MODIFIED ANATOMICAL SUBUNIT REPAIR FOR UNILATERAL CLEFT LIP PATIENTS WITHOUT PRE-SURGICAL INFANT ORTHOPEDICS
BACKGROUND: There has been no consensus till date regarding the best method of repair of a child with a cleft lip deformity with many surgical procedures producing excellent results. Millard’s rotation advancement method has been practised by surgeons for years with excellent results. The anatomical subunit cleft lip repair advocated by Dr David Fisher places the scar on the philtral column of the cleft side which parallels the non-cleft side. A small inferior triangle effectively lengthens the cleft side lip. In this article we have adopted small modifications of the Fisher technique in our patients who did not have presurgical infant orthopedics prior to surgery. PATIENTS AND METHODS: Between June 2020 to July 2022, 10 patients with complete cleft lip, 5 patients with incomplete cleft lip and 1 patient with Tessier Cleft 3 were operated using Fisher’s technique. Small modifications which included increasing the base of the inferior triangle till 3 mm in required cases, overlapping of the lateral muscle over the medial muscle segment, dissection and elimination of the alar web with overcorrection using sutures and incorporating some muscle into the triangular vermillion flap to mimic the central vermillion tubercle were done. RESULTS: Satisfaction score among the parents was extremely high. Nasal aesthetics were improved in all but 2 cases. In one case, wound disruption occurred which required secondary suturing. CONCLUSION: The anatomical subunit repair can produce excellent results in patients with cleft lip and minor modifications may be instituted based on need of individual patients.
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