The Use of an Inferior Pennant Flap during Unilateral Cleft Lip Repair Improves Lip Height Symmetry.
BACKGROUND
To improve the rotation of Cupid's bow and achieve sufficient vertical lip height, several variations of the Millard rotation-advancement have incorporated a small laterally based triangular flap above the cutaneous roll. This study uses three-dimensional photogrammetry to evaluate the outcomes of unilateral cleft lip repairs performed with and without pennant flaps.


METHODS
Three-dimensional photographs were analyzed to assess postoperative lip height asymmetry in 90 unilateral cleft lip patients (58 complete and 32 incomplete) treated between 2001 and 2012. Cleft lip repairs were performed by three pediatric cleft surgeons using different techniques. Thirty-nine of 90 procedures (43 percent) used an inferiorly placed triangular flap. All patients were photographed at least 9 months postoperatively (mean, 4.2 years). Lip height asymmetry was based on the vertical distances from the subnasale to the peaks of Cupid's bow.


RESULTS
Regression analysis revealed that the use of a pennant flap was a significant predictor of postoperative lip height asymmetry (β = 4.2 percent, p = 0.015). The surgeon performing the repair was also a significant factor in patients with complete cleft lips (β = 3.6 percent, p = 0.005). All three surgeons achieved greater lip height symmetry when a pennant flap was performed.


CONCLUSIONS
The results of unilateral cleft lip repairs are affected by both the surgeon and the surgical technique. Procedures that used a pennant flap showed better philtral height symmetry than nonpennant repairs.


METHODS
Therapeutic, III.
St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine.
Aaron J
AJ
Russell
Kamlesh B
KB
Patel
Gary B
GB
Skolnick
Albert S
AS
Woo
D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000175:diagnosis* / Q000601:surgery*; D016208:Databases, Factual; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006776:Hospitals, Pediatric; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D016014:Linear Models; D008297:Male; D010781:Photography; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology