Cupid’s Bow Leveling and Preservation of Lip Height and Width: A Modified rotation-advancement Technique

Abstract

Background: Several methods for cleft lip repair have been developed over time, with no clear method considered the standard. In the authors' department, the use of a modified rotation-advancement technique rather than the traditional rotation-advancement technique in unilateral complete cleft lip repair has increased over the past decade. This study aimed to determine which technique provides better outcomes. Methods: This retrospective study was conducted by analyzing the preoperative and postoperative aesthetic nasal and labial anthropometric measurements of the frontal and basal views of 213 consecutive patients treated between October of 2013 and June of 2019. A total of 141 participants were treated with the traditional rotation-advancement technique, and 72 with the modified rotationadvancement technique. The inclusion criteria were nonsyndromic unilateral complete cleft lip repair with high-resolution, good-quality photographs; no presurgical nasoalveolar molding; no revision in the lip or nose areas; and at least 1 year of follow-up. Result: Patients who received the modified rotation-advancement technique had significantly improved Cupid's bow position and orientation (P < 0.02 and P < 0.01, respectively) and enhanced vertical lip height symmetry (P < 0.01) while preserving the lip width. The columellar length (P < 0.03) and angulation (P < 0.045) were also significantly improved, with enhanced nostril inclination in this group (P < 0.06). Conclusions: According to the findings of the current study, modified rotation-advancement technique assisted surgeons in improving symmetrical leveling of the Cupid's bow and significantly aided in correcting lip height without compromising lip width. Moreover, the modified rotation-advancement technique resulted in better aesthetic nasal outcomes.

A Case Report: Unilateral Complete Cleft Lip Reconstruction Using the Modification Millard Technique

“…The Tennison triangular flap from the lateral side that tucked into a corner on the medial side of the fissure just above the vermillion border, across the philtral neck to the apex cupid can add length on the shortest side of the lips and avoid the vermillion notch 7,14 . Due to research by Alkebsi et al showing that patients who received the modified rotation advancement technique had better aesthetic results, the surgeons modified the Millard technique to address the drawbacks of the classical technique and to achieve better results than the classical method 16 .…”