Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study

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Authors
Denadai, R.
Tangco, I.
Valentine, M.
Wallace, C. G.
Hsiao, Y. C.
Huang, J. J.
Chang, F. C.
Lo, L. J.
Chen, J. P.
Chen, Y. R.
Journal
Plastic and reconstructive surgery
Type
Journal Article
Publisher
Lippincott, Williams & Wilkins
Rights
Copyright © 2023 by the American Society of Plastic Surgeons.
SUMMARY: Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients (n=13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for 3D morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. 3D morphometric analysis revealed a significant (all p<0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference (p>0.05) between cleft and noncleft sides. The postoperative 3D projection of the philtral ridges was significantly (p<0.001) larger in cleft (1.01±0.43 mm) than noncleft sides (0.51±0.42 mm). The average philtrum volume change was 1.01±0.68 cm3, with an average percentage fat graft retention of 43.36±11.35 percent. The panel assessment revealed significant (p<0.001) postoperative scar enhancement for qualitative rating scale, with mean preoperative and postoperative scores of 6.69±0.93 and 7.88±1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Citation
Denadai R, Tangco I, Valentine M, Wallace CG, Hsiao YC, Huang JJ, et al. Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study. Plast Reconstr Surg. 2023.
Note
Not held