J Korean Assoc Maxillofac Plast Reconstr Surg.  2012 Mar;34(2):133-139.

Repair of Unilateral Cleft Lip and Nose: Mulliken's Modification of Rotation Advancement

• Jung YS
• Lee GT
• Jung HD
• Mulliken J

Abstract

This is a review regarding Mulliken's Modification using the Millard rotation-advancement principle for the repair of unilateral complete cleft lip and nasal deformity. All patients underwent prior labionasal adhesion and dentofacial orthopedics with a pin-retained (Latham) appliance used for infants with a cleft of the lip and palate. Technical variations concerning the operation are described. A high rotation and releasing incision in the columella lengthens the medial labial element and produces a symmetric prolabium with minimal transgression of the upper philtral column through the advancement flap. The orbicularis oris muscle is everted, from caudad to cephalad, to form the philtral ridge. A minor variation of unilimb Z-plasty is used to level the cleft side of Cupid's bow handle, and cutaneous closure proceeds superiorly from this junction. The dislocated alar cartilage is visualized though a nostril rim incision and suspended to the ipsilateral upper lateral cartilage. Symmetry of the alar base is addressed in three dimensions, including maneuvers to position the deviated anterior-caudal septum, configure the sill, and efface the lateral vestibular web. The authors believe the technical refinements described herein contribute favorably to the outcome of repair regarding unilateral cleft lip and nasal distortion.

Keyword

Unilateral cleft lip; Nasolabial repair; Rotation advancement

MeSH Terms

Cartilage
Cleft Lip
Congenital Abnormalities
Humans
Infant
Lip
Muscles
Orthopedics
Palate
Succinates
Succinates