Correction of whistle deformity secondary to cleft lip repair by V-Y plasty: a simple and effective technique

2021 ◽  
Vol 14 (12) ◽  
pp. e246303
Author(s):  
H Hari Kishore Bhat ◽  
Varsha Haridas Upadya
Keyword(s):  
Local Anaesthesia ◽  
Cleft Lip ◽  
Surgical Repair ◽  
Effective Procedure ◽  
Muscle Repair ◽  
Upper Lip ◽  
Effective Technique ◽  
Outpatient Procedure ◽  
Surgical Options ◽  
Cleft Lip Repair

Several techniques are available for the surgical repair of the cleft lip, however, avoiding secondary deformities and achieving consistent results remains a challenge. The whistle deformity is a secondary lip deformity characterised by inadequate fullness of the central upper lip with abnormal exposure of the central incisors when the lips are at rest, giving a whistling appearance. The causes include scarring of the vermilion and failure to restore the mucosal or muscular continuity. Various surgical options are available ranging from simple procedures like V-Y plasty and Z-plasty to complex procedures like complete lip redo, locoregional flaps, fillers and grafts. V-Y plasty is a simple, effective procedure for lip lengthening that can be performed under local anaesthesia as an outpatient procedure. It is less technique sensitive and also allows for some degree of muscle repair. We present a case of whistle deformity satisfactorily corrected with V-Y plasty.

The Contour Lines of the Upper Lip and a Revised Method of Cleft Lip Repair

1991 ◽  
Vol 27 (3) ◽  
pp. 238-252 ◽  
Author(s):  
Takuya Onizuka ◽  
Masaharu Ichinose ◽  
Yoshiaki Hosaka ◽  
Yoshihiro Usui ◽  
Takao Jinnai
Keyword(s):  
Cleft Lip ◽  
Upper Lip ◽  
Contour Lines ◽  
Cleft Lip Repair

scholarly journals Cleft Lip Repair: Technical Refinements for the Wide Cleft

2010 ◽  
Vol 3 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Eric Meyer ◽  
Alan Seyfer
Keyword(s):  
Congenital Malformations ◽  
Cleft Lip ◽  
Common Type ◽  
Upper Lip ◽  
Vast Array ◽  
Triangular Flap ◽  
Aesthetic Results ◽  
Cleft Lip Repair ◽  
Rotation Advancement

Clefts of the lip and palate are among the most common congenital malformations. A unilateral deformity is the most common type of cleft, but even within this subgroup there is a great deal of variety due to the accompanying severe distortion of the upper lip, cheek, nose, and maxilla. To repair such a variety of clefts with good aesthetic results, several general incisional approaches should be mastered along with a variety of subtle techniques that improve the end product. The most common repair utilized in America is the Millard rotation-advancement technique. This is partly due to the perceived superiority in results compared with other repairs and the ease with which this repair can be taught to residents. This repair places the scar along an artificial philtral column and is often quite sufficient in small clefts. Unfortunately, adoption of this “one size fits all” approach can limit the arsenal of the surgeon facing the vast array of differing cleft lip deformities. For example, the modified triangular flap, or Tennison-Randall repair, can be of value when presented with the wider unilateral cleft lip. In an effort to not only demonstrate that excellent results can be achieved when incisional patterns (Millard and Tennison) are used appropriately (small versus large clefts), we compared the results of two types of repairs, performed by a single surgeon over a period of 30 years. In addition, a variety of subtle techniques are reviewed to assist in obtaining excellent aesthetic results for any size repair.

scholarly journals Adult Cleft Lip Repair under Local Anaesthesia: The Ghana Experience

2016 ◽  
Vol 06 (04) ◽  
pp. 27-32
Author(s):  
Solomon Obiri-Yeboah ◽  
Micheal Yeliborah ◽  
Alexander Oti Acheampong ◽  
Samuel Kodjo Ansah ◽  
John H. Grant ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Cleft Lip ◽  
Cleft Lip Repair

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

2020 ◽  
pp. 105566562094911
Author(s):  
Iva Burianova ◽  
Milos Cerny ◽  
Jiri Borsky ◽  
Kristyna Zilinska ◽  
Jana Dornakova ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Repair ◽  
Artificial Ventilation ◽  
Duration Of Hospital Stay ◽  
Duration Of Surgery ◽  
Ventilation Support ◽  
Cleft Lip Repair ◽  
The Impact

Objective: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. Design: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Setting: Tertiary neonatal and pediatric surgery center. Patients: Hospital A: 61 newborns, Hospital B: 157 newborns. Interventions: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Main Outcome Measures: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Results: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. Conclusions: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

scholarly journals Precision Dermal Fat Grafting for Vermillion Deficiencies in Patients With Unilateral and Bilateral Cleft Lip

