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Journal articles on the topic 'Millard, technique'

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Published: 4 June 2021

Last updated: 20 June 2025

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Mabrouk, Mohamed M., Khaled Salah Abdullateef, Ayman Hussein Abdelsattar, Mohamed Elbarbary, Sherif Kaddah, and Wesam Mohamed. "Comparative Study between Modified Millard and White Roll Vermilion Flap Techniques in Unilateral Lip Repair: A Randomised Controlled Study." African Journal of Paediatric Surgery 21, no. 1 (2024): 18–27. http://dx.doi.org/10.4103/ajps.ajps_20_23.

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Abstract Background: 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. Several approaches, including quadrangular flaps, triangular flaps and rotation-advancement procedures, White Roll Vermilion Turn Down Flap (WRV flap) from the lateral lip element were employed by Mishra to modify Millard’s technique to create the vermilion and white roll on the medial lip segment. This study aimed to use the anthropometric measurements taken pre- and post-operation to evaluate quantitative assessment of modified Millard technique compared with WRV flap technique in unilateral cleft lip (UCL) repair. Materials and Methods: Prospective, randomised controlled study recruited infants scheduled for UCL repair. Infants aged 3–6 months, either complete or incomplete deformity. A total of 42 patients were randomized in 1:1 ratio to undergo either WRV flap technique (group A) or modified Millard technique (group B) and another control included 21 age-matched healthy children. We compared WRV flap procedure to Modified Millard’s procedure in terms of both qualitative (another surgeon’s opinion) and quantitative (anthropometric) evaluation. Results: Vertical lip length and philtral lip height significantly longer in Millard group (B) than WRV flap group (A) in immediate postoperative assessment and nasal width was significantly wider in WRV flap group (A) than Millard group (B) in 3-month post-operative assessment. The lip shape, the vermilion shape was better in Millard technique than WRV flap technique; however, this was statistically insignificant. However, no major difference in the overall results between the WRV flap and Millard rotation-advancement repairs. Conclusion: 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. Overall results demonstrate no significant differences between modified Millard technique and WRV flap technique.

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Pradnyandari, Ni Kadek Parswa Diah. "Aesthetic outcome comparison between Millard and Fisher technique for cleft lip surgery: a literature review." Indonesia Journal of Biomedical Science 17, no. 2 (2023): 153–59. http://dx.doi.org/10.15562/ijbs.v17i2.439.

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Background: Cleft lip is the most common congenital defect found in children, with a prevalence of 0.5 to 1.6 per 1000 live births. Besides causing functional problems, a cleft lip greatly affects the patient's aesthetic appearance. Therefore, several surgical techniques have been developed to produce a good clinical appearance to support the patient's social functioning. The Millard and Fisher technique is the most widely used cleft lip surgery (cheiloplasty) technique. This literature review aims to compare the aesthetic outcomes between the Millard and Fisher techniques in cleft lip surgery. Methods: This literature review was carried out by searching studies in online databases in the form of PubMed, the Cochrane Library, and Google Scholar using the keywords "cleft lip surgery," "Millard," "Fisher," "aesthetic outcome," and "comparison." Appropriate studies were then carried out through a narrative synthesis analysis. Discussion: The Millard technique uses the principle of rotational and advancement flaps, performed by making incisions and flaps on two sides, namely a rotational flap on the medial lip and an advancement flap on the lateral lip. Meanwhile, the Fisher technique uses the principle of anatomical subunit approximation, in which the measurement of the boundaries and extent of the surgical procedure is very accurate, resulting in a more anatomical position of the scar tissue. Regarding surgical scars, nose symmetry, vermillion, Cupid's bow and nasal, and Steffensen grading, better aesthetic results were found in Fisher's technique compared to Millard's. Conclusion: Fisher's technique provides superior aesthetic results compared to Millard's technique in cleft lip surgery.

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Rossell-Perry, Percy. "A 20-year experience in unilateral cleft lip repair: From Millard to the triple unilimb Z-plasty technique." Indian Journal of Plastic Surgery 49, no. 03 (2016): 340–49. http://dx.doi.org/10.4103/0970-0358.197226.

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ABSTRACT Background: This study describes a 20-year experience of treating patients with unilateral cleft lip. During this time, various techniques were used including Millard's technique and its modification and two types of geometrically designed procedures. The study objective was to compare surgical outcomes of different surgical techniques for unilateral cleft lip repair. Materials and Methods: This is a retrospective audit of outcomes after unilateral cleft lip repair performed by a single surgeon since 1995. Of the 827 patients who underwent surgery, 277 met the criterion of having anthropometric measurements performed ≥1 year postoperatively. The patients were stratified into three groups according to cleft severity: incomplete, complete with less deficiency (3–6 mm difference between cleft and non-cleft lip height) and complete with more deficiency (>6 mm difference between cleft and non-cleft lip height). Anthropometric measurements, scar assessment and complications were recorded. Results: There were no differences in outcomes between Millard and Reichert-Millard techniques for incomplete unilateral cleft lip. For complete unilateral cleft lip and less tissue deficiency, lip symmetry was better using upper rotation advancement plus double unilimb Z-plasty than the Reichert-Millard technique. For complete unilateral cleft lip and more tissue deficiency, lip symmetry was better after triple unilimb Z-plasty than after upper rotation advancement plus double unilimb Z-plasty. Conclusions: We presented a 20-year experience performing unilateral cleft lip repair. An individualised classification system with corresponding surgical techniques was successfully used during this period. The individualised surgical protocol used in this study allowed us to achieve improved surgical outcomes.

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Salsabila, Rizentya, Dewi Rarasati Kresnaputri, Riani Sieman, and Ganendra Anugraha. "Unilateral cleft lip surgery symmetry observation with Millard I and Tennison techniques." Indonesian Journal of Dental Medicine 7, no. 2 (2024): 52–56. http://dx.doi.org/10.20473/ijdm.v7i2.2024.52-56.

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Background: In line with the development of Millard I and Tennison cleft lip surgery techniques, there are also advantages and disadvantages to each technique. The Cleft Lip Symmetry Index (CLCSI) was used to measure the symmetry of each measurement variable from the results of unilateral cleft lip surgery so that it could be represented by an objective number. Purpose: This study aims to observe the surgery results using Millard I and Tennison techniques in unilateral cleft lip patients. Methods: This study used descriptive study by observing the symmetry of lateral philtrum height, vermillion height, cupid’s bow width, cupid’s bow height, and nostril width after labioplasty using the Millard and Tennison technique in unilateral cleft lip patients in Surabaya, Madura, and Malang. Results: The results of the CLCSI modification for the Millard technique can be summarized that nostril width ranged from 78.82 - 195.04. Lateral philtrum height ranged from 62.5 - 107.62. Cupid’s bow width ranged from 72.17 - 155.29. Cupid’s bow height ranged from 96.43 - 487.5. Vermilion height ranged from 84.62 - 131.11. The results of the CLCSI modification for the Tennison technique can be summarized that nostril width ranged from 88.89 - 171.43. Lateral philtrum height ranged from 48.92 - 109.04. Cupid’s bow width ranged from 89.26 - 166.15. Cupid’s bow height ranged from 73.81 - 311.11. Vermilion height ranged from 72.14 - 138.46. Conclusion: It’s difficult to obtain completely symmetrical surgical results because of many factors that affect the outcome of the operation in both Millard I and Tennison methods.

