Curvilinear Transformation of Z-Shaped Upper Lip Scar by Diamond-Shaped Excision in Secondary Cleft Lip Deformities: A Photogrammetric Evaluation

Abstract

Purpose : The visible Z-shaped upper lip scar that occurs after the Tennison and Randall triangular flap technique remains a cleft stigma. Herein, we present our curvilinear transformation technique for the Z-shaped upper lip scar by diamond-shaped excision and evaluate the results using photogrammetric analyses. Patients and Methods : From 1997 to 2006, 23 patients with secondary cleft lip deformity with the visible Z-shaped upper lip scar underwent correction with the technique. The scar was excised in the diamond shape above the muscle. After curvilinear closure, the elongated length of the upper lip was excised just below the nostril sill, as the measured Cupid's bow height discrepancy. The result was assessed by the authors' standardized photogrammetry technique. Results : There was a statistically significant decrease between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear upper lip scar. The pre- and postoperative Cupid's bow height differences were not statistically significant. Conclusions : The curvilinear transformation of the Z-shaped scar is an efficient procedure that provides (1) a significant decrease in the width of an upper lip scar to make it less conspicuous, (2) incorporation of the scar into the philtral column, (3) a biconcave natural philtral column shape in frontal view, and (4) formation of the natural concave philtral contour in profile view.

Revisional Techniques for Secondary Cleft Lip Deformities

“…This procedure can be utilized in whistle deformities by pushing the vermillion inferiorly, thereby lengthening the upper lip. 3,32 When possible, this procedure is used in place of Z-plasty because it offers similar results with less scar burden. However, it is limited to correction of only small defects measuring 1 to 2 mm.…”

Scar management in patients after cleft lip repair–Systematic review Cleft lip scar management

“…Ultimately, 32 items did not meet all of the previously set inclusion criteria. Finally, nine works met the inclusion criteria and have been included in the systematic review 11‐19 . These articles were divided according to presented cleft lip scar management methods into nonsurgical methods—4 items, and surgical methods—5 items.…”

“…They include the usage of skin flaps, grafts, and orbicularis oris muscle reconstruction. As Han et al 15 point out, the correction of cleft upper lip scarring through curvilinear transformation causes a change of shape in the scar making it narrower and less visible. Another method of correction of a post‐cleft scar is tissue graft, which replenishes upper lip tissue deficiency eliminating tension within the upper lip allowing for correction of unesthetic cleft scars 16 .…”

Meta-analysis of secondary cleft lip deformities management

“…The study by Han et al 13 presented curvilinear transformation method for the Z-shaped upper lip scar by diamond-shaped excision and estimated the results using photogrammetric analyses, the study enrolled 23 patients with ages ranged from 8 to 35 years (mean age, 19.7 years). Of a total of 23 patients, 15 were male.…”

“…The mean follow-up time was 42 months. 13 As regard Outcome measures, the study by Han et al 13 reported that the width of the postoperative curvilinear scar was 4.6 6 1.6 mm. There was a statistically significant diminution between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear scar (P <.000) after the scar revision.…”