A New Technique of Unilateral Cleft Lip Repair With Scarless Cupid's Bow Peaks

Hiromu Masuoka, M.D., Ph.D.

Disclosures

Plast Reconstr Surg. 2021;148(3):597-604. 

In This Article

Abstract and Introduction

Abstract

Background: A novel technique for primary unilateral cleft lip repair with scarless Cupid's bow peaks is described. This technique focuses on the curvature of the Cupid's bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid's bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon.

Methods: The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid's bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid's bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty.

Results: The Noordhoff point was kept as the peak of the Cupid's bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid's bow, was well maintained.

Conclusion: The present technique allows for the fashioning of a reliable intended peak of the Cupid's bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.

Introduction

In recent years, unilateral cleft lip repair has focused on not only lengthening the white lip and shaping the Cupid's bow but also various issues of interest, such as scar line arrangements, the nasal structure, and anatomical subunits.[1–4] Rotation-advancement or the triangular technique had been widely applied to ensure the symmetrical setting of both peaks of the Cupid's bow.[1,5–7] Almost all of the techniques set the cleft-side peak point of the Cupid's bow at the suture line between the lateral and medial lip on the vermilion border, except for quadrilateral flap methods;[8] however, scarring through the peak sometimes causes excessive sharpening of the peak of the Cupid's bow or collapse around the peak.

In this article, the author reports a new technique for primary cleft lip repair focusing on the formation of the natural curvature of the peak of the Cupid's bow. It also simultaneously enables the preservation of the three-dimensional structure around the cleft-side peak of the Cupid's bow: the upper lip groove; the cutaneous roll, which is the anterosuperior convexity below the upper lip groove; and the white skin roll, which is the ridge at the vermilion cutaneous junction.

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