Rotation-advancement Technique Research Articles

Three-Dimensional Efficacy Evaluation of Nasal Symmetry in Unilateral Cleft Lip Primary Repair: A Modified Rotation Advancement Technique

Objective: Objective assessment of the long-term postoperative outcomes of a modified rotation advancement combined with force balance orbicularis oris muscle reconstruction in patients with unilateral complete cleft lip and palate. Methods: Consecutive patients undergoing cleft lip primary repair were included (n=90). Three-dimensional images preoperatively (n=90), postoperatively (n=90), and at 5 years follow-up (n=57) were assessed and compared to age-matched controls. Results: In preoperative measurement, the subnasale and pronasale both exhibited a significant deviation. The cleft subalare was displaced both medially and posteriorly in comparison to the controls. Conversely, the noncleft subalare demonstrated a lateral drift. These observations collectively indicated an overall lateral drift of the nasal base towards the noncleft side. Surgical intervention successfully resulted in landmark positions that closely mirrored those of the controls. The symmetry of the nasal base was maintained at late follow-up within the cleft lip group. However, there was a significant downward and retrusive displacement of the cleft alar base, along with a notable lateral displacement of the subnasale and the noncleft alar base in both the cleft lip and alveolus/palate groups. Conclusion: The modified rotation advancement technique combined with force balance reconstruction of orbicularis oris results in promising symmetry of nasal base in patients with unilateral complete cleft lip. The alar base retrusion in patients with cleft lip and alveolus/palate is probably due to bony defect, which might be addressed by secondary alveolar bone grafting.

Three-dimensional Assessment of Longitudinal Surgical Outcome in Patients with Unilateral Cleft Lip and Palate: A Modified Rotation Advancement Technique.

Optimization of a modified rotation advancement technique is hampered by lack of objective measures to quantify the longitudinal surgical outcome. We collected and assessed facial 3D images of 115 consecutive patients who underwent primary repair between 2017 and 2019. Photogrammetry was performed preoperatively, immediately postoperatively and at a first and second follow-up interval, occurring at an average year of 0.6 and 5.3 years, respectively. 10 additional age-matched noncleft control subjects were also included. Growth lag in cleft side lateral lip and gradual elongation of medial lip height on the cleft side caused continuous deviation of philtrum towards the cleft side. The columellar length on the cleft side continued to grow slower, accompanied by a persistent widening of alar base width on the cleft side, leading to in the gradual deviation of columella towards the cleft side. The pre-operative and post-operative nasolabial asymmetry would increase with greater degree of postoperative deficiencies. Right clefts presented with greater degrees of deficiencies in lateral lip height in preoperative measurement, but this discrepancy of the laterality of clefts was not observed in the two follow-up periods. The surgical outcome of this modified rotational advancement technique in unilateral cleft lip primary repair is promising. Growth lag in lateral lip and lateral displacement of alar base cause continuous deviation of philtrum towards the cleft side. Pre-operative severity does predict post-operative outcomes. Laterality of oral clefts does not significantly affect the long-term outcomes of surgery. This surgical technique meets the current trend of cleft lip and palate primary repair and is worth promoting.

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept.

To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. Retrospective single-surgeon (RD) study. Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.

Treatment Modalities to Achieve Nasal Symmetry in Unilateral Cleft Lip/Nasal Deformity: An Objective and Comparative Evaluation.

Primary cleft lip repair techniques do not address the nasal deformity adequately resulting in nasal asymmetry. Maneuvers employed to minimize this have varying degrees of success. To assess the outcome of different treatment modalities employed to establish nasal symmetry in unilateral cleft lip. 100 patients with complete unilateral cleft lip/ palate operated for primary cheiloplasty with modified Millard's rotation advancement technique were divided into five groups. Group 1: lip repair alone, Group 2: NAM followed by lip repair, Group 3: lip repair followed by placement of conformers, Group 4: NAM followed by lip repair and placement of conformers, Group 5: lip repair with semi-open rhinoplasty. Objective assessment was done using measurable parameters after 12months post-operatively on a 1:1 standard photograph. Group 5 showed statistical significance in all parameters assessed. Progressive improvement in nasal symmetry was noted from Group 1 to Group V. In our study, group V, i.e., modified Millard's repair with semi-open rhinoplasty improved the results in terms of all the objective parameters assessed. The results of the other groups showed improvement though not consistent in all parameters. Naso-alveolar molding is an effective adjunct. Additionally, nasal conformers proved to be of great value in retaining the results obtained post-surgery.

