Choice of Incision for Primary Repair of Unilateral Complete Cleft Lip: A Comparative Study of Outcomes in 796 Patients

Abstract

No one technique of cleft lip repair consistently produces ideal aesthetic and functional results. This study was carried out in a developing, high-volume center. It compares outcomes attained using two different designs of skin incision used for primary closure of unilateral complete cleft lip and sought to identify the most appropriate technique for clefts of varying morphology. Seven hundred ninety-six patients were entered into the study. In each group of slightly less than 400 patients, either a modified Millard or Pfeifer wavy line incision was used, both in conjunction with functional repair of the underlying tissues as described by Delaire. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid's bow, lip length, and nostril symmetry and appearance of the alar dome and base. Comparison of the two cohorts using Pearson chi-square testing for association and linear trend found a Millard incision gave significantly better results for vermilion match, whereas the Pfeifer method led to a better postoperative lip length. Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another, but in this study, it was found that one technique was essentially as good as the other. This suggests that the technique for closure of the underlying tissues is probably of more importance.