Sufficient downward rotation of the christa philtri on the cleft side: a modified technique

Cleft lip and palate (CLP) is the most common craniofacial congenital deformity. The etiology of CLP is multifactorial and involves complex interactions between environmental and genetic factors. Millard's rotation advancement technique has long been considered as state-of-the-art for unilateral cleft lip repair. However, this method may leave the christa philtri on the cleft side insufficiently downward rotated, especially in wide complete clefts. In this study, we introduce a modified technique to better rotate the christa philtri on the cleft side down. The skin, muscle, and mucosa in the deformed region were dissected and separately maneuvered. Sixty patients with unilateral complete cleft lip and palate were operated with this technique. The lip height, lip length, and relative height of the christa philtri were measured for symmetry evaluation. No significant difference was observed between the relative height of the christa philtri on both sides, either immediate (P = 0.214) or 10 months after surgery (P = 0.344). The difference observed in the lip height and lip length immediately after surgery became statistically insignificant after 10 months (P = 0.104 for lip height and 0.121 for lip length). These results suggested that sufficient and stable downward rotation of the christa philtri on the cleft side can be achieved using our technique.