A long term subjective and objective assessment of the scar in unilateral cleft lip repairs using the Millard technique without revisional surgery

Abstract

The aim of unilateral cleft lip repair is to achieve a functional and aesthetically acceptable upper lip scar. Many techniques have been described but do not fulfil the basic aesthetic criteria. This series assessed the long term results from a subjective and objective point of view in a group of 20 patients who only had the initial repair, as described by Millard, without further revisional surgery. Surgery was undertaken at approximately 3 months of age and no secondary procedures were performed thereafter. The analysis related essentially to the residual scar. Patients were assessed subjectively and objectively by means of questionnaires. A control group (n = 20) of normal patients, of similar age, male to female ratio and of similar racial distribution was selected for comparison of the Cupid's bow. No patients were unhappy with the middle part of the scar, however, the upper and lower thirds created more concern. The complaints in the upper part of the scar were related to an unattractive scar crossing the base of the columella. The complaints relating to the lower part of the scar were related to peaking of the vermilion skin junction and notching of the lip margin. The most striking features that were noted from the objective evaluation were: 1. Virtually all patients had scar transgression of normal anatomical boundaries in the upper part of the lip. 2. There was a very high incidence of peaking (65%) and notching (45%) in this study group. 3. Cupid's bow to horizontal lip length ratio was greater in most patients as compared to normal. The study shows that the upper part of the scar close to the nose is problematic both from a subjective and objective point of view. In addition, the ratio of Cupid's bow to the overall lip length seems to be large.