Unilateral Cleft Lip Repair With a Simple Assymetric Z-plasty

Objective: The objective of this case report is to provide an example of the repair of a complete unilateral cleft lip using a modification of the classic Z-plasty. Methods: A Z-plasty for cleft lip is described that does not depend on measurements and formulas. The tissue available on the lateral lip “unit” determines the limb length of the Z: from cupid's bow to the highest point of “good” lip skin. This length is then transposed to the medial side, scribing an arc from both cupid's bows. Where the arcs intersect determines length and direction of the releasing incision. The angles are not predetermined as in a classic Z. The incisions are made “on block” through skin, muscle, and mucosa. Flap transposition uprights the isosceles triangle-shaped philtrum, aligning the cupid's bows. Results: All degrees of unilateral cleft lips have been successfully repaired using this technique. The operation is simple, rapid, and dependable. There is minimal bleeding, as there is no muscle dissection. On both medial and lateral sides, the muscle is transposed toward the free border, that is, downward. Achieving downward rotation of cupid's bows along with the philtrum dimple provides attractive fullness and pout to the lower part of the upper lip. Fullness and length are permanently maintained by the medially based flap under the nose. Conclusions: The Z-plasty is well suited for unilateral cleft lip repair. It is especially useful for wide, complete cases but is applicable to all types of unilateral cleft lips. It is a simple, fast, and stable repair.