Issues‎ > ‎Vol6n1‎ > ‎

jsmc-10085


CORRECTION OF WHISTLE DEFORMITY BY BILOBED MUCOSAL FLAP TECHNIQUE IN UNILATERAL CLEFT LIP


Ari Raheem Qader *, Hawree A Hassan ** and Dana Abdulmajid ***


*    Department of Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.
**  Sulaimani Burn and Plastic Surgery Hospital.
*** Department of Community Health, Technical College of Health, Sulaimani Polytechnic University.


Submitted: 26/6/2015; Accepted: 27/12/2015Published: 1/6/2016


ABSTRACT


Background 

The whistle deformity is one of the common sequelae of secondary cleft lip deformities. It is often accompanied by asymmetric upper lip thickness and insufficient vermilion tubercle. The bilobed mucosal flap was described by Song Tao. To correct these deformities in a single stage, we have used the same technique in our study and combined with other procedure to correct wider array of secondary cleft lip deformities.

Objectives

To evaluate the reliability and versatility of bilobed mucosal flap in reconstruction of whistle deformity, insufficient tubercle and lateral vermilion redundant.

Methods

Nine patients with whistling deformities were included in our study. Their ages ranged from 5-34 year. All cases were corrected by bilobed mucosal flap, which consist of two lobes The first lobe located at the oral mucosa of the lateral affected lip side, used to correct whistle deformity and augmenting the tubercle. The second lobe elevated from the lateral vermilion mucosa on the affected side and used to repair the oral mucosal defect, at the same time it decreases the excess on the lateral side.

Results

Minimum follows up was 6 month. All patients were satisfied with the aesthetic outcomes. In all of the patients, whistle deformity were corrected, tubercle augmented and more symmetric vermilion appearance were achieved. Major complications (necrosis of mucosal flap, infection and recurrence of whistling deformity) did not occur in any of the patient.

Conclusion

A bilobed mucosal flap is a safe and simple procedure, effectively performed to correct combined secondary deformities after primary cheleoplasty in unilateral cleft lip patient. It can be combined with other procedures to revise upper lip scar, repair muscular diastases, and correction of severe whistle deformity.

KEYWORDS

Whistle deformity, cleft lip, Scar.

References 

1. Grewal NS, Kawamoto HK, Kumar AR, Yun Ju Han. Correction of Secondary Cleft Lip Deformity: The Whistle Flap Procedure. Plast Reconstr Surg. 2009; 124: 1590–1598. 

2. Rodgers CM, Mulliken JB. Deepithelialized Mucosal-Submucosal Flaps to correct the "whistling lip" deformity. Cleft Palate J. 1989 , 2. (26): 136-40. 

3. Cohen M. Residual deformities after repair of Clefts of the Lip and Palate. Clin Plastic Surg. 2004, No. 31: 331– 345.

4. Robnson DW, ketchum LD, Masters FW. Double V-Y  procedure for Whistling Deformity in repaired Cleft Lips. Plast Reconstr Surg. 1970;  3. (46):241-4.  

5. Stal S, Hollier. Correction of Secondary Cleft Lip Deformities. Plast Reconstr Surg. 2002; 109: 1672.

6. Thomas M, D’silva JA, Chilgar RM. Volume Enhancement of Upper Lip Secondary Deformities. Aesth Plast Surg. 2012; 36: 414-420.  

7. Baser NT, Terzioglu A, Aslan G. reconstruction of vermilion deficiencies: the running v-flap technique. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2012; 65: 1331-1334. 

8. Millard DR. Extension of the rotation-advancement principle for wide unilateral cleft lips. Plastc Reconstr Surg. 1968; 42: 553-544. 

9.  Matsuo K, Kiyoshi T, Fujiwara, Takeshi H , Hayashi R, Reiko T,et al. Bilateral lateral vermilion border transposition flaps to correct the “whistling lip” deformity. Plast Reconstr Surg. 1993; 91: 930-5.

10. Kapetansky DI. Double pendulum flaps for whistling deformities in bilateral cleft lips. Plast Reconstr Surg. 1971; 4. 47: 321-3.

11. Juri J, Juri C, de Antueno J. A modification of the Kapetansky technique for repair of whistling deformities of the upper lip. Plast Reconstr Surg. 1976;  57: 70-3.

12. Guerrero-Santos J. Use of a tongue flap in secondary correction of cleft lips. Plast Reconstr Surg 1969;  44: 368-71.

13. Wagner JD, Newman MH.  Bipedicle axial cross-lip flap for major vermilion deformities after cleft lip repair. Plastic surgery. Ann.Arbor,Michigan. 1993; 148-152.

14. Patel IA, Hall PN. Free dermis-fat graft to correct the whistle deformity in patients with cleft lip. Br J Plast Surg 2004; 57: 160-4.

15. Belyea J, R Hart, J Trites, SM Taylor. A case of autologous microfat grafting in lip reconstruction of a whistle deformity following cancer treatment. Can J Plast Surg. 2010; 4. 18: 53–54. 

16. Niechajev I. Lip enhancement: Surgical alternatives and histologic aspects. Plast   Reconstr Surg. 2000,  105: 1173-83.

17. Staebel C, Verheyden CN. The Use of Dermal Fat Grafts for the Correction of Secondary Cleft Lip Deformities. Plast Reconstr Surg. 2009; 123. 4: 151-152.

18. Cohen SR, Kawamoto HK JR: The free tongue graft for correction of secondary   deformities of the vermilion in patients with cleft lip. Plast Reconstr Surg. 1991; 4. 88: 613-9. 

19. Staffenberg DA, Wood RJ. Secondary Deformity of Cleft Lip Repair. In: Aston SJ , Beasley RW, Thoerne CH, eds. Grabb and Smiths  Plastic Surgery fifth addition. Lippincott-Raven Publisher. 1997;  276.

20. Lee KN, Koh KS. Acellular human dermis, a good option for correcting the free border deficiency in secondary cleft lip deformity. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2012; 65: 356-362.

21. Wakami S, Hardar T. Muraoka M, Ishii M. Rectangular mucosal flap with artificial dermis grafting for vermilion deformity in cleft lips. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2010; 63: 22-27.

22. Song T, Yin N, Li H, Zeinmin Z, Min Z, Jinjing J. Bilobed mucosal flap for correction of secondary lip deformities following cleft lip surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2011; 64: 589-94. 

23. Yang JY. Surgical correction of whistle deformity using cross-muscle flap in secondary cleft lip. Arch plsy.Surg 2012;39: 470-476. 

24.  Assuncao AG, Ferreira LM, Mondelli RL: Bilateral cleft lip and whistling deformity: the

X flap procedure for its correction. Plast  Reconstr Surg. 2006; 6, 117: 1986-1989.

25. Kawamoto HK. Correction of major defects of the vermilion with a cross-lip vermilion flap. Plast Reconstr Surg. 1979;64: 315-8.