Simple Z-plasty Research Articles

Evaluation of tongue mobility following release operation of ankyloglossia with genioglossus myotomy.

Ankyloglossia is a congenital anomaly characterized by a short lingual frenulum and severe form needs release surgery. Our goal in this study was to confirm the long-term safety and efficacy of Z-plasty with genioglossus myotomy compared with traditional Z-plasty alone and to develop a proper measurement tool to validate the postoperative results of release operations for ankyloglossia. Patients were divided in 2 groups, release with Z-plasty only group (group 1) and Z-plasty combined with genioglossus myotomy group (group 2) In group 2, the release of central longitudinal fiber of genioglossus muscle was added in the conventional Z-plasty operative procedure. To analyze the results of the surgery, we developed an objective assessment tool which is the direct length from the innermost point of the floor of mouth to the tip of the tongue, preoperatively and postoperatively, which is called “functional tongue length.” A total of 101 patients with ankyloglossia ranging in age from 36 months to 8 years underwent release operation. Although there was no significant difference in terms of postoperative measurements between groups in Kotlow class II, group 2 patients in Class III and IV showed greater postoperative functional tongue length. Also, there was no significant complication requiring secondary surgery. Our study demonstrated that adding genioglossus myotomy to a simple Z-plasty is a safe and effective method for improving the tongue mobility required to make lingual sounds, especially in moderate to severe form of ankyloglossia, along with suggestion of a new measurement tool, which can objectively assess tongue mobility with possibility for universal utilization in ankyloglossia release operation.

Fissura congênita cervical da linha média

Existe uma deformidade cervical da linha média que tem sido descrita com vários nomes. Embora sua causa embriológica continue sendo controversa, a etiologia mais aceita até hoje é a falha da fusão na linha média dos arcos branquiais distais. A característica principal é uma lesão protuberante na linha média da região anterior do pescoço, entre o mento e a fúrcula esternal. Recomenda-se a ressecção cirúrgica completa da lesão, e a reconstrução do defeito com w-plastia ou zetaplastia. Neste artigo, é relatado o caso de uma paciente de 38 anos, com fissura congênita cervical da linha média. Após exérese da lesão, foi realizada zetaplastia simples, obtendo-se bom resultado tanto estético como funcional. As fissuras congênitas cervicais da linha média são alterações raras na população mundial, porém seu diagnóstico precoce e tratamento cirúrgico adequado são necessários para prevenir alterações no crescimento facial e restrição na extensão do pescoço.

Posterior Z-plasty and J-Y antihelixplasty for correction of Stahl's ear deformity

The bifurcated Y-shaped antihelix characterises the normal human ear and gives it an aesthetically pleasing appearance. In Stahl's ear congenital anomaly an aberrant crus usually replaces the superior crus, crossing the scaphoid fossa from the site of the normal bifurcation of the antihelix posteriorly towards the helix, giving the antihelix an abnormal J-shape. A technique is described to correct Stahl's ear deformity adding a simple Z-plasty to the incision to lengthen the skin on the posterior surface, together with making use of the aberrant crus to reconstruct the superior crus without reducing the ear size using a modified Mustardé technique. This is achieved by posterior scoring and suturing without any cartilaginous excisions converting the 'J' antihelix into a 'Y'. Out of a series of eight cases examined, four unilateral and one bilateral cases were operated on (six ears). The first two unilateral cases were performed without Z-plasty, which was used in the third case on with very satisfactory results in different types and severities of Stahl's ear deformity. I believe that the technique detailed in this paper fulfils the main principles necessary for correction of Stahl's ear deformity and may be used in cases where the aberrant crus is reducible regardless of its shape.

Aesthetic vermilion reconstruction of a post-involuted hemangioma scar

The author describes a technique for vermilion reconstruction after excision of an involuted hemangioma scar in the upper lip in an adult female patient. Reconstruction was achieved by making use of all the available vermilion tissue remaining after a triangular excision of the scar. The incision is in the form of a horizontal “K” with extended limbs and repair by advancing and interdigitating the two medial and lateral triangular vermilion flaps with a final Z-shaped suture line. The advancement is like a modified double opposing Y–V plasty. This was complemented by a simple Z-plasty of the labial mucosa to correct an existing notch and deficiency of the free mucosal border. The aesthetic result was excellent; thus, its use can be considered when closing any similar defects resulting from scars or small benign lesion excisions.

Reanimation of the hemiparalytic tongue.

Tongue hemiparesis is the inevitable result when the freshly severed 12th nerve is anastomosed to the trunk of a paralyzed 7th nerve in the technique commonly used by neurosurgeons, head and neck surgeons, otologists, and plastic surgeons to treat unilateral facial paralysis. This author has reactivated hemiparalytic tongues after research on cats. The technique has now been proved to be successful on two human beings. The reanimation is based on a simple Z-plasty of tongue muscle across the midline. Two principles are established: (1) placing a normal muscle in direct contact with a denervated muscle stimulates axons from the normal side to penetrate into the denervated side, eventually restoring function, and (2) transposition of a flap of muscle from the normal side containing extrinsic tongue muscles could provide a motor apparatus to activate the paralytic side. Biopsy slides taken from the paralyzed side of the cat tongues after 18 months showed sprouting of multiple nerves. Nerve sprouting can be found in human tongues 1 year after Z-plasties. The two patients who experienced atrophy and hemiparesis after the 12th-7th nerve hookup regained full range of tongue movements by 2 months and 4 months, respectively, demonstrating that with time, motor axons from the normal side innervated the atrophic muscle side to form new neuromotor junctions resulting in tongue movements. EMGs of the reanimated tongue showed normal activity in both sides of the tongue. Biopsies of the interface between the normal and former paralyzed side taken 1 year later showed nerves crossing the scar barrier. Apparently, the role of additional extrinsic muscle to the paralyzed side played a minor role.

Revision of the first web space: technics and results.

Between 1975 and 1980, 91 patients in our series with involvement of 103 webs had revision of a contracted first web space. The five main causes of impairment were burns, trauma, congenital defects, cerebral palsy, and cerebrovascular accident. Technics used were simple Z-plasty; four-flap Z-plasty; modified double-opposing Z-plasty; and rotational flaps from the dorsum of the thumb, index finger, or hand. No pedicled, tubed, or distant flaps were needed. Simple Z-plasty was sufficient for increases to 1 cm; for greater increases a modified double-opposing Z-plasty or local rotational flap was necessary. The modified double-opposing Z gave excellent depth. Release of all contracting elements and addition of sufficient supple skin to the web are required for success.