Double opposing Z-plasty for congenital midline cervical web: A case report

Preoperative photographs. (A) An open-bite deformity and cleft chin. (B) Desquamating epithelium and fibrous chord. (C) Webbed neck with dorsiflexion of the head. (D) Lacrimal probe in sinus tract. S, superior and I, inferior.

Intraoperative photographs before Z-plasty. (A) The skin incision was marked to encompass the abnormal skin, the sinus tract, and the fibrous cord. The first Z-plasty was planned at the cervicomental angle, and the second Z-plasty was planned inferior to the first. Both limbs were at approximately 60° from the vertical midline. (B) A lacrimal probe was placed in the sinus tract. (C) The sinus tract extended down to the level of the manubrium. (D) The sinus tract was completely dissected out. S, superior and I, inferior.

Z-plasty and histology. (A) A planned opposing Z-plasty of the underlying platysma and soft tissue. (B) The Z-plasties of the superficial layer have been appropriately placed and the skin closed. (C) The cleft was lined with keratinized squamous epithelium and the sinus tract with cuboidal mucosal epithelium. (D) A cross-section of the sinus tract, lined by cuboidal epithelium and surrounded with collagen bundles (fibrous band, stained blue). The platysma muscle (red bundles) was also involved in the lesion. S, superior and I, inferior.

Postoperative photographs. (A) Five months after the operation, raised erythematous scar. (B)–(D) One year after the operation. (B) The cleft chin and open-bite deformity have improved. (C) The scar has flattened and shows decreased hyperemia. (D) Restored cervicomental angle.