Cleft-palate Repair by Modified Millard’s Technique with Premaxilla Shortening in Bilateral Labioplasty: A 5-Year Clinical Study
Bilateral cleft lip is one type of cleft lip classification. Because of a central lack of soft tissue and the anterior displacement of the premaxilla, this case then contributes to some challenging issues for surgeon in performing surgical operation. Surgery technique performed in this study was bilateral labioplasty using modified millard technique with premaxilla shortening. This technique was considered easier and could restore the anatomical feature of the lip. Muscle in the cleft lip can be rotated to near normal lip and twisted. In such situation premaxillary shortening is beneficial to reduce the tension of the suture wound and also reduce the scar formed in bilateral labioplasty after surgery process. This research was a 5 years cohort study from 2015 until 2019, with a retrospective approach conducted among labioplasty patients at Malahayati Hospital in Banda Aceh city. The number of sample recruited was 23 participants. The data obtained were analyzed by using frequency distribution table. This study overcame with several results. First, most of the participants were males (60.9%), the highest age group was 2 years and above (69.6%), the most frequent evaluation period was 6-9 months (87.0%), most of patients were diagnosed with complete bilateral labioplasty (65.2%), and lastly, most the outcomes gained after the bilateral labioplasty using modified millard technique with premaxilla shortening was good (73.9%). Based on those findings, it can be concluded that the majority of participants were male, the highest group for age was 2 years and above, the most frequent evaluation period was 6-9 months, the most common diagnosis was complete bilateral labiolasty, and the outcome found after the surgical intervention with modified millard techniques with premaxillary shortening was dominantly good
Gender, Age, Evaluation Period, Complete Bilateral Labioplasty, Modified Millard Techniques with Premaxillary Shortening
Marzoeki, D., Jailani, M. dan Perdanakusuma, D. P. (2002) Tehnik Pembedahan Celah Bibir dan Langit-langit, Jakarta: Sagung Seto.
Tolarova MM et al. Pediatric Cleft Lip and Palate. Medscape; 2018.
Burt JD, Byrd HS. Cleft lip: unilateral primary deformities. Plas. Reconstr. Surg. 2000; 105 (3): 1043-55.
Meara JG, Andrew BT, Ridgway EB, Raisolsadat MA, Hiradfar M. Unilateral cleft lip and nasal repair: techniques and principles. Iran J. Pediatr. 2011; 21: 129-38.
Millard, D. R. (1976) Cleft Craft and A Rhinoplasty Tetralogy Vol 1 The Unilateral Deformity, Miami: American Publishing Association.
Zayed EF, Ayad W, Moustafa WA, El-Shishtawy AH. Unilateral cleft lip repair: Experience with millard technique and introduction to the concept of junctional zones repair. Egypt J. Plast. Reconstr. Surg. 2012; 36: 109-18.
Desai S. Primary lip repair in newborn babies. In: Kehrer B, et al., eds, Long Term Treatment in Cleft Lip and Palate Bern. Stuttgart, Vienna: Hans Huber Publishers; 1981. pp. 248–53.
Naryanan RK, Hussain SA, Murukesan S, Murthy J. Synchronous palatal closure and premaxillary setback in older children with bilateral complete cleft of lip and palate. Plast Reconstr Surg. 2006; 117: 527–31.
Latham RA, Deaton TG, Calabrese CT. A question of the role of the vomer in the growth of the premaxillary segment. Cleft Palate J. 1975; 12: 351–55.
Murthy J. Primary bilateral cleft lip repair with management of premaxilla without preoperative orthopedics. J Craniofac Surg. 2009; 20: 1719–22.
Fakih-Gomez N, Sanchez-Sanchez M, Iglesias-Martin F, Garcia-Perla-Garcia A, Belmonte-Caro R, Gonzalez-Perez LM. Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery. Med Oral Patol Oral Cir Bucal. 2015 Jul 1; 20 (4): e500-7.
Abbott MM, Meara JG. Nasoalveolar molding in cleft care: is it efficacious? Plast Reconstr Surg. 2012; 130: 659–66.
Balkhi K, Fadanelli S, Subtelny JD. Treatment of bilateral cleft lip and palate. Am J Orthod Dentofac Orthop. 1991; 100 (4): 297–305.
Fernando Almas et al. Premaxillary setback with posterior vomerine osteotomy: outcomes of single stage repair of complete bilateral cleft lip with a severely protruding premaxilla. Cleft Palate-Craniofac J. 2018; 1-8.
Chauhan JS, Sharma S. Lag screw fixation of the premaxilla during bilateral cleft lip repair. J Cranio-Maxillofacial Surg [Internet]. 2019; 47 (12): 1881–6. Available from: https://doi.org/10.1016/j.jcms.2019.11.015
Almas F, Cote V, Ramly EP, Kantar RS, Hamdan U. Premaxillary Setback With Posterior Vomerine Ostectomy: Outcomes of Single-Stage Repair of Complete Bilateral Cleft Lip With a Severely Protruding Premaxilla. Cleft Palate-Craniofacial J. 2019; 56 (4): 471–8.
Vyas RM, Kim DC, Padwa BL, Mulliken JB. Primary premaxillary setback and repair of bilateral complete cleft lip: Indications, technique, and outcomes. Cleft Palate-Craniofacial J. 2016; 53 (3): 302–8.
Bittermann GKP, de Ruiter AP, Janssen NG, Bittermann AJN, van der Molen AM, van Es RJJ, et al. Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us? Clin Oral Investig. 2016; 20 (2): 207–17.
González AP, Arámburo-García R. Anatomical reconstruction in bilateral cleft lip with mendoza technique. J Craniofac Surg. 2018; 29 (6): 1452–6.
Bermudez L., Lizarraga A. Operation Smile: How To Measure Its Success. Annals Of Plastic Surgery September 2011, Volume 67, Issue 3, Pp 205-208.