Cooper University Hospital, Camden, NJ, USA.
PURPOSE: The “whistle” deformity of cleft lip repair has multiple methods available for correction. Quantifiable and reproducible objective data facilitates comparison of different techniques. We hypothesized that dermal graft for correction of the whistle deformity provides consistent cosmetic improvements that are measurable using digital analysis.
METHODS: Review of consecutive patients treated from February 1998 to December 2000 by the senior author with prior cleft lip repair and a whistle deformity was performed. The lip was augmented with a dermal-fat graft, and local tissue rearrangements performed for residual banding as needed.
Digital analysis was done using Image-Pro-Plus version 3.0. Pre/post-operative frontal views were analyzed: patients with bilateral cleft lip repair (BCL) and patients with unilateral cleft lip repair (UCL). Measurements from different photos of the same patient were standardized using the intercanthal distance, or the alar base if former is not available.
In BCL patients, the red vermilion area (RVA)of the upper lip was measured. Vertical heights were measured from 3 points to the free margin: peak of the right cupid’s bow (RCB), midpoint of the lip (MID), and peak of the left cupid’s bow (LCB) (Fig 1).
Analysis in UCL patients compared with the noncleft side for symmetry. The following measurements of the red vermilion were obtained pre/post-operatively: 1) areas of the noncleft (NCA) and 2) cleft side (CA); vertical heights to the free margin from 3) peak of the noncleft Cupid’s bow (NCB), 4) peak of the cleft Cupid’s bow (CCB), and 5) midline (MID) (Fig 2).
Statistical analysis was performed on Excel, and 2-tailed Student’s t-test was used to compare cleft versus noncleft sides.
RESULTS: Fifteen BCL and 11 UCL patients were treated. In the BCL group, mean RVA increase was 34%. MID increased a mean of 81%. Vertical red lip heights from RCB and LCB were augmented 43 and 33%, respectively. In the UCL group, the average preoperative difference of the lip areas between CA and NCA was 19% (p<0.05), versus a postoperative difference of 11% (p=0.25). MID increased by a mean of 48% (p=0.001). Analysis of CCB and NCB showed an overcorrection of the lip height on the cleft side, with a preoperative difference of 21% and a postoperative difference of -17%, both statistically significant.
CONCLUSION: This study showed the quantitative gain in red vermilion area after dermal graft placement for volume deficiency in cleft lip. Analysis also revealed a tendency for vertical overcorrection of the cleft side, which alerted the surgeon to more detailed tailoring of the graft. The digital analysis was simply to apply, and can be a useful tool for quantitative evaluation of different techniques of lip augmentation.
Figure 1A - BCL evaluation. Figure 1B - UCL evaluation.