Growth-related nasal stability following unilateral complete cleft lip repair: A comparison of the standard and modified rotation-advancement technique

Improving growth-related nasal stability is a critical goal of primary cleft lip repair. The purpose of this study was to evaluate the growth-related stability of the nose after unilateral complete cleft lip (UCCL) repair with standard rotation-advancement (RA) and modified rotation-advancement (MRA) techniques. In this retrospective study, 52 non-syndromic (UCCL) patients were treated with a MRA technique, where a C-flap and a superiorly based advanced flap were used to lengthen and support the columella and nasal sill, and 48 patients were treated with a standard RA technique. Photos were taken before surgery (T1), immediately after surgery (T2), 1 year after surgery (T3), and 5 years after surgery (T4). Cleft width ratio, maxillary discrepancy, ala collapse, ala base position, columellar angle and height, nostril height, and width were all measured. The t-test, repeated-measure analysis of variance (ANOVA), stepwise multiple regression, inter-class correlation coefficient, and ANOVA with Bonferroni corrections were conducted. MRA improved columellar height significantly at T3 and T4. Growth-related columellar height stability at T2-T4 was significantly better in the MRA group (P = 0.08) than in the standard RA group (P = 0.007). Nasal width was a moderate predictor of post-operative outcome, and maxillary discrepancy and ala collapse were moderate predictors of growth-related nostril height changes. Both groups demonstrated the same measurement stability at 1 and 5 years, except for the columellar height in the standard RA group, which deteriorated and then improved over time due to unknown reasons. Furthermore, the MRA group had better columellar height symmetry than the standard RA group at 1 and 5 years after surgery.

Clinical Application of a Resembling Rectangular Flap on Lateral Lip in Unilateral Cheiloplasty: A Modified Millard's Technique.

This clinical study aimed to design and utilize a modified rotation-advancement technique (MRAT) with a resembling rectangular flap on the lateral lip for primary unilateral cheiloplasty and evaluated its postoperative outcomes. A retrospective study was conducted on patients with a unilateral cleft lip who had undergone initial cheiloplasty with MRAT. The postoperative outcomes were assessed for nasolabial symmetry by photogrammetry. Repeated measures of ANOVA and two independent samples t tests were applied for statistical analysis. Twenty patients with unilateral cleft lip met the inclusion criteria. Postoperatively, the patients had well-shaped nasal sill and centered nasal columella. In addition to, the bilateral symmetrical ratios noticeably improved ( P <0.001). Simultaneously, the postoperative outcomes were independent of the cleft type and height differences of the two peaks ( P >0.05). Unilateral cheiloplasty using the present MRAT can better preserve the nasolabial structure and symmetry. The postoperative scar is concealed and simulates a normal philtral ridge.

Evaluation of the Effect of Surgical Repair on Lip-Nose Morphometric Parameters of Patients with Unilateral Cleft Lip using Two-Dimensional Photogrammetry: A Comparative Study between the Cleft and the Non-Cleft Side.

This prospective, comparative study was carried out to evaluate the effect of cleft lip repair on lip-nose morphometric characteristics of subjects with complete unilateral cleft lip/palate at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. The study population consisted of a total of 29 subjects. Lip repair was done using Millard's rotation advancement technique by a single consultant. Standardised photographs were taken; preoperatively and during different postoperative periods; immediately, 1 week, 3, and 6 months. Indirect measurements of eight linear distances were carried out using Rulerswift software application. For all statistical analyses of mean difference, a P-value of less than 0.05 was accepted as being statistically significant. A total of 52% were women, whereas 44% were men. There are considerable disparities between the cleft and non-cleft sides of complete unilateral cleft patients before surgery; statistically significant differences of 1.4 mm, 6.3 mm, and -17.6 mm in vertical lip height, philtral height, and nasal width respectively. Six months after repair, statistically significant differences in lip height between the cleft and the non-cleft side were observed in vertical lip height, nasal width, and philtral height (mean difference of -1.28 ± 0.78, 2.02 ± 2.86, 1.22 ± 1.83 mm; P < 0.001, P = 0.016, P = 0.022, respectively). Horizontal lip height was maintained with no statistically significant difference (mean difference of -0.12 ± 2.19 mm). Following cleft repair, using Millard's rotation advancement technique, differences in lip-nose morphometric parameters were found to be reduced, however, not always eliminated by treatment.

