The Use of an Inferior Pennant Flap during Unilateral Cleft Lip Repair Improves Lip Height Symmetry

Abstract

Background In order to improve the rotation of Cupid’s bow and achieve sufficient vertical lip height, several variations of the Millard rotation-advancement have incorporated a small laterally-based triangular flap above the cutaneous roll. This study uses three-dimensional photogrammetry to evaluate the outcomes of unilateral cleft lip repairs performed with and without pennant flaps. Methods Three-dimensional photographs were analyzed to assess postoperative lip height asymmetry in 90 unilateral cleft lip patients (58 complete, 32 incomplete) treated between 2001 and 2012. Cleft lip repairs were performed by 3 pediatric cleft surgeons using different techniques. Thirty-nine of 90 (43%) procedures utilized an inferiorly placed triangular flap. All patients were photographed at least 9 months postoperatively (mean = 4.2 years). Lip height asymmetry was based on the vertical distances from the subnasale to the peaks of Cupid’s bow. Results Regression analysis revealed that the use of a pennant flap was a significant predictor of postoperative lip height asymmetry (B = 4.2%, p = 0.015). The surgeon performing the repair was also a significant factor in patients with complete cleft lips (B = 3.6%, p = 0.005). All three surgeons achieved greater lip height symmetry when a pennant flap was performed. Conclusions The results of unilateral cleft lip repairs are affected by both the surgeon and the surgical technique. Procedures that utilized a pennant flap showed better philtral height symmetry than non-pennant repairs.

Anthropometric labial analysis of Han Chinese young adults

“…This region also has highly characterized facial expression function in addition to functions of speaking, eating, and breathing. Labial surgery is performed for reconstruction of congenital malformations, external trauma or tumour resection, and facial aesthetic improvement . Therefore, evaluation of labial morphology has become the basis for both reconstruction and cosmetic surgery.…”