Repair of the Median Microform Cleft Lip Using Z-Plasty

Samuel D. Buonocore, Marc E. Walker, Derek M. Steinbacher

Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, USA.

DOI: 10.4236/mps.2012.23011                

Abstract

A median cleft lip is a rare central midline deficiency of the upper lip. Multiple surgical techniques are described in the literature to address this defect, though there is little consensus on the preferred surgical technique. We describe an intra-oral approach for repair of the median upper lip cleft using mucosal Z-plasty. This technique provides excellent access to the attenuated orbicularis oris muscle and the frenulum fibrosed to the labial margin. The tethered lip can be mobilized and the notch converted with appropriate mucosal length, lip height, and vermillion fullness. The contour of the free labial border immediately improves, all while avoiding a cutaneous scar. The midline cleft lip notch can be effectively treated by adhering to 3 major principles: 1) excision of the tight, constrictive labial band; 2) achieving midline orbicularis oris muscle approximation; and 3) establishing mucosal lengthening using a Z-plasty.

Keywords

Median Cleft Lip; Midline Cleft Lip; Mucosal Z-plasty

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. J. Pinto and K. S. Goleria, “Transactions of the Fifth International Congress of Plastic and Reconstructive Surgery,” Butterworths, Melbourne, 1971.
[2]	W. Demyer, W. Zeman and C. G. Palmer, “The Face Depicts the Brain: Diagnosis and Significance of Median Facial Anomalies for Holoprosencephaly with Median Cleft Lip and Palate,” Pediatrics, Vol. 11, 1964, pp. 256-263.
[3]	M. M. Cohen, “An Update on the Holoprosencephalic Disorders,” The Journal of Pediatrics, Vol. 101, No. 5, 1982, pp. 865-869. doi:10.1016/S0022-3476(82)80349-1
[4]	W. Demyer, W. Zeman and C. G. Palmer, “Familial Alobar Holoprosencephaly,” Neurology, Vol. 13, 1963, pp. 913-918. doi:10.1212/WNL.13.11.913
[5]	H. O. Sedano, M. M. Cohen, J. Jirasek, et al., “Frontonasal Dysplasia,” The Journal of Pediatrics, Vol. 76, No. 6, 1970, pp. 906-913. doi:10.1016/S0022-3476(70)80374-2
[6]	P. Tessier, “Anatomical Classification of Facial, Craniofacial, and Latero-Facial Clefts,” Journal of Maxillofacial Surgery, Vol. 4, 1976, pp. 69-92. doi:10.1016/S0301-0503(76)80013-6
[7]	G. Francesconi and G. Fortunato, “Median Dysraphia of the Face,” Plastic and Reconstructive Surgery, Vol. 43, No. 5, 1969, pp. 481-491.
[8]	K. Boo-Chai, “The Bifid Nose with a Report of 3 Cases of Siblings,” Plastic and Reconstructive Surgery, Vol. 36, 1965, pp. 626-628. doi:10.1097/00006534-196512000-00007
[9]	M. M. Urata and H. Kawamoto, “Median Clefts of the Upper Lip: A Review and Surgical Management of a Minor Manifestation,” The Cleft Palate-Craniofacial Journal, Vol. 47, No. 5, 2010, pp. 104-106.
[10]	D. R. Wiemer, S. B. Hardy and M. Spira, “Anatomical Findings in Median Cleft of Upper Lip,” Plastic and Reconstructive Surgery, Vol. 62, No. 6, 1978, pp. 866-869. doi:10.1097/00006534-197812000-00006
[11]	R. da Silva Freitas, N. Alonso, J. H. Shin, L. Busato, M. C. Ono and G. A. Cruz, “Surgical Correction of Tessier Number 0 Cleft,” Journal of Craniofacial Surgery, Vol. 15, No. 9, 2008, pp. 1348-1352. doi:10.1097/SCS.0b013e318184326e
[12]	D. R. Millard and S. Williams, “Median Clefts of the Upper Lip,” Plastic and Reconstructive Surgery, Vol. 42, 1968, pp. 4-14. doi:10.1097/00006534-196807000-00002