], P = 0.56), demonstrating satisfactory upper lip symmetry. Conclusions: Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry.

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“…For repair of a small vermilion deficiency, local flaps such as the Kapetansky flap, 12 mucosal transposition flap, 13 rectangular mucosal flap, 14 vermilion double V-Y advancement, and mucosal V-Y advancement 15 can be used. According to our classification, we selected the double movable mucomuscular complex flap 12 for the treatment of grade I whistle deformities or upper lip notching and volume deficiency.…”

Section: Discussionmentioning

confidence: 99%

Strategy for Correction of the Whistling Deformity in Secondary Cleft Lip Reconstruction

Jian

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Following primary repair of a cleft lip, patients present with many facial deformities. One of the commonly observed sequelae of cleft lip repair is a whistling deformity. This retrospective study was carried out to evaluate the outcomes following correction of whistling deformities in secondary cleft lip reconstruction. Methods: We retrospectively reviewed the hospital records of patients with various whistling deformities who underwent repair from April 1989 to March 2018; 2 surgeons performed the repair using either the double movable mucomuscular complex flaps technique, modified Abbe flap technique, or Abbe flap technique. The postoperative anatomical structure and aesthetic effects of the surgery were evaluated. Results: In total, 136 patients were included in this study. Among these patients, 60 (44.2%) had a grade I whistling deformity and 47 (34.5%) had a grade II deformity and repair was performed using the double movable mucomuscular complex flaps technique and modified Abbe flap transfer technique, respectively, whereas the Abbe flap transfer technique was used in 16 patients (11.8%) and 13 patients (9.5%) with a grade III and grade IV whistling deformity, respectively. All patients were found to have normal postoperative anatomical structures and aesthetic effects of the upper lip, with all patients experiencing mild to moderate postoperative edema of the upper lip, and 29 cases (21.3%) developed an inconspicuous scar. Conclusion: The repair technique should be chosen based on the type of whistling deformity.

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New technical method to correct secondary vermilion deformities with cleft lip

Cited by 8 publications

References 17 publications

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity

Repair of Scars and Tissue Deficiency With Free Grafts of Full-thickness Scalp in Secondary Unilateral Cleft Lip Deformity

Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height

Strategy for Correction of the Whistling Deformity in Secondary Cleft Lip Reconstruction

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