Modified Fisher method for unilateral cleft lip-report of cases

Abstract

Background: Rehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisherintroduced an innovative method, named an anatomical subunit approximation technique in unilateral cleft liprepair. According to this method, circumferential incision along the columella on cleft side of the medial flap iscontinued to the planned top of the Cupids bow in straight manner, which runs parallel to the unaffected philtralridge. Usually, small inlet incision is needed to lengthen the medial flap. On lateral flap, small triangle just above thecutaneous roll is used to prevent unesthetic shortening of upper lip. This allows better continuity of the Cupidsbow and ideal distribution of tension. Case presentation: As a modification to original method, orbicularis oris muscle overlapping suture is applied tomake the elevated philtral ridge. Concomitant primary rhinoplasty also results in good esthetic outcome withsymmetric nostrils and correction of alar web. As satisfactory results were obtained in three incomplete and onecomplete unilateral cleft lip patients, indicating Fishers method can be useful in cleft lip surgery with functionaland esthetic outcome. Conclusions: Clinically applied Fishers method in unilateral cleft lip patients proved the effectiveness in improvingthe esthetic results with good symmetry. This method also applied with primary rhinoplasty.