Comparative Study between Mohler (Modified Millard) and Fisher Techniques in Unilateral Cleft Lip Repair

Abstract

Background: Cleft lip & palate are among most common congenital craniofacial malformations, with global incidence of 1/1000 live births. Goal of surgical repair is to enhance function & aesthetic presence of lip while providing appropriate anatomical reconstruction. Over time, numerous methods for cleft lip repair have been characterized. Ideal lip repair has symmetrical nasolabial folds & alae of nose on sides, natural-looking philtrum & Cupid's bow in both static & dynamic states, & hidden scar. Objectives : The purpose of this study is to compare esthetic results between Mohler & Fisher technique in unilateral cleft lip healing. Patients and methods: Prospective, randomized controlled research of 30 studied cases with unilateral cleft lip & palate was performed; divided into two groups (Mohler and Fisher groups), admitted to Plastic Surgery Department; Qena University Hospital from May 2021 to April 2022 (one year duration). Studied cases with microform cleft lip, syndromic cases, & non- compliant studied cases for photography and follow up were excluded. Anthropometric measurements were taken manually and valuation of quality of cleft lip repair was performed based on Steffensen's grading criteria. Results : Anthropometric measurements were taken postoperatively from patients photos and compared with the preoperative measurements taken manually and these measurements were compared between the two groups. Lip height and vermilion height were higher in Fisher group likened to Mohler group; however, there is no significant lip width and alar base length. Outcomes between the two groups were compared according to Steffensen's criteria, it showed that good outcomes were more frequent in Fisher group compared to Mohler group but without statistically significant difference. Assessment of patient satisfaction was compared between the two groups; it was more excellent score in Fisher's group than in Mohler's group. Conclusion : Fisher technique was more favorable than Mohler technique. This was revealed from our results according to Steffensen's grading criteria. Also, patient satisfaction from esthetic outcomes was more desirable in Fisher than Mohler repair for a long time follow up.