Cupid's Bow Leveling and Preservation of Lip Height and Width: A Modified Rotation-Advancement Technique.

Several methods for cleft lip repair have been developed over time, with no clear method considered the standard. In the authors' department, the use of a modified rotation-advancement technique rather than the traditional rotation-advancement technique in unilateral complete cleft lip repair has increased over the past decade. This study aimed to determine which technique provides better outcomes. This retrospective study was conducted by analyzing the preoperative and postoperative aesthetic nasal and labial anthropometric measurements of the frontal and basal views of 213 consecutive patients treated between October of 2013 and June of 2019. A total of 141 participants were treated with the traditional rotation-advancement technique, and 72 with the modified rotation-advancement technique. The inclusion criteria were nonsyndromic unilateral complete cleft lip repair with high-resolution, good-quality photographs; no presurgical nasoalveolar molding; no revision in the lip or nose areas; and at least 1 year of follow-up. Patients who received the modified rotation-advancement technique had significantly improved Cupid's bow position and orientation ( P < 0.02 and P < 0.01, respectively) and enhanced vertical lip height symmetry ( P < 0.01) while preserving the lip width. The columellar length ( P < 0.03) and angulation ( P < 0.045) were also significantly improved, with enhanced nostril inclination in this group ( P < 0.06). According to the findings of the current study, modified rotation-advancement technique assisted surgeons in improving symmetrical leveling of the Cupid's bow and significantly aided in correcting lip height without compromising lip width. Moreover, the modified rotation-advancement technique resulted in better aesthetic nasal outcomes. Therapeutic, III.

Unilateral cleft lip repair treatment outcomes using triangular flap and rotation-advancement techniques: A systematic review

Unilateral cleft lip repair treatment outcomes using triangular flap and rotation-advancement techniques: A systematic review

Unilateral cleft lip repair

Cleft lip and palate are considered one of the most common birth defects that possess significant medical, psychological, social, and financial implications on the affected individuals and families.The unilateral cleft lip deformity can be repaired by many techniques, despite the numerous eponymous techniques, all are derivedfrom three basic “methods” for unilateral cleft lip repair: the straight-line technique, the triangular flap technique, and the rotation-advancement technique. The Evaluation of the long-term outcomes of the primary cleft lip repair is extremely important in order to study surgical outcome and also predict the evolution of the scar over time.There is considerable variation among studies in measuring and reporting outcomes after cleft lip repair. Some investigators have used clinical photographs with subjective scoring, whereas othersuse 3-dimensional imaging, computerised measurements or anthropometry.

Can surgeons rely on growth-related changes to achieve lip height and width symmetry in unilateral complete cleft lip repair?

Surgeons face difficulties achieving simultaneous lip height and width symmetry while repairing unilateral complete cleft lip, so one is often sacrificed at the expense of the other. The aim of this study was to evaluate the effect of growth on lip height and width symmetry, to guide the surgeon to the best decision. The study patients (N = 105) were divided into two groups based on the treatment method: 42 were treated with the modified rotational advancement technique (MRA group) and 63 with the Millard rotation-advancement technique (RA group). Furthermore, based on lip height and width symmetry at 6 months postoperative, the patients were divided into three groups: 38 with symmetrical lip height and width (SL), 41 with horizontal lip width more symmetrical than lip height (RAW), and 26 with vertical lip height more symmetrical than lip width (RAH). Measurements were taken preoperatively (T0), 6 months (T1) and 5 years (T2) postoperatively. The MRA group had significantly more symmetrical lip height than the RA group at T1 (P = 0.003) and T2 (P = 0.002); however no statistically significant difference in lip width symmetry was observed between the two groups. In relation to the effects of growth, only lip width symmetry in the RAH group improved significantly between T1 and T2 (P = 0.023). In conclusion the improvement in lip width symmetry following 5 years of postoperative growth did not achieve the same symmetry as when lip width symmetry was achieved intraoperatively. Thus, the MRA technique could be used to obtain intraoperative symmetry of lip height and width.

