Minor-Form, Microform, and Mini-Microform Cleft Lip: Anatomical Features, Operative Techniques, and Revisions

Abstract

Whatever method of closure, a cleft lip scar extends along the full labial height. A smaller scar is possible in repair of limited forms of incomplete cleft lip. This retrospective study was undertaken to define the subgroups of lesser-form cleft lip, describe technical alternatives, and review results of repair. The senior author's (J.B.M.) registry was searched for patients with lesser-form cleft lip, defined by the extent of vermilion-cutaneous dysjunction as either minor-form, microform, or mini-microform. Techniques for repair of these three anatomical variants were examined and the revisions were analyzed. Of 393 patients with unilateral incomplete cleft lip, 59 lesser-form variants were identified. Minor-form clefts (n = 20), defined as a defect extending 3 mm or more above the normal Cupid's bow peak, were repaired by rotation-advancement. Microform clefts (n = 28), defined as a vermilion-cutaneous notch less than 3 mm above the normal peak, were corrected by double unilimb Z-plasty. Mini-microform clefts (n = 11), defined as a disrupted vermilion-cutaneous junction without elevation of the bow peak, were repaired by vertical lenticular excision. Primary nasal correction was necessary in all minor-form and microform types and in some mini-microform types. In all three lesser-forms, the rate of nasolabial revision was relatively low in comparison with that for unilateral complete cleft lip. The extent of disruption at the vermilion-cutaneous junction defines minor-form, microform, and mini-microform cleft lip. These anatomical designations determine the method of nasolabial repair and correlate with types and frequency of revision.