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

Patel, Terral A. B.S.; Patel, Krishna G. M.D.

Plastic and Reconstructive Surgery: August 2019 - Volume 144 - Issue 2 - p 238e-245e
doi: 10.1097/PRS.0000000000005847
Pediatric/Craniofacial: Original Articles

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.


Charleston, S.C.

From the Department of Otolaryngology, Medical University of South Carolina.

Received for publication December 23, 2017; accepted January 3, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Terral A. Patel, B.S., Head and Neck Surgery, 135 Rutledge Avenue, MSC 550, Charleston, S.C. 29425,

Copyright © 2019 by the American Society of Plastic Surgeons