Comparative study of complete unilateral cleft lip repair by Millard’s rotation advancement procedure and triangular flap repair of Tennison

This study was done to evaluate and compare the surgical outcomes of primary repair of Complete Unilateral Cleft lip by Millard’s rotation advancement technique and Randall-Tennison’s Triangular flap technique in terms of Quantitative and qualitative assessments like cupid bow pouting, vermilion symmetry, nasal floor alar base symmetry and scar appearance was analysed by 5 different Plastic surgeons. 40 patients of complete Unilateral Cleft Lip operated using either Millard’s technique or Randall-Tennison’s Triangular flap technique (20 each) in the Department of Burns, Plastic and Reconstructive Surgery, SCB Medical College and Hospital, Cuttack for 2 years. They were compared with 20 normal patients (control). Overall mean age was 5.07 ± 1.41 months and 1st birth order comprised of 45.0%. Family history was found among 6.7% cases. 78.3% patients were in age group 3 – 6 month, 21.7% in 6 -12 months age group. Postoperatively there was significant difference in total nasal width between Tennison and control , Millard and Tennison but insignificant between Millard and Control.There was no statistical difference between Modified Millard’s rotation advancement technique and Randall-Tennison’s Triangular flap technique for the primary repair of the unilateral cleft lip under the hands of a qualified and skilled Plastic Surgeon.

Principalization of the Anatomical Subunit Approximation Technique of Unilateral Cleft Lip Repair

Background: The Anatomical Subunit Approximation cleft lip repair advantageously achieves a balanced lip contour with the line of repair placed along seams of aesthetic subunits. Since Fisher’s original description, it has been adopted widely and adapted, but some surgeons find the transition away from a cut-as-you-go approach challenging. Methods: We present an adapted Anatomic Subunit Approximation technique based on essential components of Fisher’s repair. The order of surgical execution is emphasized. Paradigm shifts are presented to help the surgeon used to more traditional rotation advancement techniques understand the Subunit philosophy. Minor adaptations such as surgically releasing lateral lip elements prior to marking are discussed. Results: A total of 53 eligible patients were treated with unilateral cleft lip repair by the senior author (D.C.) between February 2008 and April 2012 at Royal Children’s Hospital in Melbourne, Australia. Representative cases were chosen to demonstrate achievable results with the described technique. Conclusion: The proposed technique employs essential skin markings to achieve an anatomic subunit approximation lip repair, and appears to facilitate surgical outcomes with a high degree of symmetry. Core principles of repair include precise anatomical planning, tissue component separation, and muscle-driven advancement.

Millard's rotation advancement technique for unilateral cleft lip repair

The unilateral cleft lip deformity includes defects of the lip and also the associated deformities in the nose. The Millard's rotation advancement technique is a versatile one for the repair of these deformities. The principle of the technique is that the raised Cupid's bow point medial to the cleft is brought down level with its noncleft side counterpart by a rotation incision, which extends to the base of the columella and ends with a back cut. The resulting defect beneath the base of the columella is filled with an advancement flap from the cleft side. The advantages of the techniques are many. The most significant one is that it adheres to the basic principles of esthetic surgery, with the main scars being along the relaxed skin tension lines. It is a versatile technique producing optimal results in all types in unilateral cleft lip patients ranging from the microform to the widest of complete clefts. The incision in this technique is so placed that there is easy access to address the associated defects of the nose. Technical refinements have been added to the classical description of the procedure to address the deficiencies in the repair. We describe important refinements introduced at our center by Dr. H. S. Adenwalla. Universally, this technique is still the most popular.

