Rotation-advancement repair of the unilateral cleft lip. One center's perspective

Most surgeons agree that the Millard rotation-advancement is the procedure of choice for treatment of the incomplete cleft lip and milder complete cleft forms. It has been found to be an effective procedure for essentially all cleft cases, regardless of width, when the staged approach described is employed. To reach the goal of establishing near-perfect anatomy and function, a protocol, which capitalizes on the strengths of Millard's repair while minimizing its weaknesses, has been adopted. Three aspects of the protocol are emphasized in this article: (1) presurgical manipulation of the maxillary alveolar segments via passive molding appliances; (2) a staged approach to lip repair for wide complete clefts, which includes preliminary lip adhesion; and (3) adherence to a standardized technique, which will allow for a long-term clinical study.