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Treatment outcomes of two surgical techniques in secondary reconstruction of unilateral cleft lip and ala nasi
Ebrahim Humadi1, Mawia Karkoutly2, Zafin Kara Beit1
1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic.
Background:
An orofacial cleft significantly impacts the oral health-related quality of life of children and teenagers. Secondary reconstruction is a more complex procedure due to tissue deficiency and scarring. The study aimed to evaluate the use of Pfeifer's wave-line incision method and the rotational flap method in the secondary reconstruction of unilateral lip clefts in patients with unilateral cleft lip and ala nasi aged 5-25 years utilizing anthropometry assessment.
Methods:
It was a double-blinded, randomized, parallel-group, active-controlled trial with two arms. Twenty-four patients were randomly divided into two groups. Group 1: Rotational flap method. Group 2: Control group, Pfeifer's wave-line incision method. The following anthropometric measurements were considered: Lb(X):En-En: The horizontal position of the center of the cupid's bow. Ch-Lt(l:r): The distance between the cheilion and the tip of the cupid's bow. Lt-Lb(l:r): The length of the cupid's bow. Lt(Y)(l:r): The size of the upper lip. Lt-Lt'(l:r): The height of the vermilion at the tip of the cupid's bow. Photographs were performed according to the follow-up periods: At the baseline and before surgery (t0). Immediately after surgery (t1). Two weeks after surgery (t2). Six months after surgery (t3).
Results:
The rotational flap method did not outperform Pfeifer's method in the studied anthropometric measurements. In the rotational flap method group, there was a significant improvement in the mean value of Ch-Lt(l:r) from t0 (1.156 ± 0.206) to t3 (0.962 ± 0.098), and in the average value of Lt(Y)(l:r) from t0 (0.944 ± 0.023) to t3 (0.990 ± 0.011) (p < 0.05). In Pfeifer's method group, the mean value of Ch-Lt(l:r) was (1.141 ± 0.158) at t0, and then improved to become (1.007 ± 0.084) at t3 (p < 0.05), the average value of Ch-Lt(l:r) at t0 was (0.942 ± 0.026), which improved to (0.991 ± 0.012) at t3, and the average value of Lt-Lt'(l:r) increased from t0 (1.308 ± 1.174) to t3 (1.050 ± 0.054) (p < 0.05).
Conclusion:
Pfeifer's wave-line incision and rotational flap methods achieve similar aesthetic results in the appearance of the lip or Cupid's bow after a 6-month follow-up.
Trial Registration:
ISRCTN registry, ISRCTN36320776, registered 06 November 2024.
