Beyond the scar: Afroze incision as a superior choice in esthetic cleft lip reconstruction

INTRODUCTION

One of the most frequent congenital abnormalities seen in pediatric surgery is cleft lip deformities, which pose a complex problem that goes beyond functional repair to the goal of esthetic perfection.^[1-4] It is impossible to overestimate the emotional and psychological toll that visible scarring has on young patients; thus, surgical methods must not only return function to normal but also produce the best possible esthetic results.^[5] Although they are successful in reestablishing anatomy and function, traditional cleft lip repair methods can result in noticeable scars that detract from facial beauty and may have long-term effects on the child’s look and self-esteem.^[6] More sophisticated methods that prioritize the twin objectives of scarless healing and functional restoration have become more popular in recent years.^[7] The Afroze incision, which is intended to reduce scarring and improve the cosmetic balance of the restored lip and surrounding structures, is one of the most promising of these.^[8] This novel technique combines careful nose alignment, little muscle dissection, and careful tissue manipulation to provide outcomes that are superior to conventional techniques in terms of both functional integrity and cosmetic appeal.^[9]

Ten patients with unilateral cleft lip are the subject of this case study, which investigates the use of the Afroze incision. This study intends to show how this procedure outperforms traditional methods in terms of scarless healing, enhanced lip symmetry, and reduced post-operative problems, with an emphasis on cosmetic results. By offering not just a functional repair but also a smooth, esthetically beautiful result that better suits the demands of the patient and their family, we wish to highlight the Afroze incision’s potential to transform cleft lip surgery through this series.

CASE REPORT

A total of ten patients with unilateral cleft lip presented to the clinic, all of whom underwent surgical intervention. Each patient had associated soft-tissue mass abnormalities and nasal deformities. Pre-operative examinations and investigations were performed to rule out any systemic conditions, including cardiac and neurological abnormalities. All patients were found to be free of such conditions, ensuring their suitability for surgery.

Surgical technique

The surgical procedure was carried out under general anesthesia with oral intubation. The Afroze incision technique was employed for cleft lip repair, with the following steps:

Incision marking and soft-tissue dissection

Precise markings for the Afroze incision were made on the cleft region. Minimal muscle dissection was performed, with careful attention to the transverse nasalis muscle to avoid unnecessary trauma [Figure 1].

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Figure 1:

Markings for Afroze incisions in unilateral cleft lip.

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Periosteal and muscle dissection

A wide periosteal dissection was carried out from the cleft side vestibule, relieving muscle attachments around the piriform rim, ala, lateral surface of the nose, infraorbital region, and malar area. On the non-cleft side, minimal muscle dissection was performed to relieve abnormal attachments at the anterior nasal spine and columella [Figure 2].

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Figure 2:

Minimal muscle dissection ensuring dissection of transverse nasalis.

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Nasal septum alignment

The nasal septum, crucial for facial symmetry, was repositioned centrally in its anatomical position. All abnormal attachments to the septum were carefully released [Figure 3].

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Figure 3:

Wide sub-periosteal dissection from the vestibule on the cleft side is done to relieve all muscle attachments from around the piriform rim, ala, lateral surface of nose, infraorbital, and malar area.

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Perioplasty and nasal symmetry

Perioplasty was performed to apply medial pressure on the palatal shelves, aiming to reduce the likelihood of anterior palatal fistulas. The nasal ala was stabilized symmetrically to ensure alignment with the contralateral side, creating harmonious nasal contours [Figure 4].

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Figure 4:

Minimal muscle dissection is done on the non-cleft side relieving all abnormal attachments on anterior nasal spine and columella.

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Closure

The white line was meticulously matched and aligned. Muscle approximation was performed using resorbable sutures to ensure proper functional and cosmetic outcomes. The surgical site was closed with careful attention to tissue tension and alignment [Figure 5].

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Figure 5:

Hypertrophic scar formation after unilateral cleft lip defect repair on infant with conventional incision methods (a) pre-operative, (b) 2 week after cleft lip repair, and (c) 1 year cleft lip repair.

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Post-operative outcome

No complications were observed in any of the cases. All patients showed satisfactory healing, with excellent esthetic outcomes, minimal scarring, and restored nasal symmetry. The Afroze incision technique demonstrated promising results in terms of both functional and cosmetic improvement in unilateral cleft lip repair [Figure 6].

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Figure 6:

Long-term follow-up of primary cleft lip repair with Afroze incision.

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DISCUSSION

In terms of both functional and esthetic effects, the case series’ results are promising. None of the instances had any postoperative issues, including infection, hypertrophic scarring, or nasal structural malpositioning. Every patient had quick healing, low surgical discomfort, and pleasing esthetic outcomes. When compared to conventional cleft lip repair methods, these results are consistent with the body of research indicating that the Afroze incision can greatly enhance esthetic results. Furthermore, the technique’s potential to become the go-to approach for cleft lip restoration is supported by its capacity to produce the best possible lip symmetry and nasal alignment with the least amount of scarring, especially in situations when esthetic results are crucial.

Even though this series has shown encouraging outcomes, there are a few issues that need to be addressed. Although the results are encouraging, bigger, multicenter prospective studies are required to further confirm the Afroze incision approach. This case series is based on a relatively small cohort of ten patients. Long-term monitoring is also necessary to determine how long the cosmetic results will last and to keep an eye out for any potential issues that might develop as the child gets older.

CONCLUSION

Afroze incision is a major development in the field of cleft lip surgery, providing a sophisticated method that improves the repair’s functional and cosmetic outcomes. The Afroze incision offers a convincing substitute for conventional methods by reducing scarring, enhancing nose symmetry, and producing a more harmonious facial appearance. It merits more research due to its potential to enhance patient outcomes and may set the standard for cleft lip surgery in the future.