engleski

Modified Millard's Technique In Unilateral Cleft Lip Surgery

For more than fifty years Millard rotation-advancement method is worldwide the most popular unilateral cleft lip technique. The method is anatomically logical, the lip looks natural, but some experience is necessary for flap design. Another advantage of the method is that it permits individual manipulations and modifications adjusted to each specific patient. The technique also allows secondary correction using the same incision. Because many modifications are described, unilateral cleft lip surgery is still a challenge in everyday surgical practice. The postoperative cleft lip scar is usually minimal and definitive appearance is often achieved few years after surgery. Sometimes because of inadequate flap design or because of the scar, the lip is pulled upward. The Cupid's bow peaks are not on the same level – the medial point is pulled upward. Therefore, white roll and a part of vermilion is above the vermilion level. Inadequate fullness of vermilion may be present. Modifications of rotation incision and back-cut allowed the extent of rotation, adequate length and natural look of the lip on non cleft side. The length of the lip on the cleft side can be extended by starting the incision more laterally along the vermilion. Small skin triangle inserted in rotation flap just above the white roll can be incorporated in the advancement flap using small incision just opposite the triangle. The method will be described in details. In fifteen cases (aged from six to twenty two years) we have used the modification with incorporated small skin triangle in rotation flap. Small skin triangle flap incorporated in rotation incision gives very good long term postoperative results. This technique can be useful for the definitive shape and lip volume, leveled white roll and fullness of vermilion in secondary cleft lip correction but it is also useful in primary surgery when the cleft side is to short. Millard rotation-advancement technique with small skin triangle added on rotation incision just above the white roll is a very useful technique. It may be used also in primary surgery, but is very useful in secondary cleft lip correction. The shape and length of the lip as well as the level of white roll are very good in long term postoperative results.

cleft clip; Millard

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