Title : Management of unilateral cleft lip using the fisher method: A case series from seoul national university dental hospital
Abstract:
Background: For the effective restoration of a cleft lip, it is imperative to restore both normal function and form. Dr. David M. Fisher introduced the "anatomical subunit approximation technique" in 2005 as a method for repairing unilateral cleft lips. In unilateral cleft lip repair, this method involves cutting a circumferential incision parallel to the unaltered philtral ridge along the columella on the cleft side of the medial flap, extending up to the predicted top of the Cupid's bow (Fig. 1 a–c). To prolong the medial flap, a tiny intake incision is frequently required. To lengthen the medial flap, a small intake incision is often necessary.
Additionally, to prevent undesirable shortening of the upper lip on lateral flaps, a small triangle is strategically employed just above the cutaneous roll. This method ensures optimal tension distribution and improved continuity of the Cupid's bow.
Case presentation: In this set of cases, we effectively treated six patients with unilateral cleft lips, incorporating scar revision through the Fisher method. The orbicularis oris muscle overlapping suture is used as a modification to the original procedure to create the higher philtral ridge. When primary rhinoplasty is done concurrently, symmetrical nostrils and alar web restoration result in a very pleasing aesthetic result. Fisher's approach demonstrated success not only in functional aspects but also in achieving pleasing aesthetics. Satisfactory outcomes were observed in three cases of unilateral cleft lip with incompletes and one case of complete cleft lip.
Conclusions: The application of Fisher's method in clinical practice for patients with unilateral cleft lips has proven successful in enhancing aesthetic outcomes, specifically by promoting good symmetry.
Keywords: Cleft lip, Fisher, Orbicularis oris muscle, Alar web correction
