Z-plasty in the treatment of unilateral cleft lip: review of its history

The study reviews the use of Z-plasty in the cheiloplasty techniques used to treat unilateral cleft lip. It highlights the contribution of Brazilian authors, especially that of Perseu Lemos. It also reports the conduct adopted by the senior author in this type of cheiloplasty.

Keywords:
Burns; Cicatrix; Surgery; Plastic; Cleft lip; Surgeons

Authorship

SERGIO CARREIRãO

Hospital da Plástica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.Hospital da Plástica do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilHospital da Plástica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0002-2924-9606

LEILA LEMOS AZEM ^**Autor correspondente: Leila Lemos Azem, Rua Julio de Castilhos, 83/301, Rio de Janeiro, RJ, Brasil., CEP: 22081-025, E-mail: leilazem@globo.com

https://orcid.org/0000-0002-4342-9734

RAFAEL SUCUPIRA MENEZES

https://orcid.org/0000-0001-8358-3157

LAILA BLEIBEL ZRAIK

https://orcid.org/0000-0002-8765-3551

Conflicts of interest: none

Institution: Hospital da Plástica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

*Corresponding author: Leila Lemos Azem, Rua Julio de Castilhos, 83/301, Rio de Janeiro, RJ, Brazil., Zip Code: 22081-025, E-mail: leilazem@globo.com

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (10)

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Figure 1
Scheme showing: incision in the lower eyelid. A second incision part of the lower eyelid toward the angle of the mandible. Another incision of the same extension is directed to the root of the nose. Detachment and transposition of flaps. Almost immediate correction of the defect. According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46..

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Figure 2
A. Zetaplasty performed by Denonvilliers (1863). According to Borges and Gibson (1973). B. Zetaplasty performed by Denonvilliers (1863). According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46.,⁴4 Denonvilliers CP. De la méthode autoplastique par pivotempar appliquée à la restauration des paupières. Bull Gén Thér Méd Chirurg. 1863;65:110-22..

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Figure 3
A. Typical double transposition of zetaplasty as it is used today. According to Borges and Gibson (1973). B. Typical double transposition of zetaplasty as it is used today. According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46..

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Figure 4
Rose’s Technique (1879)¹⁰10 Rose W. On harelip and cleft palate. London: HK Lewis; 1891..

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Figure 5
Thompson’s technique (1912)¹¹11 Thompson JE. An artistic and mathematically accurate method of repairing the defect in cases of harelip. Surg Gynecol Obst. 1912;14:498-505. with his proposed measures.

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Figure 6
A. Technique of Perseu Lemos (1956)¹³13 Lemos PC. Nova operação para lábio leporino simples. O Hospital. 1956;1(4):607-11.. Zetaplasty used in cases of high nasal wings or good position. All lip layers are incised. B. Technique of Perseu Lemos (1956)¹³13 Lemos PC. Nova operação para lábio leporino simples. O Hospital. 1956;1(4):607-11.. Zetaplasty used when the nasal wings are low. C. Perseu Lemos technique. Zetaplasty used when hemilabium present with unequal dimensions. According to Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81..

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Figure 7
Spina and Lodovici technique (1960)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7..

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Figure 8
Diagram of Nicholas. According to Giglio (1996)²⁹29 Giglio AT. Tratamento funcional das fissuras labiais unilaterais. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. 2ª ed. Rio de Janeiro: Revinter; 1996. p. 77..

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Figure 9
Kernahan Technique (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66..

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Figure 10
A. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: preoperative. B. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: preoperative. C. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: perioperative. D. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: perioperative. E. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: postoperative. F. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: postoperative. Source: Senior author.

Figure 1 Scheme showing: incision in the lower eyelid. A second incision part of the lower eyelid toward the angle of the mandible. Another incision of the same extension is directed to the root of the nose. Detachment and transposition of flaps. Almost immediate correction of the defect. According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46..

Figure 2 A. Zetaplasty performed by Denonvilliers (1863). According to Borges and Gibson (1973). B. Zetaplasty performed by Denonvilliers (1863). According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46.,⁴4 Denonvilliers CP. De la méthode autoplastique par pivotempar appliquée à la restauration des paupières. Bull Gén Thér Méd Chirurg. 1863;65:110-22..

Figure 3 A. Typical double transposition of zetaplasty as it is used today. According to Borges and Gibson (1973). B. Typical double transposition of zetaplasty as it is used today. According to Borges and Gibson (1973)³3 Borges AF, Gibson T. The original Z-plasty. Br J Plast Surg. 1973 Jul;26(3):237-46..

Figure 4 Rose’s Technique (1879)¹⁰10 Rose W. On harelip and cleft palate. London: HK Lewis; 1891..

Figure 5 Thompson’s technique (1912)¹¹11 Thompson JE. An artistic and mathematically accurate method of repairing the defect in cases of harelip. Surg Gynecol Obst. 1912;14:498-505. with his proposed measures.

Figure 6 A. Technique of Perseu Lemos (1956)¹³13 Lemos PC. Nova operação para lábio leporino simples. O Hospital. 1956;1(4):607-11.. Zetaplasty used in cases of high nasal wings or good position. All lip layers are incised. B. Technique of Perseu Lemos (1956)¹³13 Lemos PC. Nova operação para lábio leporino simples. O Hospital. 1956;1(4):607-11.. Zetaplasty used when the nasal wings are low. C. Perseu Lemos technique. Zetaplasty used when hemilabium present with unequal dimensions. According to Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81..

Figure 7 Spina and Lodovici technique (1960)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7..

Figure 8 Diagram of Nicholas. According to Giglio (1996)²⁹29 Giglio AT. Tratamento funcional das fissuras labiais unilaterais. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. 2ª ed. Rio de Janeiro: Revinter; 1996. p. 77..

Figure 9 Kernahan Technique (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66..

Figure 10 A. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: preoperative. B. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: preoperative. C. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: perioperative. D. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: perioperative. E. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: postoperative. F. Proposed conduct: Lemos (1981, 1996)¹⁸18 Lemos PC. Tratamento da fissura labial unilateral. In: Lessa S, Carreirão S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Editora Interamericana; 1981. p. 37.,¹⁹19 Lemos PC. Quilozetaplastia técnica pessoal para o tratamento cirúrgico das fissuras labiais unilaterais. In: Tratamento das fissuras labiopalatinas. In: Lessa S, Carreirão S, Zanini S, eds. Tratamento das fissuras labiopalatinas. Rio de Janeiro: Revinter; 1996. p. 81., Spina and Lodovici (1959-60)¹⁴14 Spina V, Lodovici O. Conservative technique for treatment of unilateral cleft lip. Reconstruction of the midline tubercle of the vermilion. Br J Plast Surg. 1960;13:110-7.,²⁰20 Spina V, Lodovici O. Técnica conservadora para o tratamento do lábio leporino unilateral: reconstituição do tubérculo mediano. Rev Assoc Med Bras. 1959;5(5):325-30. and Kernahan (1978, 1983)³⁰30 Kernahan DA. Muscle repair in unilateral cleft lip, based on findings on eletrical stimulation. Ann Plast Surg. 1978;1(1):48-53.,³¹31 Kernahan D, Bauer BS. Functional cleft lip repair: a sequential layred closure with orbicularis muscle realingment. Plast Reconstr Surg. 1983 Out;72(4):459-66.. Incomplete right unilateral cleft: postoperative. Source: Senior author.

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Z-plasty in the treatment of unilateral cleft lip: review of its history

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[1] Conflicts of interest: none