Septal anchoring suture: a key suture to improve the nasolabial symmetry in unilateral cheiloplasty

Rationale for white skin roll flap in unilateral cleft lip repair: A retrospective anthropometric measurement analysis

BACKGROUND

Although the "white skin roll" of the lip is often considered a line, it is better defined as the subunit between the vermilion border and the upper lip horizontal groove. In many unilateral cleft lip repair techniques, this structure is approximated between both sides of the cleft without restoration. This study aimed to analyze the white skin roll height in patients with unilateral cleft lip.

METHODS

This retrospective cohort study included 134 consecutive infants with unilateral cleft lip aged 3-6 months who underwent lip repair in a single institution between January 2019 and July 2021. White skin roll heights at the peak of the Cupid's bow on the non-cleft side (CPHIR), cleft medial element (CPHIL), and cleft lateral element (CPHIL') were measured, and differences in their averages were analyzed.

RESULTS

The mean height was 1.70 ± 0.30 mm at CPHIR, 0.98 ± 0.33 mm at CPHIL, and 1.28 ± 0.32 mm at CPHIL.' The mean difference in height between CPHIR-CPHIL, CPHIR-CPHIL,' and CPHIL-CPHIL' groups was significant for each paired sample (p < 0.01). No difference was found between the complete and incomplete clefts or left and right clefts (p > 0.01).

CONCLUSIONS

A significantly reduced mean height of the white skin roll was present more markedly on the cleft medial element than on the cleft lateral element. Therefore, we strongly support using a white skin roll flap on the cleft lateral element for unilateral cleft lip repair, embracing the concepts of subunits and lip contour lines.

Revisiting straight-line repair in unilateral complete cleft lip: a comparison with rotation-advancement repair

Rotation-advancement repair (RAR) has been the most widely used technique for unilateral cleft lip repair. We recently used a straight-line repair with medial orbicularis muscle lengthening (SLR-ml) technique, based on the hypothesis that it could minimize the postoperative scar appearance without causing s short-lip deformity when muscle reorientation is performed correctly. A retrospective cohort study was conducted on unilateral complete cleft lip patients who underwent cheiloplasty between 2009 and 2017. Two cheiloplasty techniques were compared: RAR and SLR-ml. Outcomes were evaluated by assessing follow-up photographs using three methods: (1) glance impression on a five-point scale, (2) Manchester Scar Scale, and (3) indirect anthropometry. Seventy-one patients were analysed: 41 in the RAR group (28 male, 13 female) and 30 in the SLR-ml group (15 male, 15 female). The glance impression (P=0.506) and Manchester Scar Scale (P=0.347) scores did not differ between the groups. According to the symmetry ratio (cleft side value/non-cleft side value), vertical lip height (P=0.804), horizontal lip length (P=0.881), and Cupid's bow width (P=0.122) did not differ significantly between the groups. The preoperative lip height discrepancy was not correlated with the postoperative vertical lip height. The SLR-ml method can be regarded as a successful tool for symmetric repair of unilateral cleft lip.