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da Silva Freitas, Renato, Pedro Bertoco Alves, Gisele Keiko Machado Shimizu, et al. "Beyond Fifty Years of Millard’s Rotation-Advancement Technique in Cleft Lip Closure: Are There Many “Millards”?" Plastic Surgery International 2012 (December 6, 2012): 1–4. http://dx.doi.org/10.1155/2012/731029.

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In 1955, Millard developed the concept of rotation-advancement flap to treat cleft lip. Almost 6 decades later, it remains the most popular technique worldwide. Since the technique evolved and Millard published many technical variations, we decided to ask 10 experienced cleft surgeons how they would mark Millard’s 7 points in two unilateral cleft lip patient photos and compared the results. In both pictures, points 1 and 2 were marked identically among surgeons. Points 3 were located adjacent to each other, but not coincident, and the largest distances between points 3 were 4.95 mm and 4.03 mm on pictures 1 and 2, respectively. Similar patterns were obtained for points 4, eight of them were adjacent, and the greatest distance between the points was 4.39 mm. Points 5 had the most divergence between the points among evaluators, which were responsible for the different shapes of the C-flap. Points 6 also had dissimilar markings, and such difference accounts for varying resection areas among evaluators. The largest distances observed were 11.66 mm and 7 mm on pictures 1 and 2, respectively. In summary, much has changed since Millard’s initial procedure, but his basic principles have survived the inexorable test of time, proving that his idea has found place among the greatest concepts of modern plastic surgery.

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Theodora Ratih Labdagati Iswara and Muhammad Aulia Ul Hakim. "A CASE REPORT: UNILATERAL COMPLETE CLEFT LIP RECONSTRUCTION USING THE MODIFICATION MILLARD TECHNIQUE." Jurnal Rekonstruksi dan Estetik 8, no. 1 (2023): 14–20. http://dx.doi.org/10.20473/jre.v8i1.43868.

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Highlights: The modified Millard technique, including the Tennison triangular flap, is effective in preventing vermillion notching and reducing scar complications in cleft lip repairs. The technique addresses concerns related to compromised lip tissue and nostril deformities, leading to improved appearance and functionality. Scar thinning techniques and separate nasoraphy contribute to enhanced aesthetics and optimal healing in cleft lip repairs. Abstract: Introduction: With 1 in 700 live births worldwide, cleft lip with or without cleft palate is the most prevalent congenital craniomaxillofacial birth condition. More people have a unilateral cleft lip than a bilateral cleft lip. With the exception of vision, it can influence the morphology and nearly all facial functions. The purpose of this study is to give an overview and learn more about the management of lip repair using the modified Millard approach, which can prevent straight line closure and vermilion notching. Case Illustration: We present a case of a 4-month-old male who underwent a modified Millard procedure and had a unilateral full cleft lip. The findings revealed no vermillion notch, acceptable columellar and alar lengths, symmetrical Cupid's bow, lip height, lip width, and philtrum angle. Discussion: The modified Millard technique, including the Tennison triangular flap, improves the repair of cleft lips by preventing vermillion notching and reducing scar complications. It also addresses concerns related to lip tissue compromise and nostril deformities. Scar thinning techniques and separate nasoraphy contribute to enhanced aesthetics and optimal healing. These modifications aim to achieve improved appearance and functionality in cleft lip repairs. Conclusion: The modified Millard technique can be considered as a viable option for treating unilateral cleft lip due to its ability to create a balanced Cupid's bow, maintain appropriate lip height and width, and achieve satisfactory aesthetic results in the nasal area without vermillion notching.

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Salgado, M. L. Lopez, J. C. Aliphat, and N. S. Alvarez. "Cleft lip surgery with fisher technique and millard technique comparative work." International Journal of Oral and Maxillofacial Surgery 48 (May 2019): 18. http://dx.doi.org/10.1016/j.ijom.2019.03.051.

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Taufik, Muhammad, and Muhammad Jailani. "Evaluation of Modified Millard’s Technique with Premaxilla Shortening in Bilateral Labioplasty at Malahayati Hospital Banda Aceh 2016- 2019." Jurnal Rekonstruksi dan Estetik 4, no. 2 (2021): 78. http://dx.doi.org/10.20473/jre.v4i2.28223.

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Introduction: Cleft Lip and Palate (CLP) is a congenital abnormality in the form of gaps in the lips, gums and palate. This disorder occurs due to a disruption in the first trimester of pregnancy that causes disruption of the process of fetal growth and development. Surgical techniques for reconstructive surgery vary greatly, but labioplasty using a modified millard technique with premaxillary shortening is a technique that we used in this study with the aim of premaxilla shortening to reduce the tension of the suture wound and will reduce the scar formed in Bilateral labioplasty after surgery. Method: This research is a cohort with a retrospective approach conducted on labioplasty patients at Malahayati Hospital in Banda Aceh, which was handled in the period of 2016 - 2019. The sample amounted to 23 respondents who will be analyzed using the frequency distribution table. Results: From the results of the study found male sex as much as 60.9%, the age of patients in the age group 2 years and over as much as 69.6%, 6-9 months evaluation time as much as 87.0%, the diagnosis of complete bilateral labioplasty as much as 65.2% and good outcome in bil ateral labioplasty using modified millard technique with premaxilla shortening as much as 73.9% Conclusion: From the overall it can be concluded that the majority of male sex is the most, the highest in the age group 2 years and above, the most evaluation time is 6-9 months, the most common diagnosis is complete bilateral labiolasty and the most results on bilateral labioplasty using modified millard techniques with premaxillary shortening is good outcome.

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Mishra, R. K., and Amit Agarwal. "White Roll Vermilion turn down flap in primary unilateral cleft lip repair: A novel approach." Indian Journal of Plastic Surgery 48, no. 02 (2015): 178–84. http://dx.doi.org/10.4103/0970-0358.163057.

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ABSTRACT Aim: Numerous modifications of Millard′s technique of rotation - advancement repair have been described in literature. This article envisions a new modification in Millard’s technique of primary unilateral chieloplasty. Material and Methods: Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard’s repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion. Result: With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid’s bow with no vermilion notching of the lips. Conclusion: WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.

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Zaleckas, Linas, Laura Linkevičienė, Juozas Olekas, and Nerijus Kutra. "The Comparison of Different Surgical Techniques Used for Repair of Complete Unilateral Cleft Lip." Medicina 47, no. 2 (2011): 11. http://dx.doi.org/10.3390/medicina47020011.

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Up to now, many various techniques have been proposed for the repair of complete unilateral cleft lip. The aim of this study was to compare late results of three different surgical techniques (C. Tennison, R. Millard, and J. Olekas) used for the repair of complete unilateral cleft lip and to analyze their advantages and disadvantages. Material and Methods. Sixty-six patients with nonsyndromic complete unilateral cleft lip, alveolus, and palate were examined. For 19 patients (28.8%), cleft lip repair was performed using the Tennison technique; for 20 patients (30.3%), Millard technique; and for 27 patients (40.9%), Olekas technique. Results were assessed by score, which was given by analyzing standardized photographs of nasolabial triangles. For the assessment, the modified scale according to Mortier and Anastassov was used. Separate anatomical elements – red lip, white lip, scars, and nose – were assessed. Results. The best appearance of the red lip and white lip was found after the Tennison technique. Scars and nose looked the best after Olekas cheiloplasty. There were no significant differences in the evaluation of red lip and nose appearance comparing all three analyzed surgical techniques (P>0.05). Tennison technique showed significantly better results in the appearance of the white lip (P<0.05); the appearance of scars was significantly better after the Olekas repair (P<0.001). Conclusions. Height of white lip and symmetry of the Cupid’s bow were better restored by using the Tennison technique. The physiological configuration of the white lip and less visible scars were achieved by using the Olekas technique. All techniques were equal in red lip and nose formations.

