Nasolabial appearance of bilateral cleft lip repair at 5 years of age, comparing techniques of Modified Advancement-Rotation (Delaire) with Manchester repair: a retrospective cohort study

Abstract Introduction The techniques used to repair bilateral cleft lip have evolved over time, yet little data exists to compare outcomes using the various techniques. The aim of this study was to retrospectively evaluate and compare aesthetic outcomes in two types of complete bilateral cleft repair: the advancement rotation and a historic cohort repaired with a Manchester technique. Materials and Methods 32 consecutive patients with complete bilateral cleft lip repairs were identified retrospectively from our centre using inpatient records. The first 16 patients (born between 1994 and 2005) underwent the Manchester repair, the second 16 patients (born between 2006 and 2010) underwent a Delaire modified advancement rotation technique. Standardised photographs were taken at five years post- repair and cropped to isolate the nasolabial component. Appearance outcomes were assessed by 20 members of the cleft and plastic surgery team, who were each asked to rate all 32 images using the Asher-McDade five-point scale. A Chi squared test was used to determine whether a statistically significant difference in cleft scores between two surgical approaches. Results There was a mean of 2.8 (SD = 1.02) in the advancement rotation technique repair group and 3.1 (SD = 1.07) in the Manchester repair group. There was noted to be a statistically significant difference in the distribution of scores in the advancement rotation technique compared to the Manchester group, with lower scores (better results) seen in the advancement rotation technique repair group (p = 0.003). Discussion and Conclusions This study demonstrates that the advancement rotation technique repair of bilateral cleft lip defects resulted in a superior nasolabial appearance when directly compared to the Manchester repair at age five years.