scholarly journals A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique

2016 ◽  
Vol 49 (03) ◽  
pp. 340-349 ◽  
Author(s):  
Percy Rossell-Perry
Keyword(s):  
Surgical Outcomes ◽  
Cleft Lip ◽  
Surgical Techniques ◽  
Anthropometric Measurements ◽  
Study Objective ◽  
Scar Assessment ◽  
Retrospective Audit ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Rotation Advancement

ABSTRACT Background: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. Materials and Methods: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. Results: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. Conclusions: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.

scholarly journals White Roll Vermilion turn down flap in primary unilateral cleft lip repair: A novel approach

2015 ◽  
Vol 48 (02) ◽  
pp. 178-184
Author(s):  
R. K. Mishra ◽  
Amit Agarwal
Keyword(s):  
Learning Curve ◽  
Cleft Lip ◽  
Surgical Techniques ◽  
High Light ◽  
Scar Contracture ◽  
Novel Approach ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Motivating Factor ◽  
Rotation Advancement

ABSTRACT Aim: Numerous modifications of Millard′s technique of rotation - advancement repair have been described in literature. This article envisions a new modification in Millard’s technique of primary unilateral chieloplasty. Material and Methods: Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard’s repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion. Result: With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid’s bow with no vermilion notching of the lips. Conclusion: WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.

scholarly journals Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair

2018 ◽  
Vol 4 (1) ◽  
pp. 95-100
Author(s):  
Prasetyanugraheni Kreshanti ◽  
Muhammad Irsyad Kiat
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Modified Technique ◽  
Nasal Vestibule ◽  
Base Position ◽  
Alar Base ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Rotation Advancement

Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques. Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients. Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio. Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.

scholarly journals Antropometric Evaluation Of Gentur's Cheiloplasty Method In Unilateral Cleft Lip

2017 ◽  
Vol 3 (2) ◽  
pp. 52-60
Author(s):  
Rani Septrina ◽  
Gentur Sudjatmiko
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Anthropometric Data ◽  
Cross Sectional ◽  
Before And After ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Palate Patient ◽  
Vertical Height ◽  
Rotation Advancement

Background: Cheiloplasty, the earliest surgical procedure in cleft lip and palate patient, has impact on functional and aesthetical appearance1. The Gentur’s technique is a method of cleft lip surgery that has been developed by him and has been used in RSUPN Cipto Mangunkusumo/Faculty of Medicine Universitas Indonesia2. It uses the rotation-advancement, small triangular, preventing notching concepts with some other details to overcome the wide cleft. This study was conducted to answer whether the Gentur’s technique gives symmetrical result in anthropometric measurements. Methods: Cross sectional analytic study will be taken from medical record in 14 unilateral cleft lip patients underwent cheiloplasty procedure. Direct anthropometric data before and after procedure were analyzed using SPSS17. Anthropometric data such as cupid’s bow, vertical height, horizontal height, vermillion and nostril were noted. Results: From 14 patients, we found 9 patients who underwent surgery in 3 months of age (64.3%) are mostly female (n=9, 64.3%), have complete defect (n=12, 85.8%) and left sided defect (n=8, 57.1%). Gentur’s technique is able to produce significant lip and nose symmetry (CI 95%, pvalue <0.005) in cupid’s bow, vertical height, horizontal height, thickness of vermillion and nose. By doing this technique, the author is able to create good lip and nose symmetry (78.57%) even in wide defect (64.3%) and palatal collapse (57.1%). Conclusion: Gentur’s technique is able to utilize tissue deficiency to create ideal lip and nose in unilateral cleft lip repair even in patients with wide gap.

Use of the Modified Unilateral Cleft Lip Repair Technique to Establish a Cupid’s Bow With a Natural Structure

2020 ◽  
pp. 105566562096236
Author(s):  
Tatsuya Ishigaki ◽  
Akikazu Udagawa
Keyword(s):  
Surgical Technique ◽  
Cleft Lip ◽  
Surgical Techniques ◽  
Lateral Side ◽  
Natural Structure ◽  
Repair Technique ◽  
Triangular Flap ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Projection Point

Introduction: There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique. Methods: We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows: we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow. Results: We could preserve the shape and symmetry of the peak of the Cupid’s bow. Conclusion: To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.

Cleft Lip Repair

2019 ◽  
pp. 503-518
Author(s):  
Samuel Lance ◽  
Catherine Tsai ◽  
Amanda Gosman
Keyword(s):  
Surgical Technique ◽  
Plastic Surgery ◽  
Clinical Evaluation ◽  
Postoperative Care ◽  
Cleft Lip ◽  
Surgical Techniques ◽  
Bilateral Cleft Lip ◽  
Cleft Lip Repair ◽  
Rotation Advancement

Understanding the anatomy and surgical technique for repair of the unilateral and bilateral cleft lip remain essential to the practice of plastic surgery. This chapter summarizes the relevant anatomy, clinical evaluation, surgical technique, and postoperative care of the cleft lip patient. Step-by-step surgical descriptions and illustrations are provided along with commentary regarding common pitfalls encountered with these techniques. The surgical techniques described are a modified Millard rotation advancement technique for repair of the unilateral cleft lip and a modified Byrd repair for correction of the bilateral cleft lip.

scholarly journals Primary unilateral cleft lip repair

2009 ◽  
Vol 42 (S 01) ◽  
pp. S62-S70
Author(s):  
H. S. Adenwalla ◽  
P. V. Narayanan
Keyword(s):  
Deleterious Effect ◽  
Cleft Lip ◽  
Surgical Correction ◽  
Cleft Lip Repair ◽  
Unilateral Cleft Lip Repair ◽  
Rotation Advancement

ABSTRACTThe unilateral cleft lip is a complex deformity. Surgical correction has evolved from a straight repair through triangular and quadrilateral repairs to the Rotation Advancement Technique of Millard. The latter is the technique followed at our centre for all unilateral cleft lip patients. We operate on these at five to six months of age, do not use pre-surgical orthodontics, and follow a protocol to produce a notch-free vermillion. This is easy to follow even for trainees. We also perform closed alar dissection and extensive primary septoplasty in all these patients. This has improved the overall result and has no long-term deleterious effect on the growth of the nose or of the maxilla. Other refinements have been used for prevention of a high-riding nostril, and correction of the vestibular web.

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