Aesthetic outcome comparison between Millard and Fisher technique for cleft lip surgery: a literature review

Abstract

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.