Z-Plasty technique using a large C-flap to maximize symmetry of Cupid´s bow and minimize scar in unilateral cleft lip repair

Sanjay Naran, Renata Maricevich, Lorelei Grunwaldt

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):28-31

Purpose: Gaining symmetry of Cupid's bow can be challenging in cleft lip repair. We describe a technique that utilizes a modified rotation-advancement type repair to gain maximum length and to minimize scar. Methods: A retrospective chart review of unilateral cleft lip repairs performed by a single surgeon between 2010 and 2014, with at least 6 months of postoperative follow-up, Pre-, intra-, and post-operative photographs were reviewed. Patients included were those who had undergone unilateral cleft lip repair using a Z-plasty type rotation of the C-flap. Postoperative photographs were analyzed for overall symmetry of Cupid's bow and scar appearance using a 5-point visual analog scale (VAS) performed by five independent evaluators. Results: Twenty-three patients were analyzed. On VAS assessment by five independent observers, 22 out of 23 patients (96%) had good, very good, or excellent symmetry of Cupid's bow. All patients (100%) had good, very good, or excellent scar appearance. Twenty-two out of 23 patients (96%) had good, very good, or excellent overall appearance of the repaired lip. Conclusion: Z-Plasty with a very large C-flap as the method for the rotation flap in unilateral cleft lip repair is a useful technique for leveling Cupid's bow and for attaining scars that are nearly imperceptible. Further work will include longer-term follow-up, will look at the severity of the preoperative cleft, and will compare this to postoperative appearance of the lip (symmetry of Cupid's bow and scar).

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