Comment on "Unit approach for vermilion repair in unilateral cleft surgery" by Onishi and Maruyama

Abstract

In their article “Unit approach for vermilion repair in unilateral cleft surgery” Onishi and Maruyama [3] authors show that they well understand the esthetic details in cleft lip repair, indicating their extensive experience, and we would like to thank for sharing it with us. There are different and distinct patterns in cleft lips; thus only one repair technique cannot be applied to all lips. This is the main reason for the various techniques described in the literature. The classic Millard technique which has incisions in the esthetic lines of the lip requires a back cut to overcome the tissue deficiency on the cleft side, and in spite of this back cut there may be an elevation of Cupid’s bow in the long term [2]. In these cases triangular and quadrangular flaps from the lateral part of the cleft can produce better results [1, 4, 7]. Drs. Onishi and Maruyama mention an extension region craniad to vermilion border [3]. This is found in every individual, more markedly in males, and it is the hairless region between the vermilion borders and mustache. The upper border of this region is termed the “groove line” (Fig. 1) [5]. In the Onizuka technique a triangular flap from the lateral part of the cleft lip is prepared and placed to the medial part of the lips (Fig. 2) [6]. This helps to correct the shortness in the height of the cleft side and the groove line continuity is maintained. The importance that the authors place on this point can be seen in the excellent postoperative esthetic results. Although the evaluation of 14 cases is not enough for a 7-year follow-up period, undoubtedly there will be even more convincing results in a larger series in the future.