Comparative Evaluation of Esthetic Outcomes in Unilateral Cleft Lip Repair Between the Mohler and Fisher Repair Techniques: A Prospective, Randomized, Observer-Blind Study.

PURPOSE: The Mohler and Fisher techniques are 2 of the most widely used surgical techniques of cleft lip repair showing satisfactory esthetic results. Their random use and preference by some surgeons irrespective of cleft severity have invited considerable doubt regarding whether one technique performs better than the other. The aim of this study was to measure and compare the esthetic outcomes between these 2 techniques of unilateral cleft lip repair.

MATERIALS AND

METHODS

This prospective, randomized, observer-blind study included 50 patients with unilateral cleft lip with or without cleft palate. Preoperative cleft severity was evaluated based on the Unilateral Cleft Lip Severity Index. All patients then underwent 1 of the 2 techniques of lip repair, assigned by randomization, performed by a single blinded surgeon. The postsurgical esthetic outcome was evaluated by 3 laymen using the Surgical Outcomes Evaluation Scale. Pearson product moment correlation was used to determine the correlation between cleft severity and esthetic outcome. A 1-way analysis of covariance was performed to determine the relation between the technique and the esthetic outcome using technique as the independent variable and esthetic outcome as the dependent variable, with the means adjusted using cleft severity as the covariate. A simple main effect (post hoc) test was performed to determine whether there was any difference in the mean esthetic outcome for different cleft severities with both techniques.

RESULTS

The study included a total of 50 patients with unilateral cleft lip with or without cleft palate, among whom left-sided clefts predominated, at 68%. The median age was 8.50 months. We found significance when relating cleft severity with esthetic outcomes, with the latter worsening with increasing severity. A significant difference was measured in the mean esthetic outcome and repair technique even when means were adjusted for initial cleft severity: The Fisher technique had a significantly better mean esthetic outcome than the Mohler technique.

CONCLUSIONS

Although both techniques showed satisfactory postoperative esthetics clinically, the Fisher technique fared better overall than the Mohler technique.