Objective. To compare the cutaneous lip height at early and late postoperative periods and to objectively determine the average amount of lip height improvement during the first year of unilateral complete cleft lip repair using Cutting extended Mohler technique. Methods. In this prospective cohort study, 26 unilateral complete cleft patients and 50 noncleft subjects were included. Photographs were taken between 12 and 16 weeks (T1) and also taken between 12 and 13 months after surgery (T2). The cutaneous lip height distance (photogrammetric lip analysis) obtained in these two periods of time were measured and statistically analyzed. Results. The average lip heights were in T1 and in T2 ( ). The average lip height asymmetry in the noncleft individuals was . Conclusion. Since all principles to obtain a symmetrical Cupid’s bow were performed, the postoperative pull-up of Cupid’s bow is probably owed to the scar contracture, which improves by 2 times during the first year after surgery. 1. Introduction Ralph Millard revolutionized the treatment of cleft lip by describing the innovative principles to repair a unilateral cleft lip, that allows surgeons around the globe to treat patients with different racial characteristics [1–4]. Consequently, his principles remain as a foundation to the development of surgical strategies and tactics to improve the results in the cleft lip repair worldwide [5–7]. Mohler [8] used Millard’s principles to develop his own technique, that adds a more vertical incision in the cleft philtrum column, creating a final faint scar that represent a mirror image of the contralateral philtrum column. In the Mohler technique [8], the Millard’s C-flap is used to fill the gap created by the downward rotation of the cleft lip segment, instead of the lateral advancement segment as proposed by Millard [5]. Thus, a short lip height may be produced as a consequence of these maneuvers (straight-line scar and absence of the lateral advancement segment fulfilling the medial gap after the back-cut incision). Cutting’s modifications of the Mohler technique are the following: (1) an extension of the medial incision toward the columella, (2) the Millard’s back-cut incision never passes the noncleft philtral column, (3) a more vertical incision than that described by Millard, that creates a, and (4) wider C-flap that fills the medial rotation defect [9]. Cutting and Dayan [9] subsequently analyzed cleft patients who underwent a cheiloplasty, using the Cutting extend Mohler technique, in order to respond whether this technique produces a short lip height
References
[1]
D. R. Millard, “A radical rotation in single harelip,” The American Journal of Surgery, vol. 95, no. 2, pp. 318–322, 1958.
[2]
D. R. Millard, “Rotation-advancement principle in cleft lip closure,” Cleft Palate-Craniofacial Journal, vol. 12, pp. 246–252, 1964.
[3]
D. R. Millard, “Refinements in rotation-advancement cleft lip technique,” Plastic and Reconstructive Surgery, vol. 33, no. 1, pp. 26–38, 1964.
[4]
D. R. Millard, “Rotation-advancement method for cleft lip,” Journal of the American Medical Women's Association, vol. 21, no. 11, pp. 913–915, 1966.
[5]
S. Stal, R. H. Brown, S. Higuera et al., “Fifty years of the millard rotation-advancement: looking back and moving forward,” Plastic and Reconstructive Surgery, vol. 123, no. 4, pp. 1364–1377, 2009.
[6]
A. B. Weinfeld, L. H. Hollier, M. Spira, and S. Stal, “International trends in the treatment of cleft lip and palate,” Clinics in Plastic Surgery, vol. 32, no. 1, pp. 19–23, 2005.
[7]
T. J. Sitzman, J. A. Girotto, and J. R. Marcus, “Current surgical practices in cleft care: unilateral cleft lip repair,” Plastic and Reconstructive Surgery, vol. 121, no. 5, pp. 261e–270e, 2008.
[8]
L. R. Mohler, “Unilateral cleft lip,” Plastic and Reconstructive Surgery, vol. 80, no. 4, pp. 511–516, 1987.
[9]
C. B. Cutting and J. H. Dayan, “Lip height and lip width after extended mohler unilateral cleft lip repair,” Plastic and Reconstructive Surgery, vol. 111, no. 1, pp. 17–23, 2003.
[10]
P. Rossell-Perry and A. M. Gavino-Gutierrez, “Upper double-rotation advancement method for unilateral cleft lip repair of severe forms: classification and surgical technique,” Journal of Craniofacial Surgery, vol. 22, no. 6, pp. 2036–2042, 2011.
[11]
H. S. Adenwalla and P. V. Narayanan, “Primary unilateral cleft lip repair,” Indian Journal of Plastic Surgery, vol. 42, supplement 1, pp. S62–S70, 2009.
[12]
G. S. Reddy, R. M. Webb, R. R. Reddy, L. V. Reddy, P. Thomas, and A. F. Markus, “Choice of incision for primary repair of unilateral complete cleft lip: a comparative study of outcomes in 796 patients,” Plastic and Reconstructive Surgery, vol. 121, no. 3, pp. 932–940, 2008.
