Comparison of Rotation-Advancement and Straight-Line Methods for Repairing of Unilateral Cleft Lip (A Randomized Controlled Clinical Trial).

Abstract

INTRODUCTION:A cleft is a universal and non-standardized defect. To overcome stigmatization; cleft repair is essential to normalize the facial appearance. Thus, different surgical techniques and modifications have been developed. These techniques are based on three surgical approaches: The straight-line (Rose-Thompson), rotation-advancement (upper lip Z-plasty), and the triangular flap (lower lip Z-plasty). OBJECTIVES: Comparing the effectiveness of rotation-advancement approach to the straight-line approach in repairing unilateral cleft lip. METHODOLOGY: A prospective control clinical trial of twelve patients with unilateral cleft lip (aged between 1-and 24 months) was conducted. These patients were randomly selected and equally divided into two groups of 6 participants, each group was operated on with Millard or Fisher incisions. Caliper measurements of the lip and nose were recorded preoperatively. The analysis was based on a quantitative and qualitative comparison of the cleft side versus the non-cleft side for 3 outcomes (the constructed philtral ridge, the degree of labial scar, and degree of nasal symmetry) which were all used to assess the aesthetic difference between the two incisions. These outcomes were measured postoperatively at 6 months. Both Chi-square and Mann Whitney tests were used for statistical comparison of outcomes. RESULTS:The nasal asymmetry improved in both groups with a better result in cases operated on with Fisher; which was statistically significant at (2.201 * (0.028 * ). Medial lip height was increased in both groups with no statistical significance. The difference was statistically significant for the increase of lateral lip height of both groups at a P-value of <0.05. CONCLUSION: Nasolabial appearance in both incisions was satisfactory. Lip dimensions were improved in both groups. Due to the ''BACK CUT'' use; the lateral lip height was better with the Millard. Meanwhile, the nasal symmetry showed better results with the Fisher due to the definite preoperative measurements. Therefore, neither Fisher nor Millard incision was predominantly better than the other.

A Prospective Comparative Study of ALA Repair between Modified Tajima Suture and Cinch Suture in Unilateral Cleft Lip Patients

“…Over several years, many surgical techniques have been developed to normalized patient's aesthetics and functions. Despite cleft lip types (unilateral or bilateral cleft) and severity (mini/microform, incomplete/complete); different surgical techniques and modifications were developed to repair this defect [14].…”