Comparison of the Fisher Anatomical Subunit and Modified Millard Rotation-Advancement Cleft Lip Repairs

Abstract

Background: When analyzing cleft lip repair techniques, the modified rotation-advancement repair is most widely used; however, the anatomical subunit approach is gaining popularity. The purpose of this study was to compare the outcomes of these two surgical techniques performed by the same surgeon. Methods: Anthropometric measurements were performed on postoperative photographs of cleft lip repairs performed by a single surgeon. As described by Rossell-Perry, four parameters were measured: lip height, lip width, vermilion height, and alar base width. An aesthetic ratio of cleft to noncleft sides for each measurement was used as a quantitative measure of outcome. Qualitative analysis of cleft lip repair was evaluated using the Steffensen criteria. Results: Twelve modified rotation-advancement repairs and 10 anatomical subunit repairs were analyzed. A one-sample t test was used to assess the difference of each aesthetic ratio from the perfect ratio of 1.00. For repairs involving an incomplete cleft lip, statistically significant asymmetry was detected in vermilion height for the rotation-advancement repair and no measurements in the anatomical subunit approach. For repairs involving a complete cleft lip, statistically significant asymmetry was detected in lip height, vermilion height, and alar base for the rotation-advancement repair and in lip height for the anatomical subunit approach. Conclusions: The authors’ findings show that when separating the complete and incomplete cleft lips, the rotation-advancement technique seemed to have asymmetry in more parameters than the anatomical subunit approach. This seems to suggest that the outcomes of the anatomical subunit technique are less dependent on cleft lip severity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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

“…The comparison between pre-operative and post-operative nasal cleft values in the same group showed a positive change in the values of nasal dimensions in both groups. The Fisher incision has shown a better statistical significance (Z (p0) =2.201 * (0.028 * ) compared to Millard incision in terms of cleft nostril width (13,31) . This difference was statistically significant at P > 0.05.…”

“…The Fisher technique is based on precise measurements and equivalent dimensions of anatomical subunits preoperatively and intra operatively. For this reason, Fisher's postoperative nasolabial results are predictive in almost all cases (30,31) . The nasal dimensions (total nasal width, cleft nostril width, non-cleft nostril width) are improved with the Fisher method because it improves alar rim position and nostril width.…”

Comparative study between fisher anatomical subunit approximation technique and millard rotation- advancement technique in unilateral cleft lip repair

“…Though quantitative results suggest that the Fisher anatomical subunit technique may have more reliable outcomes despite the degree of severity of the cleft. [3] Fujimoto et al in 2020 studied the surface area of the part sacrificed from lateral lip during primary repair of a "unilateral cleft lip" using three-dimensional measurements comparing the design of incisions of three different techniques (Millard, Onizuka, and Fisher) [24].…”

“…Many techniques were described for the repair of the cleft lip over time, denoting that there is no single best one [3][4][5].…”

A Need for Updating the Research Agenda for Cleft Lip and Palate and Extending the Cleft Team Model to Dental Medicine

“…When measuring outcomes of surgery, independent of the technique or the type of cleft lip (unilateral vs. bilateral), a small subset of individuals scored poorly in measurements of vermilion roll, scar hypertrophy, cupid's bow, lip length, nostril asymmetry, alar dome, and alar base (18). A valid hypothesis is that some variation may be explained by biological mechanisms.…”