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العنوان
Comparative study between fisher anatomical subunit approximation technique and millard rotation- advancement technique in unilateral cleft lip repair/
المؤلف
El Maghraby, Mohamed Farouk Khalil.
هيئة الاعداد
مشرف / ناصر أحمد غزلان
مشرف / أدهم فاروق محمد
مشرف / منى حمدى عشري
مناقش / ممدوح أحمد أبو الحسن
الموضوع
Plastic Surgery.
تاريخ النشر
2021.
عدد الصفحات
52 p. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
جراحة
تاريخ الإجازة
11/3/2021
مكان الإجازة
جامعة الاسكندريه - كلية الطب - Department of Surgery
الفهرس
Only 14 pages are availabe for public view

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from 65

Abstract

Cleft lip is considered as one of the most common congenital malformations, with a mean incidence of 1/1000 live births world wide.
The proper management of cleft patients implies early functional and esthetic rehabilitation, which is now accomplished through many mangement algorithms based on multidisciplinary approaches in specialized centers in the whole world. The aim of the surgical treatment is not only dependant on the anatomical reconstruction of the oral and nasolabial region with the main purpose is improving the function and the aesthetics. The recent treatment should be providing appropriate anatomical basis, so that the midface structures grows normally without any impairement.(3)
Many techniques were described for cleft lip repair over time, denoting that there is no single best one.(5-7)
In 1964, Millard(40) introduced the rotational advancement technique which entails the advancement of a lateral flap into the upper part of the lip, with rotation of the medial part downwards. The advantage of this technique is that it reconstructed the philtrum and the Cupid’s bow with transfering the tension of the wound beneath the base of the alae, decreasing flare and directs normal growth of the alveolar process.
Afterwards, Wynn(41) and Davies(42) described variations of triangular flaps introduced into the upper lip. Nevertheless, Millard’s repair has withstood the test of time and remains the most popular method for closure of the unilateral cleft lip. Skoog(43) and Trauner(44) independently described procedures that involve a combination of flaps in the upper and lower portions.(45)
In 2005 Fisher introduced a new technique called anatomical sub unit approximation technique which is derived from a previously described techniques and stick to a concept of anatomical subunits of the lip.(46)
The Fisher’s technique gained the idea of using sloped incisions to increase the length of the lip from Rose-Thompson technique, which allowed him to design smaller triangular flap above the cutaneous roll which was described by Noordhoff’s(47) with the incisions respecting the anatomical subunits of the lip.(46)
This study was conducted for 40 patients with unilateral cleft lip deformity in the Alexandria Main University hospital. The study included 2 groups; the first group included (20) patients with unilateral cleft lip deformity which were repaired by Fisher’s anatomical subunit approximation technique, the second group included the other (20) patients which were repaired by Millard rotational-advancement technique.
The postoperative photographs of the patients were captured and processed in computer photogrammetry software through which anthropometric parameters including; (lip height, lip width, vermilion height, and alar base width) were compared between the normal side and the repaired side. In this software, each anthropometric parameter length on the normal side is taken as a control with fixed value of (1) then the same parameter on the repaired side was measured as a ratio of this value to avoid bias.
Comparison between both groups showed that there was no significant difference in the anthropometric measurements. While the comparison between the two groups using Steffensen grading criteria showed that the Fisher’s group surpassed the Millard’s group.