Midline Cervical Cleft Excision of Fibrous Cord – Z Plasty Closure

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
Presence of the lesion
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
The deformity is the cutaneous defect and abnormal cutaneous tissue and the associated fibrous cord which extends from the sternum to the mentum of the mandible which causes anterior contracture
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, seroma, infection or hematoma
Dena Zabilka
Int J Pediatr Otorhinolaryngol . 2019 Dec;127:109657. doi: 10.1016/j.ijporl.2019.109657. Epub 2019 Aug 23.

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