Objective evaluation of vertical Z-plasty with double transposition vermillion flaps for secondary whistling deformity correction: A method for uni- and bilateral correction

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

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.

Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip

PURPOSE

Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area.

METHODS

We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively.

RESULTS

There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips.

CONCLUSIONS

The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople

Objective:

To gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople.

Design:

An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis.

Setting:

Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA.

Patients:

Photographs of 6- to 18-year-old patients with repaired UCLP.

Results:

“Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant (P = 0.89).

Conclusions:

Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.