2019 ◽  
Vol 57 (1) ◽  
pp. 127-131
Author(s):  
Oksana A. Jackson ◽  
Alfred Lee ◽  
Elena Nikovina ◽  
Alison E. Kaye
Keyword(s):  
Cleft Lip ◽  
Scar Tissue ◽  
Fat Grafting ◽  
Fat Graft ◽  
Aesthetic Outcome ◽  
Upper Lip ◽  
Lip Augmentation ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Repair ◽  
The Aesthetic

Objective: Deficiencies of the upper lip vermilion occur with some frequency following repair of unilateral and bilateral clefts of the lip and can compromise the aesthetic outcome. The presence of dense scar tissue within the lip at the cleft site as well as intrinsic vermillion deficiencies can make long-lasting correction of this deformity challenging. We describe a technique to address vermillion deficiencies after cleft lip repair. Design: A novel lip augmentation technique for correction of residual vermilion deficiencies after unilateral and bilateral cleft lip repair is presented. This technique combines precise placement of a contoured dermal fat graft with local tissue (V-Y) rearrangement. Conclusion: In our experience, this method of lip augmentation following either unilateral or bilateral cleft lip repair can restore upper lip vermillion symmetry and provide predictable and durable results in patients with mild to severe vermillion deficiency.

scholarly journals Comparison of professional and laypeople evaluation of nasolabial esthetics following unilateral cleft lip repair

2018 ◽  
Vol 12 (04) ◽  
pp. 516-522 ◽  
Author(s):  
Adekunle Moses Adetayo ◽  
Modupe Olusola Adetayo ◽  
Oguntade Funmi A ◽  
Mayowa Solomon Somoye ◽  
Michael O Adeyemi ◽  
...  
Keyword(s):  
Prospective Study ◽  
Cleft Lip ◽  
Surgical Repair ◽  
University Teaching ◽  
Facial Esthetics ◽  
Surgical Evaluation ◽  
Significant Disagreement ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
A Prospective Study

ABSTRACT Objectives: The objective is to know the extent of agreement of clinicians' perception of nasolabial esthetic compared to that of laypeople (parents). Materials and Methods: This was a prospective study of comparison of clinician's perception of nasolabial esthetics with that of laypeople following surgical repair of UCL. Participants were recruited from the Cleft Clinic of the Lagos University Teaching Hospital, and surgical repair of the cleft was performed under general anesthesia. Surgical evaluation was done through direct clinical evaluation using the modified form of the Christofides' criteria by laypeople and professionals. Results: A total of 48 cleft participants were enrolled in the study. The evaluation of the lip by both the laypeople and professionals was similar, and there was no difference (0.588) in their rating. However, there was a significant disagreement (P = 0.001) between them in the nose assessment. Conclusion: Neither the solitary opinion of the professionals nor that of the laypeople is satisfactory in the evaluation of facial esthetics; both are equally important, especially in the assessment of nasal esthetics. However, opinion of either the laypeople or the professional might be enough in the evaluation of the lip esthetics.

The Lambda Flap for Secondary Cleft Lip Repair

1997 ◽  
Vol 34 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Ichiro Tange
Keyword(s):  
Cleft Lip ◽  
Donor Site ◽  
Skin Surface ◽  
Upper Lip ◽  
Lower Lip ◽  
Cleft Lip Repair ◽  
Technical Details ◽  
Abbé Flap ◽  
Figure Type

Objective: A modified Abbe flap of the lambda figure type, designed by the author and used before or after secondary cleft lip repair in 146 consecutive cases since 1990 is described. Design: This series consisted of 71 cases with unilateral deformity and 75 cases with bilateral deformity at adolescent or adult ages. The technical details of this method and representative cases with the results are shown. The philtrum is created by incising the two branches of the lambda flap obliquely at 45 degrees to the skin surface in the lower lip, then matching them in the central recipient bed of the deficient upper lip. Results and Conclusions: The resultant upper lip is not only full and slack, but also attractive with an acute cubic contour of the philtrum. Furthermore, the residual scar at the donor site is concealed in the mentolabial fold.

scholarly journals Median cleft lip: A new method of surgical repair

2010 ◽  
Vol 43 (01) ◽  
pp. 111-113
Author(s):  
B. V. Khandekar ◽  
S. Srinivasan ◽  
N. J. Mokal
Keyword(s):  
Cleft Lip ◽  
Surgical Repair ◽  
New Method ◽  
Muscle Repair ◽  
Median Cleft ◽  
Midline Cleft

ABSTRACTThe aim is to discuss a new method of muscle repair in midline cleft lip. Three patients with midline cleft lip were repaired with our technique of muscle repair and the results evaluated. Our new method of muscle repair in the form of ‘Z’ helps in forming the philtral dimple.

