Introduction: Achieving good nasolabial esthetics and symmetry in unilateral cleft lip repair is often challenging. Although techniques of cleft lip repair have evolved over the years, each has different implications and its own setbacks. The aim of the current paper is to describe a double unilimb Z-plasty with upper rotation advancement for the management of complete unilateral cleft lip. Materials and Methods: A prospective cohort study was conducted at our center, including all patients who reported to us for the correction of unilateral cleft lip. Preoperative frontal and submental photogrammetric evaluation facilitated the planning of rotation-advancement flaps with double unilimb Z-plasties. Nasolabial esthetics were assessed using the Asher–McDade scale and a modified photographic evaluation by three independent reviewers to evaluate the efficacy of the technique in enhancing nasolabial esthetics. Results: Thirty-three patients with unilateral cleft lip within the age group of 4 to 10 months were enrolled in the study. Twenty-five patients were included based on the inclusion and exclusion criteria. The average width of the cleft ranged between 14 and 18 mm, the mean discrepancy in the height of the philtral column was 6–12 mm, and the mean discrepancy in the thickness of the vermilion was 3 mm. The immediate postoperative period did not reveal any significant surgical-site complications, while late postoperative evaluation revealed satisfactory nasolabial esthetics, with none of the patients requiring revision cheiloplasty. Conclusion: Upper rotation advancement with double unilimb Z-plasty appears to be an effective method of achieving good nasolabial esthetics in patients with wide unilateral cleft lip without NAM.
Pendem et al. (2026) studied this question.