[13]
S. G. Reddy, R. R. Reddy, E. M. Bronkhorst, R. Prasad, A. M. Kuijpers Jagtman, and S. Bergé, “Comparison of three incisions to repair complete unilateral cleft lip,” Plastic and Reconstructive Surgery, vol. 125, no. 4, pp. 1208–1216, 2010.
[14]
H. Schaaf, P. Streckbein, G. Ettorre, J. C. Lowry, M. Y. Mommaerts, and H. P. Howaldt, “Standards for digital photography in cranio-maxillo-facial surgery. Part II: additional picture sets and avoiding common mistakes,” Journal of Cranio-Maxillofacial Surgery, vol. 34, no. 7, pp. 444–455, 2006.
[15]
P. Fudalej, C. Katsaros, K. Hozyasz, W. A. Borstlap, and A. M. Kuijpers-Jagtman, “Nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate,” British Journal of Oral and Maxillofacial Surgery, vol. 50, no. 7, pp. 621–625, 2012.
[16]
M. Heller, M. Schmidt, C. K. Mueller, M. Thorwarth, and S. Schultze-Mosgau, “Clinical-anthropometric and aesthetic analysis of nose and lip in unilateral cleft lip and palate patients,” Cleft Palate-Craniofacial Journal, vol. 48, no. 4, pp. 388–393, 2011.
[17]
S. W. Kim, S. O. Park, T. H. Choi, and D. T. Hai, “Change in upper lip height and nostril sill after alveolar bone grafting in unilateral cleft lip alveolus patients,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 65, no. 5, pp. 558–563, 2012.
[18]
G. B. Wong, R. Burvin, and J. B. Mulliken, “Resorbable internal splint: an adjunct to primary correction of unilateral cleft lip-nasal deformity,” Plastic and Reconstructive Surgery, vol. 110, no. 2, pp. 385–391, 2002.
[19]
S. Gosla-Reddy, K. Nagy, M. Y. Mommaerts et al., “Primary septoplasty in the repair of unilateral complete cleft lip and palate,” Plastic and Reconstructive Surgery, vol. 127, no. 2, pp. 761–767, 2011.
[20]
S. A. Wolfe, “Choice of incision for primary repair of unilateral cleft lip,” Plastic and Reconstructive Surgery, vol. 123, no. 6, pp. 1882–1883, 2009.
[21]
K. E. Salyer, H. Xu, and E. R. Genecov, “Unilateral cleft lip and nose repair; closed approach dallas protocol completed patients,” Journal of Craniofacial Surgery, vol. 20, no. 8, pp. 1939–1955, 2009.
[22]
M. Noordhoff, The Surgical Technique For the Unilateral Cleft Lip-Nasal Deformity, Noordhoff Craniofacial Foundation, Taipei, Taiwan, 1997.
[23]
J. Thompson, “An artistic and mathematically accurate method of repairing the defect in cases of harelip,” Surgery Gynecology and Obstetrics, vol. 14, pp. 498–505, 1912.
[24]
C. W. Tennison, “The repair of the unilateral cleft lip by the stencil method,” Plastic and Reconstructive Surgery, vol. 9, no. 2, pp. 115–120, 1952.
[25]
M. A. Le, “A method of cutting and suturing the lip in the treatment of complete unilateral clefts,” Plastic and Reconstructive Surgery, vol. 4, no. 1, pp. 1–12, 1949.
[26]
M. K. WANG, “A modified LeMesurier-Tennison technique in unilateral cleft lip repair,” Plastic and Reconstructive Surgery, vol. 26, pp. 190–198, 1960.
[27]
V. Spina and O. Lodovici, “Conservative technique for treatment of unilateral cleft lip: reconstruction of the midline tubercle of the vermilion,” British Journal of Plastic Surgery, vol. 13, pp. 110–117, 1960.
[28]
D. V. Dado, “Analysis of the lengthening effect of the muscle repair in functional cleft lip repair,” Plastic and Reconstructive Surgery, vol. 82, no. 4, pp. 594–601, 1988.
[29]
B. van Loon, S. G. Reddy, N. van Heerbeek et al., “3D stereophotogrammetric analysis of lip and nasal symmetry after primary cheiloseptoplasty in complete unilateral cleft lip repair,” Rhinology, vol. 49, no. 5, pp. 546–553, 2011.
[30]
D. R. Millard, “The unilateral deformity,” in Cleft Craft: The Evolution of Its Surgery, vol. 1, pp. 449–485, Little, Brown, Boston, Mass, USA, 1976.
[31]
D.R. Millard, Saving Faces: A Plastic Surgeon's Remarkable Story, Write Stuff Syndicate, Fort Lauderdale, Fla, USA, 2003.
[32]
I. Al-Omari, D. T. Millett, and A. F. Ayoub, “Methods of assessment of cleft-related facial deformity: a review,” Cleft Palate-Craniofacial Journal, vol. 42, no. 2, pp. 145–156, 2005.
[33]
R. M. McKearney, J. V. Williams, and N. Mercer, “Quantitative computer-based assessment of lip symmetry following cleft lip repair,” The Cleft Palate-Craniofacial Journal. In press.