854 Modified Millard Forked-flap for Complete Nasal Stenosis After Smoking While on Home Oxygen

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S265-S265
Author(s):  
Sagar Mulay ◽  
Roger L Simpson ◽  
Ahmed Nasser ◽  
Basil Nwaoz
Keyword(s):  
Cleft Lip ◽  
Burn Injury ◽  
Full Thickness ◽  
Upper Lip ◽  
Nasal Vestibule ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Initial Symptoms ◽  
Cleft Lip Repair ◽  
The Aesthetic

Abstract Introduction Nasal stenosis is an uncommon burn scar deformity which can result in breathing obstruction. The reconstruction of nasal stenosis secondary to burns can be challenging due to the limitation of localized tissue, rate of recurrence, and burn injury to the surrounding areas. A vascularized composite flap of local composite tissue (forked flap) from the lip can reliably reconstruct the nasal vestibule and nasal sill diminishing the risk of recurrent nasal stenosis. We describe our use of a modified Millard forked flap, a cleft lip repair technique. Methods A 52-year-old female presented with complete stenosis of the right nares secondary to burn contracture of the nostril, vestibule, and upper lip. She had suffered a flash burn to her face while smoking on home oxygen requiring prolonged ventilatory support and only received topical dressings. Three months after her burn injury she was referred for the reconstruction of her contractures. A lateral rhinotomy was performed to define the nasal floor defect. Scar release of the remaining vestibule and ala and the aesthetic units of the lip were defined. A supple unburned area of the upper lip was harvested as a vascularized composite forked flap and rotated into the vestibule defining the vestibule floor. The ala was rotated outward and full-thickness skin grafts was used to resurface the vestibular portion. The lateral aesthetic subunit of the lip was then resurfaced as a complete unit with a full-thickness skin graft. She later required fabricated nasal splint for nighttime stenting and serial daytime nostril dilatation with Hegar dilators. Results At nine months post-reconstruction, the patient maintains a patent nasal airway with limited vertical lip contraction, resolution of her initial symptoms of sinus congestion, and no further difficulty breathing. Conclusions In 1955, Ralph Millard presented the rotation-advancement technique for cleft lip repair. The Procedure was designed to create a softer, more natural-looking reconstructed lip. In the cleft lip repair, he suggested preserving the prolabial tissue lateral to the central segment as forked flaps that were rotated and banked on the nasal vestibule floor. Had that principle not been appreciated, that tissue might have been discarded in order to respect the aesthetic unit of the lip. The surgeon must utilize reliable principles to restore and retain form and function. The use of this modified forked flap incorporated composite vascularized tissue for the nostril floor reconstruction while respecting the subunit reconstruction of the lip. Applicability of Research to Practice Reconstruction of the injury needs to restore both functional and aesthetic deformities. Utilization of a local vascularized composite graft, taken from an area to be discarded within the upper lip subunit, provided quality tissue that significantly reduces the risk of secondary nasal contracture.

Novel Passage of Dermis-Fat Graft for Augmentation of Vermilion Deficiency Following Cleft Lip Repair

2020 ◽  
Vol 57 (7) ◽  
pp. 919-922
Author(s):  
Daniel C. Sasson ◽  
Sergey Y. Turin ◽  
Arun K. Gosain
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Cleft Lip ◽  
Soft Tissue Augmentation ◽  
Fat Graft ◽  
Upper Lip ◽  
Fat Injection ◽  
Cleft Lip Repair ◽  
Rubber Catheter ◽  
Established Technique

Despite timely repair of cleft lip, secondary deformities such as vermilion notching or “whistle deformity” often require further surgical treatment. The use of dermis-fat graft for soft tissue augmentation of the upper lip is an established technique. We propose an innovation on this technique, by which the dermis-fat graft can be placed reliably and with minimal dissection by use of a soft red rubber sheath to protect the Keith needle while delivering the graft through the submucosal pocket in the dry vermilion, thereby avoiding the needle inadvertently catching soft tissue inside the pocket. We recommend using an 8F red rubber catheter, cutting the catheter to be just shorter than a 2.5-inch Keith needle. This provides a sheath through which the Keith needle can be passed within the submucosal vermilion tunnel. We believe this to be much more reliable for vermilion augmentation than other techniques, including fat injection, and makes graft inset more predictable, faster, and simpler.

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