Z-Plasty in Unilateral Cheiloplasty: Evolution and Techniques

Abstract

Introduction

Cleft lip and palate is the most common congenital deformity among craniofacial malformations. The treatment of cleft lip patients has crucial stages, with several surgical techniques, among which the most used is the Millard I. Initially, Z-plasty involved creating Z-shaped incisions along the edges of the cleft lip, but, eventually, more precise suturing techniques and absorbable suture materials started to be used in order to reduce tissue tension and enhance healing. The development of these modifications to the Z-plasty technique has led to better aesthetic and functional outcomes in unilateral cleft lip repair. Z-plasty has been extensively employed in unilateral cleft lips to achieve satisfactory aesthetic and functional results. The present study examines the most significant advances in Z-plasty technology and their impact on enhanced lip aesthetics and functionality.

Objective

The current study aimed to investigate the Z-plasty evolution in cheiloplasty, analyzing the technical developments achieved over time, focusing on improving aesthetic outcomes and restoring functionality in repaired unilateral cleft lips.

Materials and Methods

The article is a narrative summary from selected specific studies investigating the development of Z-plasty in cheiloplasty using electronic databases such as PubMed, LILACS, Scielo, and articles from the Brazilian Journal of Plastic Surgery (RBCP), and research on technical developments and the pros and cons of Z-plasty.

Results

Z-plasty is an effective and adaptable surgical technique, easily tailored to the demands of contemporary plastic surgery. Its remarkable evolution over the years demonstrates significant advances in aesthetic and functional outcomes, and new technical approaches are increasingly frequent to enhance the natural appearance of repaired lips.

Conclusion

Z-plasty has shown significant aesthetic and functional advancements in correcting unilateral cleft lips. Its adaptations improved symmetry and reduced the need for secondary surgeries. The technique selection must be careful, and a multidisciplinary approach is essential for optimal outcomes.

Keywords

cheiloplasty - cheilozetaplasty - cleft lip surgery - unilateral cleft lip - Z-plasty

• Referências

• 1 Spencer LSDB, Buzzo CL. Tratamento primário da deformidade labial e nasal nas fissuras labiais e labiopalatinas unilaterais. Rev Bras Cir Plást 2017; 32 (01) 37-45 10.5935/2177-1235.2017RBCP0006
• 2 Rossell-Perry P. A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique. Indian J Plast Surg 2016; 49 (03) 340-349
• 3 Anger J, Sertorio CB. Avaliação das Medidas do Alongamento do Lábio nas Queiloplastias com Plástica em Z no Tratamento das Fissuras Labiopalatinas Unilaterais. Rev Bras Cir Plást 2006; 21 (03) 133-139
• 4 Barreiros H, Goulão J. Z-Plasty: useful uses in dermatologic surgery. An Bras Dermatol 2014; 89 (01) 187-188 PubMed
• 5 Chen B, Song H. The Modification of Five-Flap Z-Plasty for Web Contracture. Aesthetic Plast Surg 2015; 39 (06) 922-926 PubMed
• 6 Bae DS. Z-plasties for the Pediatric Orthopaedic Surgeon. Journal of the Pediatric Orthopaedic Society of North America 2023; ;5(3): -700 , ISSN 2768–2765,
• 7 Garg S, Dahiya N, Gupta S. Surgical scar revision: an overview. J Cutan Aesthet Surg 2014; 7 (01) 3-13 PubMed
• 8 Koc MN, Orbay H, Uysal AC, Unlü RE, Sensöz O. Z plasty closure of lower lip defects after tumor excision. J Craniofac Surg 2007; 18 (05) 1120-1124 PubMed
• 9 Moraes MARd, Ramos RR, Ferreira LM. Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents. Rev Bras Cir Plást 2017; 32 (02) 241-244 10.5935/2177-1235.2017RBCP0038
• 10 Shkoukani MA. , Chen, M, Vong A. Cleft lip – a comprehensive review. Front Pediatr 2013; 1 (53) ••• PubMed
• 11 Carreirão S, Azem LL, Menezes RS, Zraik LB. Plástica em Z no tratamento da fissura labial unilateral: revisão de sua história. Rev Bras Cir Plást 2021; ; 36(4): 490-495
• 12 Rossell-Perry P. The Triple Unilimb Z Plasty Technique for Severe Forms of Unilateral Cleft Lip Repair. Plast Reconstr Surg Glob Open 2020; 8 (10) e3213
• 13 Worley ML, Patel KG, Kilpatrick LA. Cleft Lip and Palate. Clin Perinatol 2018; 45 (04) 661-678 PubMed
• 14 Lopes DdC, Cano AFC, Gobetti L, Menegazzo MR, Saldanha O. Avaliação da técnica de Millard associada à zetaplastia no tratamento de portadores de fenda labial unilateral. Rev Bras Cir Plást 2018; ;33(1) 82-88 10.5935/2177-1235.2018RBCP0012
• 15 Miachon MD. e Leme PLS. Tratamento operatório das fendas labiais. Rev Col Bras Cir 2014; ;41(3): 208-214 ,. ISSN 1809–4546 PubMed
• 16 Tse R. Exploring Surgical Principles and Management Techniques for Unilateral Cleft Lip Repair: Highlighting Millard and Fisher Methods. . J Craniofac Surg 2012
• 17 Adetayo AM, Adetayo MO, Adeyemo WL, James OO, Adeyemi MO. Comparison of Surgical Outcomes Between Tennison–Randall and Millard Techniques for Unilateral Cleft Lip Repair: Qualitative Assessment by Patients and Professionals. J Craniofac Surg 2019; 45 (03) 1128999
• 18 ElMaghraby MF, Ghozlan NA, Ashry MH, Abouarab MH, Farouk A. Comparative study between fisher anatomical subunit approximation technique and millard rotation-advancement technique in unilateral cleft lip repair. Alex J Med 2021; ;57(1): 92-102 10.1080/20905068.2021.1885954
• 19 Sales PHdH Rocha SSd, Albuquerque AFM, Cunha Filho JFd. Queiloplastia primária unilateral através da técnica de Fisher. Rev. Odontol. Univ. Cid. São Paulo 2016; ;28(2): 148-154 10.26843/ro_unicid.v28i2.225