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Han, Kihwan, Jeongseob Park, Seongwon Lee, and Woonhyeok Jeong. "Personal technique for definite repair of complete unilateral cleft lip: modified Millard technique." Archives of Craniofacial Surgery 19, no. 1 (2018): 3–12. http://dx.doi.org/10.7181/acfs.2018.19.1.3.

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Manlove, Ashley E., and Alexis M. Linnebur. "Primary Bilateral Cleft Lip Repair Using the Modified Millard Technique." Atlas of the Oral and Maxillofacial Surgery Clinics 30, no. 1 (2022): 19–25. http://dx.doi.org/10.1016/j.cxom.2021.11.005.

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Manlove, Ashley E., and Alexis M. Linnebur. "Primary Unilateral Cleft Lip Repair Using the Modified Millard Technique." Atlas of the Oral and Maxillofacial Surgery Clinics 30, no. 1 (2022): 13–17. http://dx.doi.org/10.1016/j.cxom.2021.11.012.

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Shah, Syed Asif Hussain, Muhammad Tauqeer Aslam, Muhammad Saad Zulfiqar, Tahir Mehmood, Muhammad Tahir Mehmood, and Mushtaq Ahmed. "Comparison of Outcomes of Millard's Rotational Advancement Flap and Fisher's Techniques for Surgical Correction of UCLD." Pakistan Journal of Medical and Health Sciences 16, no. 4 (2022): 334–36. http://dx.doi.org/10.53350/pjmhs22164334.

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Objective: The objective of our study is to compare the surgical outcomes of two surgical techniques namely Fisher’s technique and Millard’s Rotational Advancement Flap, particularly in terms of white roll symmetry, lip length, lip height, scar quality, notching, cupids bow and alar base symmetry. Study design: Prospective Randomized Clinical Trial study. Place and duration of study: Department of Pediatric surgery, Sheikh Zayed Hospital, Rahim Yar Khan for a period of six months from 1st March 2021 to 31st August 2021. Patients and method: A total of 56 patients were enrolled in the study, equally divided into two groups. Group 1 will include patients undergoing treatment via Millard's Rotational Advancement Flap technique, while group 2 will include those receiving Fisher's procedure. A single consultant performed the procedure. Variables like lip length, Alar base symmetry, scar quality, cupids bow symmetry, and notching were accessed postoperative via the Steffensen grading method, and Vernier caliper was used for anthropometric measurements. The SPSS v 23 was used to evaluate the data. All numerical data were provided in mean and standard deviation (SD) formats. Frequencies were computed for qualitative data. Nonparametric tests (paired and unpaired t-tests) and parametric tests (Fisher's exact test) were utilized to compare the variables. P-value of < 0.05 was considered statistical significant. Results: Both groups had identical outcomes in terms of lip length, nasal symmetry, and alar dome. On the other hand, Fisher's approach was superior in terms of vermilion roll symmetry, white roll symmetry, scar appearance, and Cupid Bow. Anthropometric measures, such as lip height and breadth, were taken; however, the results were statistically insignificant. There was no discernible difference between the outcomes of complete and incomplete cleft lip. Conclusion: We propose using the Fisher's surgical method in unilateral cleft lip repair since it produces better outcomes than the Millard's procedure. Keywords: Anthropometric measurement; Fisher; Lip Notching; Millard; Scar; Unilateral cleft lip.

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Emmanuel, JK Adu. "Management of Cleft Lip and Palate: A Five Year Review." Archives of Otolaryngology and Rhinology 3, no. 1 (2017): 023–26. https://doi.org/10.17352/2455-1759.000038.

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Introduction: Clefts of the lip may cause cosmetic and social problems. Clefts of the palate may affect feeding, speech and hearing.  Objective: To document the clinical and epidemiological features, surgical techniques (Millard’s repair for cleft lip, and the Oxford palatoplasty for cleft palate) and the outcome of treatment of patients with cleft lip and palate at Komfo Anokye Teaching Hospital (KATH), Kumasi, between January 2010 and December 2014. Patients and Methods: Data on cleft patients were retrieved from the records of the cleft clinic and theatre records at KATH and analysed.  Results: From January 2010 to December 2014, 150 patients were treated for clefts. Their ages ranged from 0.25 to 25 years, mean age of 12 months with standard deviation of 14.5  The commonest deformity (85, N=150) was combined cleft lip and palate. Isolated cleft palate was the least common (23, N=150). There was predominance (83%) of unilateral cleft lip, 46% were left sided, 71% were complete. Unilateral cleft lip was repaired by Millard’s rotation-advancement technique; bilateral cleft lip with Millard’s one stage repair (Mulliken’s modifi cation). Both included closed primary rhinoplasty. Cleft palate was repaired with single stage palatoplasty with intravelar veloplasty - the Oxford palatoplasty.

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Kaufman, Yoav, Patrick Cole, Daniel A. Hatef, Terry W. Bruner, Larry H. Hollier, and Samuel Stal. "Refinements of the Unilateral Millard Technique: The Texas Children’s Hospital Approach." Plastic and Reconstructive Surgery 124, no. 2 (2009): 612–14. http://dx.doi.org/10.1097/prs.0b013e3181addb74.

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Ghali, G. E., and Jason L. Ringeman. "Primary Bilateral Cleft Lip/Nose Repair Using a Modified Millard Technique." Atlas of the Oral and Maxillofacial Surgery Clinics 17, no. 2 (2009): 117–24. http://dx.doi.org/10.1016/j.cxom.2009.05.002.

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Maharanii, R. Aj Aulia, Agus Nurwiadh, and Harmas Yazid Yusuf. "Management of Tessier No. 2 Facial Cleft Using Millard Technique with Zig- Zag Ad-vancement Flap: A Case Report." International Journal of Medical and Biomedical Studies 8, no. 5 (2024): 80–86. http://dx.doi.org/10.32553/ijmbs.v8i5.2876.

