An alternative approach to avoiding the whistling deformity after cleft lip surgery: dermal flap and irregular Z-plasty.

The whistling deformity is characterized by tissue loss in the medial tubercle of the lips after cleft lip repair. Vermilion deficits can be treated by performing upper-lip flaps, Z-plasties, V-Y plasty techniques, and tongue flaps or grafts. However, the debate continues as to which of these is the most effective procedure. In this study, the combination of dermal flap derived from lateral mucosal flap and irregular Z-plasty repair is proposed as an alternative approach for the repair of vermilion deformities. Fourteen patients who presented to our clinic with cleft lip deformities between April 2008 and December 2009 underwent modified Millard repair, Mohler repair, or Mulliken method to successfully treat 9, 3, and 2 patients, respectively. At the end of the study, it was observed that all cases resulted in a favorable postoperative cosmetic appearance. Consequently, we believe that this technique is an alternative approach that could be applied to cleft lip patients with vermilion deformity.