Beyond Fifty Years of Millard’s Rotation-Advancement Technique in Cleft Lip Closure: Are There Many “Millards”?

Abstract

In 1955, Millard developed the concept of rotation-advancement flap to treat cleft lip. Almost 6 decades later, it remains the most popular technique worldwide. Since the technique evolved and Millard published many technical variations, we decided to ask 10 experienced cleft surgeons how they would mark Millard's 7 points in two unilateral cleft lip patient photos and compared the results. In both pictures, points 1 and 2 were marked identically among surgeons. Points 3 were located adjacent to each other, but not coincident, and the largest distances between points 3 were 4.95 mm and 4.03 mm on pictures 1 and 2, respectively. Similar patterns were obtained for points 4, eight of them were adjacent, and the greatest distance between the points was 4.39 mm. Points 5 had the most divergence between the points among evaluators, which were responsible for the different shapes of the C-flap. Points 6 also had dissimilar markings, and such difference accounts for varying resection areas among evaluators. The largest distances observed were 11.66 mm and 7 mm on pictures 1 and 2, respectively. In summary, much has changed since Millard's initial procedure, but his basic principles have survived the inexorable test of time, proving that his idea has found place among the greatest concepts of modern plastic surgery.

Unilateral cleft lip repair treatment outcomes using triangular flap and rotation-advancement techniques: A systematic review

“…The outcome of philtral and vermilion heights was discussed in a study by De Silva Amaratunga et al [10] by calculating cleft lip component symmetry index score. In this study, the philtral height outcomes in the trian gular flap group (Cronin technique) obtained a better score, so the results of vermilion height.…”

Novel Technique for the Surgical Management of Pleomorphic Adenoma of the Upper Lip

“…To overcome this shortcoming and to achieve a tension-free closure, the rotation and advancement of Millard's technique were adopted and modified to suit our case. Millard's technique was followed and an intentional through and through incision of the upper lip was made, and back cuts were created to accommodate the C-flap [16]. This technique achieved tension-free closure and significantly reduced postoperative scar formation.…”

The Millard Rotation-Advancement Cleft Lip Repair: 50 Years of Modification

“…To provide greater columellar lengthening, Millard proposed a modification of the C-flap in 1968 wherein the flap was expanded along the columellar defect and along the septum in a one-sided forked flap (Millard, 1968). The positioning of Millard's standard marking point at the end of the C-flap has been shown to be a point of contention between surgeons, giving rise to the variety of shapes of the C-flap (da Silva Freitas et al, 2012).…”