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Introduction: Craniofacial cleft is a rare congenital disorder that affects facial and skull. development, with an incidence estimated between 1.4-4.9 per 100,000 births. This condition often results in significant complications such as feeding difficulties, impaired speech, hearing issues, and psychosocial challenges. Among craniofacial clefts, the oblique facial cleft, including Tessier No. 2 cleft, is the rarest and least documented. This cleft is characterized by specific soft and hard tissue deformities resulting from a failure of fusion among facial processes during embryonic development. Case: An 8-month-old female presented with a unilateral cleft of the lips, gums, and palate on the left side, accompanied by a Tessier No. 2 facial cleft. The patient's mother reported no history of teratogenic exposure or family history of clefts. Clinical examination revealed hypoplasia of the middle third of the nasal margin, a flattened lateral nose, a widened nasal bridge, and a deviated nasal septum. The patient was diagnosed with unilateral complete labiognatopalatoschizis accompanied by Tessier No. 2 cleft. Case Management: The patient was prepared for labioplasty under general anesthesia after meeting the "rules of ten" criteria (10 weeks old, 10 pounds, 10 grams/dl hemoglobin). The surgery was performed using the Millard technique with a zig-zag advancement flap to achieve optimal tissue coverage and symmetry. Postoperative care included antibiotics, pain management, and follow-up visits. At the 3-month follow-up, the surgical site showed good healing with no signs of infection or significant complications. Conclusion: Understanding the specific anatomy and pathophysiology of Tessier No. 2 clefts is essential for effective surgical planning and outcomes. The modified Millard technique provides satisfactory aesthetic and functional results, although challenges remain. Comprehensive postoperative management and long-term follow-up are crucial to monitor healing and address any complications. Further research and multidisciplinary.Keyword: Facial Cleft, Tessier 2, Millard Technique, Zig-zag Advancement Flap

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Wilson, Adel M. "Widening of Scars: Foe Coaxed into a Friend? The Millard Technique Revisited." Plastic and Reconstructive Surgery 106, no. 7 (2000): 1488–93. http://dx.doi.org/10.1097/00006534-200012000-00006.

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Zaidov, Mirazim. "Surgical Techniques Used in Cleft Lip Reconstruction." Porta Universorum 1, no. 3 (2025): 245–53. https://doi.org/10.69760/portuni.010320.

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Cleft lip is a congenital deformity with both aesthetic and functional implications. Various surgical techniques have been developed and refined to achieve optimal repair outcomes. This article reviews common surgical approaches to cleft lip reconstruction, comparing their principles, indications, and outcomes. To review and compare the major surgical techniques currently used in cleft lip reconstruction, focusing on unilateral and bilateral repairs, and to evaluate their esthetic, functional, and clinical outcomes. The most frequently used techniques—Millard rotation-advancement, Tennison-Randall triangular flap, Fisher anatomical subunit method, and Mulliken bilateral repair—were analyzed in detail. No single technique is universally superior; rather, optimal outcomes are achieved through careful assessment of cleft anatomy, appropriate technique selection, and integration of multidisciplinary care. Continued advancements in surgical planning, technology, and outcome assessment tools are likely to refine current approaches and further improve both functional and esthetic results in cleft lip reconstruction.

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Jorge, Paula Karine, Níkolas Val Chagas, Eloá Cristina Passucci Ambrosio, et al. "Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate." Brazilian Journal of Oral Sciences 21 (August 23, 2022): e226343. http://dx.doi.org/10.20396/bjos.v21i00.8666343.

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Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) – children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) – children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) – children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C’), anterior length of dental arch (I-CC’), and total length of the dental arch (I–MM’), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

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Sudjatmiko, Gentur, and Mohamad Rachadian Ramadan. "The Use Of Control Suture In Cleft Lip Surgery." Jurnal Plastik Rekonstruksi 1, no. 6 (2012): 560–62. http://dx.doi.org/10.14228/jpr.v1i6.240.

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    To achieve an optimal result in cleft surgery, executing the proper designs and precise techniques are mandatory. Several techniques are proposed for the repair of unilateral and bilateral cleft lip. In 1955, Millard !rst described the techniques of advancing a lateral upper lip "ap combined with downward rotation of the medial segment.1 From experience, the above- mentioned technique may be modi!ed to facilitate better lip rotation and symmetry. Technically, it also provides a more ef!cient work"ow and more accurate results. All efforts in lip repairs have one ultimate goal, which is to achieve corrected lips with minimal scar and as much resemblance to that of the normal lips: by anatomy, symmetry, and muscle function.   

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Abulezz, Tarek Abdelhameed, Ahmed K. Elsherbiny, and Ahmed S. Mazeed. "Management of cleft lip and palate in Egypt: A National survey." Indian Journal of Plastic Surgery 51, no. 03 (2018): 290–95. http://dx.doi.org/10.4103/ijps.ijps_104_18.

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ABSTRACT Background: Variable protocols for the management of cleft lip and/or palate (CLP) patients are currently used. However, to our knowledge, there are no previously published data about cleft management and practice in Egypt. Materials and Methods: One-hundred questionnaires were distributed to cleft surgeons attending the annual meeting of the Egyptian Society of Plastic and Reconstructive Surgeons in March 2016 to investigate timing, techniques and complications of cleft surgery. Seventy-two colleagues returned the questionnaire, and the data were analysed using Microsoft Excel software. Results: The majority of cleft lip cases are repaired between 3 and 6 months. Millard and Tennison repairs for unilateral cleft lip, while Millard and Manchester techniques for bilateral cleft lip are the most commonly performed. Cleft palate is usually repaired between 9 and 12 months with the two-flap push-back technique being the most commonly used. The average palatal fistula rate is 20%. Pharyngeal flap is the method of choice to correct velopharyngeal incompetence. Polyglactin 910 is the most commonly used suture material in cleft surgery in the country. Multidisciplinary cleft management is reported only by 16.5% of participants. Conclusion: Management of CLP in Egypt is mainly dependent on personal preference, not on constitutional protocols. There is a lack of multidisciplinary approach and patients’ registration systems in the majority of centres. The establishment of cleft teams from the concerned medical specialties is highly recommended for a more efficient care of cleft patients.

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Meara, John G., and Kerry A. Morrison. "Unilateral Cleft Lip and Nasal Deformity: 8 Principles for Symmetrical Correction." Plastic and Reconstructive Surgery - Global Open 13, no. 6 (2025): e6795. https://doi.org/10.1097/gox.0000000000006795.

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Background: This article describes the first author’s hybrid approach to unilateral cleft lip and nasal deformity repair, which has evolved from the Skoog, Millard, and Fisher techniques. Methods: Key differentiating technical surgical pearls are delineated, including drawings and video content. Results: The first author incorporates 2 triangular skin flaps from the lateral lip into releasing incisions in the medial lip element. Furthermore, this technique obviates the need for a columellar back-cut or a C-flap, as both create a scar that distorts the natural columellar-labial junction and the appearance of the footplate region. Instead, the technique described here creates a natural skin “apron” that flows from the columella over the footplate region laterally on both sides and smoothly and gradually onto the philtrum in the midline. Conclusions: The first author highlights 8 surgical principles for symmetrical correction.

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Refahee, Shaimaa Mohsen, Mamdouh A. Aboulhassan, Omniya Abdel Aziz, et al. "Is PRP Effective in Reducing the Scar Width of Primary Cleft Lip Repair? A Randomized Controlled Clinical Study." Cleft Palate-Craniofacial Journal 57, no. 5 (2019): 581–88. http://dx.doi.org/10.1177/1055665619884455.

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Objective: To evaluate and analyze the effect of platelet-rich plasma (PRP) injection on the scar formed after unilateral complete cleft lip scar repair using a modified Millard technique. Hypothesis: An unavoidable cheiloplasty scar is a result of the wound healing process that not only influences patient self-esteem for life but also affects muscle function. Design: Blind, randomized, controlled clinical trial. Patients: From December 2016 to February 2018, 24 patients with unilateral complete cleft lip undergoing primary cheiloplasties were equally assigned to study and control groups. Intervention: All patients were treated by modified Millard cheiloplasty. In the study group, PRP was injected into the muscle and skin layers immediately after wound closure, while the control group patients were treated with no PRP injection. Outcomes Measures: Scar width was assessed after 6 months through the muscle using ultrasonography and at the skin surface via photographs. Results: Scar width showed a significant improvement in the study group. Conclusions: Injection of autologous PRP provides effective improvement of cutaneous and muscular wound healing and decreases scar tissue formation.

