Primary unilateral cleft lip repair

Abstract

The 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.

Nostril Morphometry Evaluation before and after Cleft Lip Surgical Correction: Clinical Evidence

“… 27 Other authors, who disagree with the preoperative procedures, claimed that the secondary deformities on the nose are caused by many factors, but the greatest determinant of nasal appearance after treatment is the primary deformity, 3 and cited that associated procedures generate higher costs and are very dependent on the cooperation patient and family for a good result. 2 Among the results, we noticed that patients who used a nostril mold had improvement of asymmetry even before surgery.…”

“…Nasal deformities associated with unilateral cleft lip are characterized by asymmetry, which gradually progresses with severity of the cleft, and nostril structures with morphological changes. 1 2 3 4 The main supporting structure of the nasal wing, the nasal lower lateral cartilage, in patients with cleft lip is concave with a depressed nasal tip, and separates from the opposite side, not the cleft, resulting in depression and collapsed nasal tip asymmetry, 5 which is very common, even after surgical treatment of cleft lip. 6 …”

Lip Height Improvement during the First Year of Unilateral Complete Cleft Lip Repair Using Cutting Extended Mohler Technique

“…Andewalla and Narayanan [11] also observed that a straight-line part of the Millard incision often contracts and pulls Cupid's bow up in the first few months and it descends at one year after surgery, without the need of a secondary surgery. Thus, we designed this study to objectively quantify the amount of pulls up of Cupid's bow, when it appeared to be maximum.…”

Tribute to Hirji Sorab Adenwalla–A Unique Medical Missionary

“…For microform cleft lips, he devised a technique called the Cutaneous Millard's repair with minimal surgical intervention. 7 He was fascinated with the cleft palate deformity. His meticulous and skillful mobilization of the nasal layers left most visitors to the department dumbfounded.…”

“…For the repair of the unilateral cleft lip, he took a fascination to Millard’s rotation advancement procedure and introduced technical refinements, including a protocol to avoid a vermillion notch, 6 a method of primary cleft lip nose correction in unilateral cleft lips 7 which included an extensive closed alar cartilage shift, and an aggressive septal repositioning which he and his mentor Charles Pinto started performing almost simultaneously but independent of each other in the 1970s. Those were times when very few cleft surgeons ventured to correct the cleft lip nasal deformity primarily.…”