xRead - Treatment of Cleft Lip and Cleft Palate (May 2025)

MODIFIED ROTATIONAL ADVANCEMENT TECHNIQUE

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Authors’ Contributions Conceptualization, project administration, and supervi sion by B.S. and Y.L. Conceptualization, data collec tion, data curation, anthropometric measurements, statistic analysis, writing-original draft preparation, re view and editing by K.A. Data curation, methodology, and reviewing by C.L. Reviewing, editing, and final draft approval by A.B. Reviewing and editing, supervi sion by W.A.T. and K.A.S. We confirm that the article has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the article has been ap proved by all of us.

In SM, we transposed the CPh-commissures of the noncleft side without sacrificing the horizontal length of the lip at the expense of the vertical lip height by lat eralization of the PCh. Thus, we maintain the symmetry of the vertical lip height and horizontal lip width by en gaging the superiorly based advanced flap on the cleft side. This flap will allow the rotation of point 4 to the nor mal position without needing lateralization of point 4 to increase the vertical lip height, resulting in decreased lip width. The improvement in the lip width symmetry is shown by the CPh-Ch ratio (0.97). The nose is a significant element in the success of cleft lip repair. Several studies had consistently reported sig nificant outcomes when the nose repair was conducted at the time of primary lip repair. 23–25 Although several surgical techniques have adequately corrected the lips, the same success in correcting the nose cannot be achieved. 7 Suturing a part of the C-flap to the columella in the cleft side may increase its length, and this is shown by the CL ratio (0.82). However, future studies are rec ommended to find out the effect of this technique on nasal outcomes. In summary, we used the Millard method for > 30years to treat unilateral cleft lip patients; shortcomings such as insufficient lip width, height, and short columella were encountered in this method’s outcomes. To alleviate these drawbacks, in 2009, the design of the Millard method in the noncleft side was improved by advancing bisector theory to enhance the symmetry of the Cupid’s bow. In this study, we used the SM to treat UCCL pa tients in whom the C flap is rotated in to increase the col umellar length and form the nasal sill. Meanwhile, the back-cut gap is filled with an advanced flap from the cleft side, which helps improve the lip height and pre serving the lip width. These modifications will result in a straight instead of a curved scar, as shown in the Millard method (Fig. 1; right). Satisfactory labial and nasal out comes were demonstrated through quantitative analysis of the patients’ photographic measurements (see Supple mentary Figures S1–S7). For > 6 years, SM has been widely used to treat UCCL patients in the cleft lip and palate department at the West China Stomatology Hospi tal of Sichuan University, which is considered one of the largest centers for cleft lip and palate treatment in China. This study is a descriptive study of new modifications to Millard’s technique, focusing on these modifications’ in-depth description and objectives. Therefore, the lack of a comparison group could be a limitation of this study. However, future comparative studies are recommended for more details. Conclusion The present technique had leveled the Cupid’s bow while preserving the lip height and width, with resultant satis factory nasal outcomes. Downloaded by Travis T Tollefson from www.liebertpub.com at 03/02/25. For personal use only.

Author Disclosure Statement No competing financial interests exist.

Funding Information No funding was received for this article.

Supplementary Material Supplementary Figure S1 Supplementary Figure S2 Supplementary Figure S3 Supplementary Figure S4 Supplementary Figure S5 Supplementary Figure S6 Supplementary Figure S7 Supplementary Video S1

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