CC BY-NC 4.0 · Arch Plast Surg 2019; 46(02): 114-121
DOI: 10.5999/aps.2018.00332
Original Article

Surgical outcomes of 14 consecutive bilateral cleft lip patients treated with a modified version of the Millard and Manchester methods

Department of Surgery, University of Kufa College of Medicine, Najaf, Iraq
Department of Surgery, University of Baghdad Al-Kindy College of Medicine, Baghdad, Iraq
Department of Surgery, University of Baghdad Al-Kindy College of Medicine, Baghdad, Iraq
› Author Affiliations

Background Bilateral cleft lip deformity is much more difficult to correct than unilateral cleft lip deformity. The complexity of the deformity and the sensitive relationships between the arrangement of the muscles and the characteristics of the external lip necessitate a comprehensive preoperative plan for management. The purpose of this study was to evaluate the repair of bilateral cleft lip using the Byrd modification of the traditional Millard and Manchester methods. A key component of this repair technique is focused on reconstruction of the central tubercle.

Methods Fourteen patients with mean age of 5.7 months presented with bilateral cleft lip deformity and were operated on using a modification of the Millard and Manchester techniques. Patients with a very wide cleft lip and protruded or rotated premaxilla were excluded from this study. We analyzed 30 normal children for a comparison with our patients in terms of anthropometric measurements.

Results By the end of the follow-up period (between 9 and 19 months), all our patients had obtained a full central segment with adequate white roll in the central segment and a deep gingivolabial sulcus, and we obtained nearly normal anthropometric measurements in comparison with age-matched normal children.

Conclusions We recommend this modified technique for the treatment of bilateral cleft lip deformity.

Publication History

Received: 20 March 2018

Accepted: 21 December 2018

Article published online:
03 April 2022

© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (

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  • 1 Giele H, Cassele O. Plastic and reconstructive surgery (Oxford specialist handbook in surgery). New York: Oxford University Press; 2008
  • 2 Olasoji HO, Ukiri OE, Yahaya A. Incidence and aetiology of oral clefts: a review. Afr J Med Med Sci 2005; 34: 1-7
  • 3 Gorlin RJ, Cohen MM, Hennekam RC. Syndromes of the head and neck. New York: Oxford University Press; 2003
  • 4 Mulliken JB. Primary repair of bilateral cleft lip and nasal deformity. Plast Reconstr Surg 2001; 108: 181-94
  • 5 Spritz RA. The genetics and epigenetics of orofacial clefts. Curr Opin Pediatr 2001; 13: 556-60
  • 6 Vieira AR, Orioli IM. Candidate genes for nonsyndromic cleft lip and palate. ASDC J Dent Child 2001; 68: 272-9
  • 7 Hopper RA, Cutting C, Grayson B. Cleft lip and palate. In: Thorne CH, Bartlett SP, Beasley RW. et al. Grabb and Smith’s plastic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007: 201-25
  • 8 Yuzuriha S, Oh AK, Mulliken JB. Asymmetrical bilateral cleft lip: complete or incomplete and contralateral lesser defect (minor-form, microform, or mini-microform). Plast Reconstr Surg 2008; 122: 1494-504
  • 9 El-Hadidy AM, Eldeen AM, Elbassiony LE. An improved technique for repair of bilateral cleft lip deformities through extensive muscle dissection in one stage sugery Egypt. J Plast Reconstr Surg 2006; 30: 131-7
  • 10 Mulliken JB. Repair of bilateral cleft lip and its variants. Indian J Plast Surg 2009; 42 Suppl: S79-90
  • 11 Millard Jr DR. Closure of bilateral cleft lip and elongation of columella by two operations in infancy. Plast Reconstr Surg 1971; 47: 324-31
  • 12 Byrd HS, Ha RY, Khosla RK. et al. Bilateral cleft lip and nasal repair. Plast Reconstr Surg 2008; 122: 1181-90
  • 13 Mulliken JB, Burvin R, Farkas LG. Repair of bilateral complete cleft lip: intraoperative nasolabial anthropometry. Plast Reconstr Surg 2001; 107: 307-14
  • 14 Gundlach KK, Schmitz R, Maerker R. et al. Late results following different methods of cleft lip repair. Cleft Palate J 1982; 19: 167-71
  • 15 Fillies T, Homann C, Meyer U. et al. Perioperative complications in infant cleft repair. Head Face Med 2007; 3: 9
  • 16 Mulliken JB, Wu JK, Padwa BL. Repair of bilateral cleft lip: review, revisions, and reflections. J Craniofac Surg 2003; 14: 609-20
  • 17 Jackson IT, Fasching MC. Secondary deformities in cleft lip and palate. In: McCarthy JG. Plastic surgery. 2nd ed. Philadelphia: Saunders; 1990: 2796
  • 18 Kim SK, Lee JH, Lee KC. et al. Mulliken method of bilateral cleft lip repair: anthropometric evaluation. Plast Reconstr Surg 2005; 116: 1243-51