Z-plasty allows broken-line closure, reorientation of the defect in the horizontal plane with re-creation of a cervicomental angle, and most importantly, a lengthening of the anterior neck skin that aids in preventing recurrent contracture. We present our experience managing a congenital cervical midline cleft in a 3-month-old patient and describe a simple technique for planning the ideal Z-plasty closure. No simple description for planning the ideal closure for this defect could be found in the otolaryngology literature.
Excision and Z-Plasty Closure of Midline Cervical Cleft
To increase neck mobility and natural mandibular growth; to establish natural cosmetic neck contour
Where the skin and cutaneous circulation is compromised in such a manner that a transpositional flap (z-plasty) can not be performed
standard soft tissue neck set up with neck extension
physical examination with attention to neck range of motion, mandibular clefting/hypoplasia; no specialized imaging required
Instead of z-plasty one large z-plasty can be performed or multiple z-plasty's can be performed
Complete subcutaneous cord excision enhances surgical results and mobility; Z-plasty lengthens the surgical scar and makes it less cosmetically conspicuous over time
Incomplete excision of the fibrous cord can result in wound contracture and failure to achieve surgical goals; lack of execution of Z-plasty can result in inadvertent neck contracture or sub-optimal scar appearance
Int J Pediatr Otorhinolaryngol
. 2019 Dec;127:109657. doi: 10.1016/j.ijporl.2019.109657. Epub 2019 Aug 23.