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Rai, Sushant, Himalaya Niraula, Samit Sharma, Jayan M. Shrestha, and Ishwar Lohani. "Cleft Lip and Palate Repair Surgeries in a Tertiary Care Center: A Descriptive Cross-Sectional Study." Journal of Institute of Medicine Nepal 45, no. 1 (2023): 41–44. http://dx.doi.org/10.59779/jiomnepal.1254.

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Introduction: The burden of cleft lip and palate in Nepal is high. Surgeries should be performed at the right age and weight for the safety and optimal development. We aimed to identify the socio-demographic and peri-operative attributes of cleft lip and palate patients. Methods: A descriptive, cross-sectional study of cleft lip and palate surgeries conducted in Tribhuvan University Teaching Hospital, over a two-year period. Variables studied include age and weight at the time of surgery, gender, ethnicity, type of repair, other congenital defects, the length of stay, and complications. Results: Overall, 28 cleft lip and palate surgeries were performed. The median age at operation of cleft lip patients was six months and of cleft palate patients was 20.5 months. The median weight in kilograms of cleft lip patients was six, whereas of cleft palate patients was 10. The male-to-female ratio among all the patients was 1.2:1. The patients hailed from all seven provinces of Nepal. For cleft lip, Millard technique 13 (93%) was most commonly performed and for cleft palate, the Bardach repair 10 (71.4%) was mostly preferred. Only two patients suffered from peri-operative complications. Conclusion: Millard technique and Bardach repair were the most commonly performed surgeries for cleft lip and palate respectively. Two peri-operative complications were encountered.

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ElMaghraby, Mohamed F., Nasser A. Ghozlan, Mona H. Ashry, Mohamed H. Abouarab, and Adham Farouk. "Comparative study between fisher anatomical subunit approximation technique and millard rotation- advancement technique in unilateral cleft lip repair." Alexandria Journal of Medicine 57, no. 1 (2021): 92–102. http://dx.doi.org/10.1080/20905068.2021.1885954.

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Meyer, Eric, and Alan Seyfer. "Cleft Lip Repair: Technical Refinements for the Wide Cleft." Craniomaxillofacial Trauma & Reconstruction 3, no. 2 (2010): 81–86. http://dx.doi.org/10.1055/s-0030-1254377.

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Clefts of the lip and palate are among the most common congenital malformations. A unilateral deformity is the most common type of cleft, but even within this subgroup there is a great deal of variety due to the accompanying severe distortion of the upper lip, cheek, nose, and maxilla. To repair such a variety of clefts with good aesthetic results, several general incisional approaches should be mastered along with a variety of subtle techniques that improve the end product. The most common repair utilized in America is the Millard rotation-advancement technique. This is partly due to the perceived superiority in results compared with other repairs and the ease with which this repair can be taught to residents. This repair places the scar along an artificial philtral column and is often quite sufficient in small clefts. Unfortunately, adoption of this “one size fits all” approach can limit the arsenal of the surgeon facing the vast array of differing cleft lip deformities. For example, the modified triangular flap, or Tennison-Randall repair, can be of value when presented with the wider unilateral cleft lip. In an effort to not only demonstrate that excellent results can be achieved when incisional patterns (Millard and Tennison) are used appropriately (small versus large clefts), we compared the results of two types of repairs, performed by a single surgeon over a period of 30 years. In addition, a variety of subtle techniques are reviewed to assist in obtaining excellent aesthetic results for any size repair.

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Ness, John, and Jonathan Sykes. "Basics of Millard Rotation - Advancement Technique for Repair of the Unilateral Cleft Lip Deformity." Facial Plastic Surgery 9, no. 03 (1993): 167–76. http://dx.doi.org/10.1055/s-2008-1064608.

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Hoffman, D., and D. Dyleram. "Comparison of the Millard and Fisher technique for closure of the unilateral cleft lip." International Journal of Oral and Maxillofacial Surgery 40, no. 10 (2011): e14. http://dx.doi.org/10.1016/j.ijom.2011.07.1061.

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Upadhayaya, DivyaNarain, Shivani Atri, Brijesh Mishra, ArunKumar Singh, Vijay Kumar, and Veerendra Prasad. "Esthetic outcomes of unilateral cleft lip repaired by Millard technique through a proposed scoring system." Journal of Cleft Lip Palate and Craniofacial Anomalies 4, no. 1 (2017): 26. http://dx.doi.org/10.4103/2348-2125.205408.

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Sykes, Jonathan M., Paul Davis, and Craig W. Senders. "MODIFICATIONS OF THE MILLARD ROTATION-ADVANCEMENT TECHNIQUE FOR REPAIR OF THE UNILATERAL CLEFT LIP DEFORMITY." Facial Plastic Surgery Clinics of North America 3, no. 1 (1995): 57–68. http://dx.doi.org/10.1016/s1064-7406(23)00545-x.

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Kreshanti, Prasetyanugraheni, and Muhammad Irsyad Kiat. "Lip Symmetry Evaluation Of The Gentur's Method Compared To Fisher Techniques For Unilateral Cleft Lip Repair." Jurnal Plastik Rekonstruksi 4, no. 1 (2018): 95–100. http://dx.doi.org/10.14228/jpr.v4i1.221.

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    Background : Cleft lip and palate are the most common congenital anomalies that were found in plastic surgery. There are so many techniques for unilateral cleft lip repair. Rotation-advancement method by Gentur based on Millard technique has become the most widely used in unilateral cleft lip repair in RSCM. The Fisher technique repair is a modified technique based on approximation of anatomical subunit of the lip. The purpose of this study is to objectively compare and evaluate the lip symmetry of these two techniques. Method : Two senior board-certified plastic surgeons will perform different surgical techniques for the unilateral cleft lip: rotation-advancement technique by Gentur and Fisher technique. This study prospectively analyzed preoperative and postoperative of randomized single blinded patients who underwent unilateral cleft lip repair performed by each surgeon in 2016. Using caliper, facial points on the cleft and non-cleft sides were measured, including height and symmetry of Cupid’s bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to non cleft side measurements were calculated to standardize comparisons between patients. Result : From July-October 2016, 14 patients performed surgery as preliminary data, showed that there are statistically difference in length of design and surgery time. Preoperative, comparable of cupid’s bow and vermillion showed statistically difference. Although, we found no statistically difference in postoperative ratio. Conclusion : Lip symmetry outcomes after cheiloplasty procedure are same between Gentur method and Fisher technique.   

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Adenwalla, H. S., and P. V. Narayanan. "Primary unilateral cleft lip repair." Indian Journal of Plastic Surgery 42, S 01 (2009): S62—S70. http://dx.doi.org/10.1055/s-0039-1699378.

