Unilateral Cleft Lip Repair : Modified Millard and Mishra Technique
Condition: Cleft Lip
MeSH terms: Cleft Lip
Study type: Interventional

Summary: 
      Our study findings show that vertical lip length and philtral lip height significantly longer
      in Millard group than Mishra group in immediate postoperative assessment and nasal width was
      significantly wider in Mishra group than Millard in 3-month postoperative assessment, This
      may be attributed to that Mishra group deformity was more severe. The lip shape, the
      vermilion shape was better in Millard technique than Mishra technique, however, this was
      statistically insignificant The scar shape was less evident in Mishra technique than Millard
      technique. But this was also statistically insignificant. However, no major difference in the
      overall results between the Mishra and Millard rotationadvancement repairs. Thus, either
      technique could be used for unilateral clefts, as the goal of cleft lip repair is making a
      symmetrical lip with minimal scar restoring the normal appearance of the face and functional
      anatomy Anthropometric Measurement of surgical outcome evaluates the surgical technique used
      and helps to compare between cleft and non-cleft side showing the degree of deformity and we
      used Subjective assessment to analyse facial aesthetics and appearance impairment as the
      harmony of a person's face is as Important as measurements, so they should be used together
      in our opinion.
    

Detailed description: 
      Cleft lip and palate, which affects 0.5-1.6 out of every 1000 live births, is the most
      prevalent congenital defect of the head and neck .

      When the palatal shelves and the medial nasal process fail to fuse together between the
      fourth and eighth weeks of development, unilateral cleft lip and palate results . Lip muscles
      are disrupted and abnormally inserted to the columellar base on the non-cleft side and from
      the alar base on the cleft side. The nasal floor and alveolus on the cleft side may be
      deficient or absent. Several approaches, including quadrangular flaps, triangular flaps, and
      rotationadvancement procedures, were established in the middle of the twentieth century White
      Roll Vermilion Turn Down Flap (WRV flap) from the lateral lip element Making a symmetrical
      lip with a small scar and restoring the face's natural appearance and functional structure
      are the objectives of cleft lip repair . Over the past century, numerous surgical repair
      approaches have been developed The first known cleft-lip repair was a straight-line suture
      and a simple cut along the cleft borders, followed by a curved incision to lengthen the lip
      Drawbacks of straight-line restorations included vertical scar contracture and lip notching
      Tennison-triangular Randall's approach, which relies on mathematical calculations and lessens
      vertical lip contraction, is the most popular triangular technique, however the scar violates
      the philtrum.The Millard rotation-advancement approach was created to align the scar with the
      philtral column naturally occurring. The initial rotation-advancement technique underwent
      various variations. Vermilion notching and a scar along the philtral line can be noticed in
      Millard's repair. The Cupid's bow is distorted and the white roll up is pulled up by scar
      contracture. was employed by Mishra to modify Millard's technique to create the vermilion and
      white roll on the medial lip segment. If there is medial hypoplastic vermilion or partial
      medial vermilion loss, the Mishra procedure is also used Anthropometric Evaluation of
      surgical technique and comparison of cleft and non-cleft sides are two benefits of measuring
      surgical outcome .Farkas and colleagues, provided normative measurements of the lip and nose.
      Qualitative Assessment is subjective assessment and can analyze facial aesthetics and
      appearance impairment using scales, indices, scoring systems, and rankings. Both direct and
      indirect techniques can be used to perform anthropometric measurements and qualitative
      assessments. The most accurate anthropometric method is direct anthropometry, which is the
      gold standard but requires general anesthesia in young kids. Two dimensional (2D) images can
      be used for indirect anthropometry; however, calibration and image distance standardization
      are needed for linear measurements.
    

Intervention name(s): Unilateral cleft lip repair
Intervention type(s): Procedure
Intervention description(s): Surgical repair unilateral cleft lip
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment