Evaluation of Vermillion Symmetry and Scar Quality in Unilateral Cleft Lip Repair Using Modified Millard's Technique Versus Fisher's Technique

Document Type

Article

Publication Date

4-2024

Abstract

Background: Since the primary goal of cleft lip repair is to achieve a symmetrical, aesthetic lip, several surgical techniques have been utilized. Accordingly, in this study, a unilateral cleft lip was surgically repaired using two techniques: modified Millard's and Fisher's techniques.

Purpose: This study was designed to compare the vermillion symmetry and scar quality in the surgical management of patients with unilateral incomplete cleft lip using the modified Millard's and Fisher's techniques.

Study design, setting, and sample: We conducted a prospective randomized controlled clinical study. The study involved 20 patients selected from the Department of Plastic Pediatric Surgery at the Specialized Pediatric Hospital, Faculty of Medicine, Cairo University. The patients included in the study were aged between 2 and 6 months old, had a primary nonsyndromic unilateral incomplete cleft lip, and had no other associated anomalies.

Predictor variable: The predictor variable was operative management of the cleft lip, and subjects were randomly assigned to either the modified Millard or Fisher techniques.

Main outcome variables: The primary outcome, vermillion symmetry, was evaluated by computerized photogrammetric lip analysis with Image J software. Additionally, scar quality, considered a secondary outcome, was assessed with the Vancouver Scar Scale and the Image J software. Every measurement was meticulously recorded in millimeters.

Covariates: Age, sex, and cleft side were considered.

Analyses: Descriptive and analytic statistics were computed. Statistical significance was set at P < .05.

Results: The study comprised 20 children (12 males and 8 females), with a mean age of 140.5 ± 23.7 days in the Fisher's group and 137.4 ± 25.6 days in the modified Millard's group (P = .8). No statistically significant differences (P = .6) were found in vermillion height and width between both groups at 1 week, 3 months, and 6 months. Similarly, there were no statistically significant differences (P = .4) between both groups in terms of scar length and width at the 3- and 6-month follow-up periods.

Conclusion and relevance: This study found no statistically significant differences in vermillion symmetry and scar quality between the two cleft lip repair techniques. Notably, one patient in the modified Millard group exhibited a notch on the vermillion border, which was not statistically significant.

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