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ABSTRACTThe unilateral cleft lip is a complex deformity. Surgical correction has evolved from a straight repair through triangular and quadrilateral repairs to the Rotation Advancement Technique of Millard. The latter is the technique followed at our centre for all unilateral cleft lip patients. We operate on these at five to six months of age, do not use pre-surgical orthodontics, and follow a protocol to produce a notch-free vermillion. This is easy to follow even for trainees. We also perform closed alar dissection and extensive primary septoplasty in all these patients. This has improved the overall result and has no long-term deleterious effect on the growth of the nose or of the maxilla. Other refinements have been used for prevention of a high-riding nostril, and correction of the vestibular web.

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Davies, Alex, and Sherif Wilson. "Invited commentary on: comparative study between Fisher anatomical subunit approximation technique and Millard rotation-advancement technique in unilateral cleft lip repair." Alexandria Journal of Medicine 57, no. 1 (2021): 137–38. http://dx.doi.org/10.1080/20905068.2021.1911111.

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Widodo, Dini Widiarni, Raden Ayu Anatriera, and Taty Zubaidah Cornain. "Tatalaksana komprehensif prosedur Millard modifikasi dengan nasoalveolar molding pada labiognatopalatoskizis komplit bilateral." Oto Rhino Laryngologica Indonesiana 48, no. 1 (2018): 88. http://dx.doi.org/10.32637/orli.v48i1.259.

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Latar belakang: Bibir sumbing dengan celah palatum merupakan suatu kelainan kongenital denganberbagai macam presentasi klinis, bersifat multifactoral inheritance dimana terdapat bakat genetikataupun kontribusi dari faktor lingkungan. Pasien cleft lip palate (CLP) membutuhkan penangananmultidisiplin untuk mengoptimalkan hasil. Penanganan sebelum dan pasca tindakan pembedahan yangkomprehensif diperlukan untuk menghasilkan outcome dan prognosis yang baik. Tujuan: Melaporkankasus labiognatopalatoskizis komplit bilateral dengan pilihan teknik labioplasti modifikasi Millard untukkoreksi primer celah bibir, disertai penggunaan nasoalveolar molding (NAM) sebelum pembedahan.Laporan kasus: Bayi laki-laki berusia 6 bulan datang dengan keluhan terdapat celah pada bibir danpalatum disertai adanya kelainan kongenital multipel sejak lahir. Hasil pemeriksaan fisik didapatkan celahpada bagian atas bibir komplit bilateral, gusi atas, serta palatum. Kavum nasi kedua hidung tampak defekpada bagian dasar hidung. Pada pasien dipasang NAM sejak usia 3 bulan agar dapat membantu asupanmenyusui. Kemudian pasien menjalani tindakan labioplasti menggunakan teknik Millard untuk koreksiprimer celah bibir. Metode: Penelitian literatur dengan mencari melalui Pubmed, Google Scholar, danClinicalKey sesuai pertanyaan klinis dalam beberapa tahun terakhir. Setelah penyaringan dengan kriteriainklusi dan eksklusi, diperoleh 1 jurnal yang relevan, selanjutnya jurnal ini dilakukan pengkajian kritis.Hasil: Dalam jurnal tersebut menyatakan bahwa penggunaan teknik modifikasi Millard dengan penggunaanNAM mempunyai outcome yang baik terhadap perbaikan bentuk bibir dan hidung pasien celah bibirkomplit bilateral. Kesimpulan: Penggunaan nasoalveolar molding sebelum pembedahan dapat bergunamenghasilkan perbaikan bentuk bibir dan hidung serta memperbaiki outcome dan prognosis pasien. ABSTRACTBackground: Cleft lip with cleft palate is either a non-syndromic disorder or a manifestation ofanother syndrome, with a variety of clinical presentations. Non-syndromic cleft lip is a multifactorialinheritance disorder in which there is a genetic tendency in the family, or being contributed byenvironmental factors. Cleft lip and cleft palate (CLP) patients need multidisciplinary managementto optimize results. A comprehensive prior and post surgery treatment are required to produce betteroutcome and prognosis. Objective: Reporting a case of complete bilateral labiognatopalatoschizis withMillard modified labioplasty approach for primary correction and the use of nasoalveolar molding(NAM) prior to surgery. Case Report: A 6-months-old male baby came with a complete bilateral cleftlip and palate, accompanied by multiple congenital abnormalities at birth. Physical examination showedcomplete bilateral cleft along lips, gums, hard and soft palate. There was also a defect at the base of thenose. In this patient, NAM was inserted since 3 months of age to assist breastfeeding intake. The patientunderwent a labioplasty procedure using Millard technique for primary correction of cleft lip. Method:Literature searching through Pubmed, Google Scholar, and ClinicalKey according to clinical questions.After screening with the inclusion and exclusion criteria, one relevant journal was obtained, then criticallyappraised. Result: The journal stated labioplasty procedure with NAM had a good outcome for lip andnose repair in a bilateral complete cleft lip. Conclusion: The use of NAM before surgery could be usefulin improving patient’s outcome and prognosis.

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Risandy, Ditia Widhani, Jilvientasia, Utami Gladya, et al. "The Evaluation of Hospital Social Responsibility Services in Gatot Soebroto Indonesia Central Army Hospital in 2015 – 2019 of Cleft Lip and Palate Patients." International Journal Of Medical Science And Clinical Research Studies 02, no. 11 (2022): 1346–50. https://doi.org/10.5281/zenodo.7354951.

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Background : Cleft lip and cleft palate are the most common congenital craniofacial anomalies treated by plastic surgeons. The incidence of cleft lip and palate is higher at lower socioeconomic levels. Hospital Social Responsibility (HSR) in Gatot Soebroto Central Army Hospital provides free cleft lip and palate surgeries to those who need it the most. The HSR services still need to be evaluated, to get an overview of epidemiologic profile of cleft lip and palate patients, and to improve the services itself.   Materials and Method: The authors conducted a retrospective descriptive study based on online data of Smile Train HSR RSPAD Cleft Center from period of January 2015 to December 2019. All patients presented with cleft lip and/or palate were included.   Results : Of all 713 patients in total; The gender distribution male 62.2% (444/713) was higher than female 37.7% (269/713). Most of the patients came from Java Island 77.5% (553/713). 685 were primary surgeries, 28 secondary surgeries. Among the primary surgeries, lip repair has the highest numbers 71.6% (491/685), followed by palate repair 27.2% (187/685), and alveolar bone grafting 1% (7/685). The most widely used surgical technique in lip surgery was the Millard 50% (345/685), while the most widely used surgical technique in palate surgery was the Bardach technique  22.9% (157/685). The median age for the primary lip repair patients was 1 year (range, 3 months to 60 years), and the median age for the primary palate repair patients was 4 year (range, 7 months to 26 years). Among secondary surgeries, lip revision with Millard technique was the highest (82.1%), followed by scar revision 3.57%, fistula repair (7.1%). The most common diagnosis was unilateral cleft lip (left 34.4%, right 13.2%) and followed by complete cleft palate (22.7%)   Conclusion : Male patients were more dominant than females. The most common diagnosis was unilateral cleft lip. Incomplete diagnostic data and clinical photos of patients make it difficult to determine the complete diagnose of cleft lip and palate.

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LOPES, DANIEL DE CAZETO, ANDRÉS FERNANDO CÁNCHICA CANO, LEONARDO GOBETTI, MARCOS RICARDO MENEGAZZO, and OSVALDO SALDANHA. "Evaluation of the Millard technique associated with zetaplasty in the treatment of patients with unilateral cleft lip." Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery 33, no. 1 (2018): 82–88. http://dx.doi.org/10.5935/2177-1235.2018rbcp0012.

