Esthetic outcomes of unilateral cleft lip repaired by Millard technique through a proposed scoring system

Shivani Atri, Brijesh Mishra, Divya Narain Upadhayaya, Arun Kumar Singh, Vijay Kumar, Veerendra Prasad

Journal of Cleft Lip Palate and Craniofacial Anomalies 2017 4(1):26-33

Introduction: Measurement of treatment outcome is vital in estimating the success of cleft management and for quality improvement, especially in the present age. Scoring systems for the measurement of cleft lip treatment outcome can be broadly divided into qualitative and quantitative methods. Millard's rotation-advancement technique is a commonly used technique for cleft lip repair. Aims and Objectives: The aim and objective of this study was to assess the esthetic outcome of unilateral cleft lip repaired by Millard technique through a scoring system. Materials and Methods: The study comprised fifty patients with unilateral cleft lip who presented to our department for lip repair. Specific preoperative assessment of the extent of deformity was done by photographic evaluation and scoring. The preoperative assessment was done using an initial scoring system (ISS). Different scores were allotted to each of the nose and lip components, so as to grade the deformity from nil to severe. On the basis of ISS scoring, the cleft lip patients' preoperative deformity was graded into three grades: Mild, moderate, and severe. All patients were operated by a single surgeon, with extensive experience in cleft care. Postoperative evaluation was performed on the same lines, using postsurgical score as proposed by Asher-McDade et al., and further graded into excellent, good, fair, poor, and very poor. Nasolabial areas were evaluated independently by a panel of five investigators preoperatively and postoperatively at 1 week, 1 month, 3 months, and 1 year, the mean value and standard deviation were calculated in each group. Statistical analysis was done in all patients using appropriate statistical tools, with a confidence interval of 95%. Results: Incomplete cleft lip has better esthetic outcome than complete cleft lip repair using Millard's technique. Conclusions: Esthetic outcome depends on the extent of preoperative deformity, and the Millard method of lip repair shows excellent outcome in incomplete lip repair.

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