Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique

BACKGROUND: Millard’s rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. METHODS: We retrospectively reviewed 82 patients’ medical records and presented surgical technique and outcomes. The main features of the authors’ strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients’ nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen’s kappa statistics. RESULTS: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. CONCLUSION: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

Unilateral cleft lip repairment via improved Millard technique:a 64-case study / 实用医学杂志

Objective To observe the clinical effects of unilateral cleft lip repairmen via improved Millard technique. Methods 64 cases of patients with unilateral cleft lip were collected from July 2014 to June 2015. The traditional Millard technique was improved by moving traditional fixed point of columella nasi to close with the lateral nasal columella roots,and the moving range was adjusted according to the nasal columella deformity and nostril size. Meanwhile ,the nasal floor and the alar basal incisions were not designed. Instead ,fully free of affected side orbicularis oris muscles were applied to making apposition suture with the healthy side. Results It showed that anatomic form of the upper lip and the philtral column of patients ,whose unilateral cleft lips were repaired by the improved Millard technique,were normal,and both sides of the lip peak were basically symmetrical after 1 ~ 12 month(s)follow-up. Conclusions Compared with the traditional Millard technique,the improved technique could bring a better effect on appearance of the patients. And it will be one of the ideal repairing techniques for unilateral cleft lip.