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Zhang, Rui, Jingtao Li, Qian Zheng, et al. "Symmetry in nasolabial area of UCCL patients one year after primary lip repair with modified Millard technique." Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 114, no. 5 (2012): S11—S18. http://dx.doi.org/10.1016/j.tripleo.2011.08.015.

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Galarza, Laura I., Jack D. Sudduth, Alexandra M. Rose, Clayton A. Moss, Laura S. Humphries, and Ian C. Hoppe. "The Fisher Subunit Anatomical Approach for Cleft Lip Revisions." Annals of Plastic Surgery 92, no. 6S (2024): S379—S381. http://dx.doi.org/10.1097/sap.0000000000003955.

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Abstract Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

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Adeyemo, WL, O. James, MO Adeyemi, et al. "An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap) technique." African Journal of Paediatric Surgery 10, no. 4 (2013): 307. http://dx.doi.org/10.4103/0189-6725.125419.

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Lee, Taik Jong, and Sang Tae Kim. "A Survey of Cleft Lip and Palate Management Taught in Training Programs in Korea." Cleft Palate-Craniofacial Journal 40, no. 1 (2003): 80–83. http://dx.doi.org/10.1597/1545-1569_2003_040_0080_asocla_2.0.co_2.

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Objective A national survey was conducted to obtain an overall view of the status, assess changes in trends of cleft management, and study new categories of interest. Method Questionnaires were sent to 90 chief residents of all Korean institutes with plastic surgery training programs. Results Forty-eight respondents returned completed questionnaires. The results were: (1) the most common unilateral cleft lip repair method used is the rotation-advancement technique (100%); (2) 73% of respondents correct cleft lip nasal deformity at preschool age; (3) the Millard technique is the most common management in bilateral cleft lip repair (65%); (4) in the management of protruding premaxilla, 44% of the respondents choose presurgical orthopedics; (5) the usual cleft palate repairs are the pushback (64%) and double-opposing Z-plasty (43%) in complete cleft palates and the double-opposing Z-plasty (75%) and pushback (36%) comprised the common techniques in incomplete cases; (6) 86% of responding programs perform alveolar cleft repairs during the period of mixed dentition; the most common treatment of velopharyngeal incompetence is pharyngeal flap (71%); and (8) the interdisciplinary team approach is practiced by 64% of respondents. Conclusions Many changes were noted since a previous 1995 survey. We hope that this study provides the necessary information needed for the eventual establishment of standard cleft management in Korea.

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Mulay, Sagar, Roger L. Simpson, Ahmed Nasser, and Basil Nwaoz. "854 Modified Millard Forked-flap for Complete Nasal Stenosis After Smoking While on Home Oxygen." Journal of Burn Care & Research 41, Supplement_1 (2020): S265. http://dx.doi.org/10.1093/jbcr/iraa024.422.

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Abstract Introduction Nasal stenosis is an uncommon burn scar deformity which can result in breathing obstruction. The reconstruction of nasal stenosis secondary to burns can be challenging due to the limitation of localized tissue, rate of recurrence, and burn injury to the surrounding areas. A vascularized composite flap of local composite tissue (forked flap) from the lip can reliably reconstruct the nasal vestibule and nasal sill diminishing the risk of recurrent nasal stenosis. We describe our use of a modified Millard forked flap, a cleft lip repair technique. Methods A 52-year-old female presented with complete stenosis of the right nares secondary to burn contracture of the nostril, vestibule, and upper lip. She had suffered a flash burn to her face while smoking on home oxygen requiring prolonged ventilatory support and only received topical dressings. Three months after her burn injury she was referred for the reconstruction of her contractures. A lateral rhinotomy was performed to define the nasal floor defect. Scar release of the remaining vestibule and ala and the aesthetic units of the lip were defined. A supple unburned area of the upper lip was harvested as a vascularized composite forked flap and rotated into the vestibule defining the vestibule floor. The ala was rotated outward and full-thickness skin grafts was used to resurface the vestibular portion. The lateral aesthetic subunit of the lip was then resurfaced as a complete unit with a full-thickness skin graft. She later required fabricated nasal splint for nighttime stenting and serial daytime nostril dilatation with Hegar dilators. Results At nine months post-reconstruction, the patient maintains a patent nasal airway with limited vertical lip contraction, resolution of her initial symptoms of sinus congestion, and no further difficulty breathing. Conclusions In 1955, Ralph Millard presented the rotation-advancement technique for cleft lip repair. The Procedure was designed to create a softer, more natural-looking reconstructed lip. In the cleft lip repair, he suggested preserving the prolabial tissue lateral to the central segment as forked flaps that were rotated and banked on the nasal vestibule floor. Had that principle not been appreciated, that tissue might have been discarded in order to respect the aesthetic unit of the lip. The surgeon must utilize reliable principles to restore and retain form and function. The use of this modified forked flap incorporated composite vascularized tissue for the nostril floor reconstruction while respecting the subunit reconstruction of the lip. Applicability of Research to Practice Reconstruction of the injury needs to restore both functional and aesthetic deformities. Utilization of a local vascularized composite graft, taken from an area to be discarded within the upper lip subunit, provided quality tissue that significantly reduces the risk of secondary nasal contracture.

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Pandey, Rajeev, Nitin Bhagat, Rajat Gupta, and Anit Khatri. "Use of combination of Millard and Pfeifer incision technique for treatment of unilateral complete cleft of lip: A report of two cases." SRM Journal of Research in Dental Sciences 7, no. 3 (2016): 178. http://dx.doi.org/10.4103/0976-433x.188806.

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Christofides, E., A. Potgieter, and L. Chait. "A long term subjective and objective assessment of the scar in unilateral cleft lip repairs using the Millard technique without revisional surgery." Journal of Plastic, Reconstructive & Aesthetic Surgery 59, no. 4 (2006): 380–86. http://dx.doi.org/10.1016/j.bjps.2005.04.037.

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Assi, Patrick E., Alixendra Hunzicker, John Jones, John Pemberton, and Michael Samuel Golinko. "An Ode to Gillies and Millard: “The Ten Commandments Applied to Self-Inflicted Head and Neck Gunshot Wounds”." FACE 3, no. 1 (2021): 87–102. http://dx.doi.org/10.1177/27325016211064344.

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Within the field of craniofacial trauma surgery, reconstruction following high-energy ballistic injuries to the face remains a daunting task requiring a multidisciplinary approach for best outcomes. These injuries are complex with large defects requiring reconstruction of different lamellae and skeletal buttresses of the face and no 2 are exactly alike. The reconstruction efforts are multidimensional and focus on restoring facial height, width, projection, jaw occlusion, and function. We present a challenging course of a 56 year old patient with a self- inflicted gunshot wound to the face that resulted in devastating injuries to the mandible and midface. We describe our multistage and multiple technique surgical approach that spanned nearly 2 years and 11 operations that included open reduction, internal fixation of extensive facial fractures, primary bone grafting, free fibula for maxillary reconstruction and palatal fistula obliteration, pre-expanded paramedian forehead flap, and mandibular distraction. In reviewing the patient’s course, his complications, and wins, we were inspired by the fundamentals principles of head and neck reconstruction as we interpreted from the famous “Ten Commandments of Drs. Gillies and Millard.” We discuss these Commandments with the reader in our reflection of this challenging reconstruction and hope others, particularly, those in training are encouraged to find application of the “Ten Commandments” we review as they develop their own surgical practices and styles.