Prevalence of cleft lip: A retrospective hospital based study

Amongst the most frequent congenital birth defects are facial malformations, including cleft lips associated with or without cleft palate (CL/P) and cleft palate (CP). Although the incidence of such malformations worldwide is around 1.5 per 1,000 live births, the rate for CL/P ranges six-fold and for CP three-fold. The study aims to determine the prevalence and gender variations of isolated cleft lip among patients who have visited Saveetha Dental College and have undergone primary cleft lip repair procedure. A retrospective study was conducted and data collection was done from dental archives pertaining from June 2019 to April 2020. Data consisted of patients with isolated cleft lip who underwent primary cleft lip repair procedure. Data was imported to IBM SPSS Version 20 for statistical analysis. Results were tabulated. From this study, it has been observed that prevalence of isolated cleft lip is more among males (55.6%) compared to females (44.4%) and belonging to the age group 0 to 6 years. Millard's technique (rotation advancement technique) is the most commonly employed technique for primary cleft lip repair. Male predilection observed (statistically not significant). This study was conducted in a single centre – Saveetha Dental College. Extensive multi centre study with increased sample size is to be done.

854 Modified Millard Forked-flap for Complete Nasal Stenosis After Smoking While on Home Oxygen

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.

Unilateral cleft lip repair

Cleft lip is one of the most commonly encountered craniofacial deformities. While comprehensive management of this deformity requires a multidisciplinary team approach, this article is specifically focused on the surgical management of the unilateral cleft lip deformity. As evidenced by the multiple techniques that have been developed for its repair, a functionally and aesthetically pleasing result is challenging to attain. Optimal surgical repair requires a thorough understanding of the underlying anatomy, which is reviewed. Generally, all methods of repair recognize that each structural component of the lip, skin, muscle, and mucosa, must be individually repaired but differ in their placement of the cutaneous incisions and how those incisions permit gains in lip height. This article reviews pre and postoperative management and gives special attention to the rotation advancement, Fisher subunit, and Tennison Triangle techniques of repair.

Long-term Results of Unilateral Cleft Lip Repair With Multiple Infantile Hemangiomas Including the Cleft Side of the Upper Lip

PURPOSE: Cleft lip and infantile hemangioma are relatively common congenital diseases. However, infantile hemangiomas on the cleft side, in the operative field of 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 infantile hemangioma on the cleft side. We performed cleft lip repair on a patient with infantile hemangioma on the cleft side of the cleft lip at 3 months after birth and have been following-up on the patient for the past 18 years. We report the results of 18-year follow-up after the surgery of this rare patient. METHODS: The male patient was diagnosed with a left unilateral complete cleft lip with alveolar cleft and a submucous cleft palate. There were multiple infantile hemangiomas throughout his body, with no notable abnormalities in the chromosomal analysis. In particular, the patient had infantile hemangiomas on the upper lip and lower lip, right ear helix, back, and left shoulder. The hemangioma on the upper lip was on the lateral segment of the cleft side. As per the general treatment guidelines, cleft repair was performed at 3 months after birth. Millard’s rotation advancement technique was used for the repair, which uses the lower small triangular flap. The patient was followed up for 18 years after surgery. RESULTS: There was no excessive bleeding during the surgery, and blood transfusion was not needed. The excised tissue was confirmed to be infantile hemangioma in the histopathologic examination. The patient did not show any abnormalities during recovery, and there was some residue of infantile hemangioma in the repair site in the upper lip vermilion. The residual infantile hemangioma in the repair site of the upper lip vermilion was involuted by 5 years old, and there was only a normal degree of scarring after cleft lip repair of the upper lip vermilion. At the same time, the infantile hemangiomas in the right ear helix, back, and left shoulder were completely involuted without any scarring. The patient has been followed up until now, and at 18 years, he has no particular problems other than the red scar on the lower lip. CONCLUSION: Infantile hemangiomas requiring lip repair for unilateral complete cleft lip are extremely rare, and there are no established surgical guidelines for this condition. In such cases, delaying lip repair until the infantile hemangioma is involuted may not be desirable for obtaining the best esthetic outcome, and it is also not desirable because it may induce psychosocial impairment in patients and caregivers. Therefore, we believe that general cleft lip repair produces good outcomes even in cases involving hemangiomas on the cleft side.

The new rotation-advancement technique in unilateral cleft LIP

Background: The treatment of the lip deformity in operated cleft patients is a critical task as the malformation gets more severe throughout growth, which requires a clear understanding of associated complex anatomic abnormalities. Meanwhile, the effect is not as ideal as expected