Unilateral cleft lip repair: a comparison of treatment outcome with two surgical techniques using quantitative (anthropometry) assessment

Abstract

Objectives: The unilateral cleft lip (UCL) repair technique has evolved extensively over the past century into its modern form and has been identified as an important determinant of treatment outcome. The aim of this study was to evaluate and compare treatment outcomes following repair of UCL using either the Tennison-Randall (triangular) technique or the Millard rotation-advancement technique.

Materials and methods: This was a prospective randomized controlled study conducted at the Lagos University Teaching Hospital between January 2013 and July 2014. A total of 48 subjects with UCL presenting for primary surgery and who satisfied the inclusion criteria were recruited for the study. The subjects were randomly allocated into two surgical groups through balloting. Group A underwent cleft repair with the Tennison-Randall technique, while group B underwent cleft repair with the Millard rotation-advancement technique. Surgical outcome was assessed quantitatively according to anthropometric measurements, using a method described by Cutting and Dayan (2003).

Results: Our 48 enrolled subjects were evenly divided into the two surgery groups (n=24 for both group A and group B). Twenty-seven subjects were male (56.3%) and 21 were female (43.8%), making a sex ratio of 1.3:1. The Millard group showed a greater increase in postoperative horizontal length and vertical lip height and a greater reduction in nasal width and total nasal width. Meanwhile, the Tennison-Randall group showed better reduction of Cupid's-bow width and better philtral height.

Conclusion: We did not find any significant differences in the surgical outcomes from the two techniques. The expertise of the surgeon and individual patient preferences are the main factors to consider when selecting the technique for unilateral cleft repair.

Keywords: Anthropometry; Assessement; Cleft lip.

Fig. 1. Clinical picture of a six-monthold female following Millard's repair imported into Adobe Photoshop 7.0 software showing postoperative measurement of vertical lip height on the cleft side (D1: 11.6 mm).

Fig. 2. Preoperative anthropometry reference points. (Point 1: alar base, cleft side, Point 2: alar base, non-cleft side, Point 3: midpoint of the columella, Point 4: peak of Cupid's bow, cleft side [where the white roll begins to disappear], Point 5: peak of Cupid's bow, non-cleft side, Point 6: corresponding peak of Cupid's bow, cleft side, Point 7: commissure, cleft side, Point 8: commissure, non-cleft side, Point 2 to 5: vertical lip height, non-cleft side, Point 1 to 4: vertical lip height, cleft side, Point 5 to 8: horizontal lip length, non-cleft side, Point 4 to 7: horizontal lip length, cleft side, Point 2 to 3: nasal width, non-cleft side, Point 1 to 3: nasal width, cleft side, Point 1 to 2: total nasal width)

Fig. 3. Postoperative anthropometry reference points. (Point 1 to 3: nasal width, cleft side, Point 2 to 3: nasal width, non-cleft side, Point 4 to 5: Cupid's-bow width, Point 1 to 4: vertical lip height, cleft side, Point 2 to 5: vertical lip height, non-cleft side, Point 5 to 8: horizontal lip length, non-cleft side, Point 4 to 7: horizontal lip length, cleft side, Point 3 to 4: philtral height, cleft side, Point 3 to 5: philtral height, non-cleft side)