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Jeong, Dae Kyun, Jae Woo Lee, Soo Jong Choi, and Yong Chan Bae. "Long-term results of unilateral cleft lip repair with multiple infantile hemangiomas including one involving the cleft side of the upper lip." Archives of Plastic Surgery 47, no. 3 (2020): 263–66. http://dx.doi.org/10.5999/aps.2019.00395.

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Infantile hemangiomas have a growth phase and an involution phase. For this reason, serial observation has generally been recommended as the treatment for uncomplicated infantile hemangiomas. Recently, however, individualized approaches have been emphasized. Although cleft lip and infantile hemangioma are common congenital diseases, infantile hemangiomas on the cleft side (i.e., in the operative field of the cleft lip) are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had an infantile hemangioma on the cleft side. In accordance with general treatment guidelines, cleft repair was performed 3 months after birth. The Millard rotation-advancement technique, which involves the use of a lower small triangular flap, was used for the repair. No intraoperative complications, such as massive bleeding, or postoperative complications were noted. The patient has received regular follow-up for the past 18 years, and other than a reddish scar on the lower lip, he currently has no related issues. Therefore, this case demonstrates that cleft lip repair performed according to cleft lip treatment guidelines produces good outcomes, even in cases involving a hemangioma on the cleft side.

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A Jassim, Haider. "Evaluating the effects of botulinum toxins to minimize post cleft lip hypertrophic scar." Iraqi National Journal of Medicine 5, no. 1 (2023): 1–4. http://dx.doi.org/10.37319/iqnjm.5.1.1.

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Abstract:  Background: Cleft lip deformity is one of the most common congenital anomalies. Repair of cleft lip may create too much tension especially when done in wide cleft lip, and this may result in unacceptable scar.  Aim of study: To evaluate the efficacy of botulinum toxin in reducing or preventing post cheiloplasty hypertrophic scar.  Patient and method: Between the period from October 2019 to August 2021, 10 patients with cleft lip were subjected to primary cheiloplasty using Millard rotation advancement flap technique followed by botulinum toxin injection into the site of repair. Follow up period was 6 months postoperatively.  Results: All of our patients showed excellent result which was evaluated using visual analogue scale assessment which was done by tow independent surgeons. Our patients showed barely visible scar at 6 months postoperatively with no recorded hypertrophic scar. No side effect was recorded related to botulinum toxin injection.  Conclusion: Botulinum toxin injection after primary cheiloplsty showed to be safe and effective in prevention of development of unacceptable hypertrophic scar.   Keywards: botulinum, cleft lip, hypertrophic scar, cheiloplasty.

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Juntaro, Nishio, Yamanishi Tadashi, Hiroshi Kohara, et al. "Early Two-Stage Palatoplasty Using Modified Furlow's Veloplasty." Cleft Palate-Craniofacial Journal 47, no. 1 (2010): 73–81. http://dx.doi.org/10.1597/08-067.1.

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Objective To achieve sufficient velopharyngeal function and maxillary growth for patients with unilateral cleft lip and palate (UCLP), the authors have designed a new treatment protocol for palate closure involving early two-stage palatoplasty with modified Furlow veloplasty. Details of the surgical protocol and the outcomes of the dental occlusion of patients at 4 years of age are presented. Design and Setting This was an institutional retrospective study. Patients Seventy-two UCLP patients were divided into two groups based on their treatment protocols: patients treated using the early two-stage palatoplasty protocol (ETS group; n = 30) and patients treated using Wardill-Kilner push-back palatoplasty performed at 1 year of age (PB group; n = 42). Interventions The features of the ETS protocol are as follows: The soft palate is repaired at 12 months of age using a modified Furlow technique. The residual cleft in the hard palate is closed at 18 months of age. Lip repair is carried out at 3 months of age with a modified Millard technique for all subjects. Results The ETS group showed a significantly better occlusal condition than the PB group. The incidence of normal occlusion at the noncleft side central incisor was 7.1% in the PB group; whereas, it was 66.7% in the ETS group. Conclusion The results indicate that the early two-stage protocol is advantageous for UCLP children in attaining better dental occlusion at 4 years of age.

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Lusiana, Nova, Nadya Salsabila, Saffanah Aizzah, and Ulfi Hidayatul Husna. "Keefektifan Metode Operasi Dalam Penanganan Labiopalastokisis." Journal of Health Educational Science And Technology 4, no. 1 (2021): 1–14. http://dx.doi.org/10.25139/htc.v4i1.3537.

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Abstrak : Labiopalastokizis merupakan kelainan kongenital yang paling sering terjadi. Labiopalastokizis adalah saluran yang tidak normal yang melewati langit – langit mulut yang menuju ke saluran udara di hidung. Prognosis dari Labiopalatoskisis ialah kelainan yang dapat disembuhkan. Labiopalastokisis disebabkan oleh beberapa faktor, baik faktor genetik, teratogen ataupun faktor nutrisi dan faktor lingkungan. Penyembuhan kelainan labiopalastokisis dapat dilakukan dengan melakukan pembedahan menggunakan beberapa teknik pembedahan, antara lain Millard, Tennison, Barsky, dan juga Furlow. Penulisan ini bertujuan guna mengetahui keefektivan dari metode penanganan Labiopalastokisis dengan cara mengumpulkan data dari berbagai jurnal baik nasional ataupun internasional yang diperoleh melalui google dengan total jurnal yang direview sebanyak 10 jurnal. Dalam penanganan Labiopalastokisis metode yang dapat digunakan dalam pembedahan celah bibir unilateral menggunakan metode Millard, dan juga metode Tennison. Metode yang paling banyak dilakukan dalam penanganan celah unilateral ialah metode Millard. Pemilihan metode pembedahan dipilih berdasarkan jenis dari Labiopalastokisis. Setiap metode dinilai efektiv karena tidak ditemukan adanya gangguan dan juga infeksi pada pasien. Kata Kunci : Labiopalastokisis, Metode Millard, Metode Tennison, Metode Furlow, Metode Barsky Abstract : Labiopalastokizis is the most common congenital disorder. Labiopalastokizis is an abnormal channel that passes through the roof of the mouth to the airways in the nose. The prognosis of Labiopalatoskisis is a disorder that can be cured. Labiopalastokisis is caused by several factors, both genetic factors, teratogens or nutritional factors and environmental factors. Curing labiopalastokisis disorders can be done by performing surgery using several surgical techniques, including Millard, Tennison, Barsky, and Furlow. This writing aims to determine the effectiveness of the Labiopalastokisis handling method by collecting data from various journals both national and international obtained through Google with a total of 10 journals reviewed. In the treatment of Labiopalastoskisis the method that can be used in unilateral cleft lip surgery uses the Millard method, as well as the Tennison method. The most widely used method in handling unilateral gaps is the Millard method. The choice of surgical method is selected based on the type of Labiopalastokisis. Each method was assessed as effective because it did not find any interference or infection in the patient. Keywords : Labiopalastocisis, Milliard Method, Tennison Method, Furlow Method, Barsky Method.

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