Comparison between Millard’s Rotational Advancement Flap and Tennison-Randall Flap Techniques for Surgical Correction of Unilateral Cleft Lip Deformity

Research Article

Austin J Otolaryngol. 2016; 3(3): 1081.

Comparison between Millard’s Rotational Advancement Flap and Tennison-Randall Flap Techniques for Surgical Correction of Unilateral Cleft Lip Deformity

Gadre P*, Borle R, Rudagi BM, Bhola N and Yadav A

Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Sawangi Meghe, Wardha, Maharashtra, India

*Corresponding author: Pushkar Gadre, Department of Oral and Maxillofacial Surgery, Consultant Gadre Clinic, 2132, Vijaynagar Colony, 204 ‘Trimurti’ Apartments, Above Hotel Masemari, off Tilak Road, Behind Girja Juice Center, Maharashtra, India

Received: July 16, 2016; Accepted: September 28, 2016; Published: September 30, 2016


A congenital cleft lip deformity has significant physical and psychological. Successful repair of cleft lip deformity is a challenging as well as rewarding task. Though localized to a small anatomic area, the face it demands more attention and priorities. It is a three-dimensional anomaly involving hard tissue that changes in the fourth dimension with growth and function. The treatment goals of correction are early tension-free correction to attain an early tension free closure and have mobile and balanced lip. Many techniques have been used since eons for the correction of the unilateral cleft lip deformity and each has its own merits and demerits.

The present study was carried out in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital and in Acharya Vinobha Bhave Rural Hospital, (AVBRH) Sawangi, Wardha. Surgeries were performed on consecutive patients with unilateral cleft lip deformity. 60 unilateral cleft lip patients were randomly assigned to two groups, each compromising of thirty patients (Millard’s -Group M and Tennison- Randall- Group T).

All the patients were evaluated preoperatively, on 7th postoperative day and on one month follow up. Comparison between the two techniques was made keeping in mind the aesthetic and functional aspects of the repair.

Keywords: Unilateral Cleft Lip (UCL); Millard’s rotational advancement flap; Tennison-Randall flap; Lip Notching; Scar; Alar base symmetry


The comprehensive management of cleft lip and palate has received significant attention in the surgical literature over the last half century. It is the most common congenital facial malformation. It has a significant developmental, physical, and psychological impact on the affected individuals and their families. Treatment of the deformity presents a constant challenge and hence, a plethora of treatment philosophies have been propounded. Each philosophy has its ardent advocates, as well as equally emphatic opponents [1]. Successful correction of the deformity is one of the most professionally satisfying experiences for a surgeon.

Compared with the non-cleft individuals, the three groups of superficial facial muscles (i.e., the nasolabial, bilabial, and labiomental) are all displaced inferiorly. The orbicularis oris muscle finds a new and abnormal insertion on the left side and a partially distorted insertion on the non-cleft side. The Cupid’s bow on the left side and the white skin roll on either side are also distorted [2].

The treatment goals for cleft lip defects are early correction of the cleft, with primary correction to a tension-free, mobile, and balanced lip. The repair of any cleft lip deformity should not only be accounted for a mere closure but, also a functional anatomical repair of the underlying hard and soft tissues [2].

One of the most popular methods for Unilateral Cleft Lip [UCL] repair is the original or modified rotational advancement technique of Dr Millard which was given in 1955. Through the years, he added various refinements to his initial technique. Many authors have reported its modifications [3].

Tennison and Marcks (1950-1960) and colleagues introduced triangular flap which created a Z-plasty at lower part of lip. Subsequently, Randall used the same design as Tennison but, reduced size of triangular flap [4].

Aim and Objective

To compare the outcomes of two different surgical techniques namely Millard’s Rotational Advancement Flap Technique and Tennison- Randall Flap Technique or Triangular Flap Technique for correction of UCL defect in terms of aesthetic and function and to find out a better suited technique amongst the two.

Materials and Methods

The prospective clinical randomized clinical trial was carried out in The Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital and in Acharya Vinobha Bhave Rural Hospital, (AVBRH) Sawangi, Wardha between August 2010 to May 2012. Approval for the present study was obtained from our institution’s Experimental Medical Research and Practicing Center Ethical Committee. Informed consent was obtained from all patients who were enrolled in the study.

Sixty unilateral cleft lip patients were included in present comparative study from the patients reporting to our department. The UCL patients were randomly assigned to be treated by one of the technique.

Group M: Patients treated using Millard’s Rotational Advancement Flap- 30 patients.

Group T: Patients treated using Tennison-Randall Flap (Triangular Flap technique) - 30 patients.

The inclusion criteria were – (a) Non syndromic patients, (b) UCL patients with complete or partial cleft, (c) Age ranging from 6 months to 60 years, (d) Either of the sexes and (e) ASA I and ASA II category. Patients with Orofacial cleft, Bilateral cleft lip, and requiring secondary lip revision with ASA III and ASA IV were excluded from the study.

All the patients were hospitalized two days prior to surgery to facilitate investigations and complete pre-surgical and preanesthetic evaluation. The patients were counseled by the cleft team comprising of surgeon, orthodontist, anesthetist and psychiatrist. They underwent a mandatory pre-surgical dental checkup and orthodontic treatment whenever necessary. All patients received the same preanasthetic medication which included anxiolytics, laxative, antacids and antibiotics.

Operative technique

The patients were operated by a team of senior consultants, but their surgical differences were minimized in the present study by following a standard protocol of surgical procedure. A standard aseptic principle and optimum degree of sterilization of instruments followed in all the surgeries.

Standard Triangular Flap Technique (Group T) (Figure 1) Millard’s Rotational Advancement Flap Technique (Group M) (Figure 2) and was performed for 30 patients each. For the patients below the age of 4 yrs and having associated cleft palate, anterior palatal repair was carried out in single stage. This was done in order to avoid anterior palatal fistula occurrence during the later palatal repair.