title: Comparison of the rotation-advancement and philtral ridge techniques for unilateral cleft lip repair.
abstract: BACKGROUND
  The Millard rotation-advancement flap has become the most widely used technique for unilateral cleft lip repair. The philtral ridge repair is a modified straight-line technique that was developed to further optimize the scar associated with the rotation-advancement flap. The purpose of this article is to introduce the philtral ridge repair and objectively compare the outcomes of these two techniques.
  
  
  METHODS
  Two senior board-certified surgeons, who are active members of their respective craniofacial teams, use different surgical techniques for the unilateral cleft lip: the philtral ridge and rotation-advancement repairs. The authors retrospectively analyzed preoperative and postoperative photographs of consecutive patients who underwent repair performed by each surgeon between 2003 and 2009. Using Adobe Photoshop imaging software, facial points on the cleft and noncleft sides were measured, including height and symmetry of Cupid's bow, width and height of the nasal vestibule, height of the vermilion, and alar base position. Ratios of cleft side to noncleft side measurements were calculated to standardize comparisons between patients. In addition, the symmetry of each lip repair was graded subjectively by health care professionals and the general public.
  
  
  RESULTS
  There were no differences in preoperative ratios between the two techniques with the exception of a wider cleft nasal vestibule in the rotation-advancement group (p = 0.04). There were no statistically significant differences in postoperative measures or subjective analysis of symmetry between the groups.
  
  
  CONCLUSIONS
  Both the rotation-advancement and philtral ridge techniques produced outcomes with a high degree of facial symmetry and are excellent options for unilateral cleft lip repair.
authors.affiliation: Charleston, S.C.; and Sacramento, Calif. From the Department of Otolaryngology-Head and Neck Surgery and the Department of Surgery, Medical University of South Carolina; and the Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center.
authors.forename: Jay M
authors.initials: JM
authors.lastname: Cline
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Oyer
authors.forename: Hedyeh
authors.initials: H
authors.lastname: Javidnia
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Sykes
authors.forename: Richard M
authors.initials: RM
authors.lastname: Kline
authors.forename: Krishna G
authors.initials: KG
authors.lastname: Patel
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008046:Lip / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012399:Rotation; D013524:Surgical Flaps; D016896:Treatment Outcome