Modifications to the WHISTLE Flap Procedure for Correction of Secondary Cleft Lip Deformities

Author:

Collar Yagas Lucia1,Bautista Catherine H.1,Chen Joanna1,Tausinga Telisha L.1,Kim Erinn N.1,Johns Dana N.1,Gociman Barbu R.1

Affiliation:

1. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, School of Medicine, Salt Lake City, Utah.

Abstract

Background: The whistle deformity, a deficiency of tissue in the central upper lip, is a consequential outcome of primary cleft lip repair. Among multiple described reconstructive options, the wide-hinged island swing transposition labial enhancement (WHISTLE) flap procedure by Grewal et al has been shown to be a reliable technique that restores the continuity of the orbicularis oris muscle and creates a more natural appearing tubercle and central lip element. This article aims to refine the WHISTLE flap procedure with the addition of tailored mucomuscular flaps and an upper lip-lengthening mucosal Z-plasty. Methods: A total of 11 patients with a whistle deformity were examined. All underwent the WHISTLE flap procedure with tailored mucomuscular flaps and a mucosal Z-plasty. The patients were followed for a period of from 6 to 51.5 months. Pre- and postoperative photographs were used for objective outcome comparison. Results: From 2018 to 2023, a total of 11 patients with a whistle deformity were included in the final cohort, comprised four bilateral and seven unilateral cleft lips. Ten cases (90.1%) resulted in satisfactory postoperative cosmetic appearance and did not require further interventions. A single patient with a significant preoperative discrepancy between the upper and lower lip volumes had a postoperative residual deformity. None of the patients demonstrated any functional deficits associated with the procedure. Conclusions: The WHISTLE flap procedure with the proposed individual tailoring of the mucomuscular flap and Z-plasty for mucosal scar lengthening has excellent cosmetic outcomes and can be considered as the primary treatment modality in most patients with a whistle deformity.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference11 articles.

1. Modified lip revision surgery for the severe whistle lip deformity in bilateral cleft lip.;Falguera-Uceda;J Oral Maxillofac Surg,2022

2. Correction of secondary cleft lip deformity: the whistle flap procedure.;Grewal;Plast Reconstr Surg,2009

3. Double pendulum flaps for whistling deformities in bilateral cleft lips.;Kapetansky;Plast Reconstr Surg,1971

4. Kapetansky-Juri technique to correct the whistlers lip in the multiple operated cleft patient.;Kiran;J Maxillofac Oral Surg,2015

5. A new plastic operation for the relief of deformity due to double harelip.;Abbe;Plast Reconstr Surg,1968

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