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Double unilimb Z-plastic repair of microform cleft lip.
Plast Reconstr Surg 2005; 116(6):1623-32PR

Abstract

BACKGROUND

Microform unilateral cleft lip is characterized by 1) notched mucosal margin; 2) thin medial vermilion; 3) elevated medial peak of Cupid's bow; 4) furrowed philtral column; 5) hypoplastic orbicularis oris; and 6) minor nasal deformity.

METHODS

The author's registry of unilateral incomplete cleft lip was culled for patients with microform cleft lip. Operative correction included: double-limb Z-plasty at the vermilion-cutaneous and vermilion-mucosal junctions; eversion of orbicularis oris; augmentation of philtral ridge with a dermal graft; medial positioning of the alar base; and elevation of the lower lateral cartilage.

RESULTS

Microform phenotype was found in 33 of 360 infants (9.2 percent) with unilateral incomplete cleft lip. Male-to-female and left-to-right ratio were both 2:1. Median age at presentation was 11 months (range, 2 weeks to 9 years). Twenty-three patients had a double unilimb Z-plastic repair (including dermal graft and nasal correction). No revisions have been necessary at median follow-up of 5 years, however, 13 percent of children lacked prominence of the upper philtral column and one-third of children exhibited minor nostril asymmetry.

CONCLUSIONS

Double unilimb Z-plasty corrects the vertical asymmetry in a microform cleft lip while limiting the scar to the lower one-half of the lip. The philtral ridge is formed by repair of the muscular diastasis and onlay of a dermal graft. Components of this technique are applicable to secondary cleft deformities, such as elevated peak of the Cupid's bow and inadequate philtral ridge.

Authors+Show Affiliations

Craniofacial Center, Division of Plastic Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. john.mulliken@childrens.harvard.edu

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16267423

Citation

Mulliken, John B.. "Double Unilimb Z-plastic Repair of Microform Cleft Lip." Plastic and Reconstructive Surgery, vol. 116, no. 6, 2005, pp. 1623-32.
Mulliken JB. Double unilimb Z-plastic repair of microform cleft lip. Plast Reconstr Surg. 2005;116(6):1623-32.
Mulliken, J. B. (2005). Double unilimb Z-plastic repair of microform cleft lip. Plastic and Reconstructive Surgery, 116(6), pp. 1623-32.
Mulliken JB. Double Unilimb Z-plastic Repair of Microform Cleft Lip. Plast Reconstr Surg. 2005;116(6):1623-32. PubMed PMID: 16267423.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Double unilimb Z-plastic repair of microform cleft lip. A1 - Mulliken,John B, PY - 2005/11/4/pubmed PY - 2006/2/24/medline PY - 2005/11/4/entrez SP - 1623 EP - 32 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 116 IS - 6 N2 - BACKGROUND: Microform unilateral cleft lip is characterized by 1) notched mucosal margin; 2) thin medial vermilion; 3) elevated medial peak of Cupid's bow; 4) furrowed philtral column; 5) hypoplastic orbicularis oris; and 6) minor nasal deformity. METHODS: The author's registry of unilateral incomplete cleft lip was culled for patients with microform cleft lip. Operative correction included: double-limb Z-plasty at the vermilion-cutaneous and vermilion-mucosal junctions; eversion of orbicularis oris; augmentation of philtral ridge with a dermal graft; medial positioning of the alar base; and elevation of the lower lateral cartilage. RESULTS: Microform phenotype was found in 33 of 360 infants (9.2 percent) with unilateral incomplete cleft lip. Male-to-female and left-to-right ratio were both 2:1. Median age at presentation was 11 months (range, 2 weeks to 9 years). Twenty-three patients had a double unilimb Z-plastic repair (including dermal graft and nasal correction). No revisions have been necessary at median follow-up of 5 years, however, 13 percent of children lacked prominence of the upper philtral column and one-third of children exhibited minor nostril asymmetry. CONCLUSIONS: Double unilimb Z-plasty corrects the vertical asymmetry in a microform cleft lip while limiting the scar to the lower one-half of the lip. The philtral ridge is formed by repair of the muscular diastasis and onlay of a dermal graft. Components of this technique are applicable to secondary cleft deformities, such as elevated peak of the Cupid's bow and inadequate philtral ridge. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/16267423/Double_unilimb_Z_plastic_repair_of_microform_cleft_lip_ L2 - http://Insights.ovid.com/pubmed?pmid=16267423 DB - PRIME DP - Unbound Medicine ER -