What We Learnt in Unilateral Cleft Lip Repair Between Millard's and Tennison-Randall's Techniques: Comparison of the Outcomes in Adult Patients

Objective To compare long-term esthetic and morphological outcomes of unilateral cleft lip (UCL) repair using the Millard rotation-advancement versus the Tennison-Randall triangular flap technique, testing whether Millard provides superior lip symmetry.Design Retrospective cohort study.Setting Single tertiary cleft center.Patients, Participants Forty adults aged 18-25 were selected from 168 patients treated between 1988 and 1995. Inclusion criteria: complete UCL, primary cheiloplasty, absence of secondary lip revisions, complete frontal photographic documentation, and no syndromic diagnoses. Twenty underwent Millard repair and twenty Tennison-Randall repair.Interventions Primary UCL reconstruction performed using either Millard rotation-advancement or Tennison-Randall triangular flap. All operations were carried out by the same senior cleft surgeon under comparable operative conditions.Main Outcome Measure(s) Long-term lip symmetry quantified through a Symmetry Index derived from predefined anthropometric landmarks on standardized images. Subjective esthetic satisfaction assessed using the esthetic Units Satisfaction Questionnaire and the Cleft esthetic Rating Scale, completed by patients, the operating surgeon, and a blinded observer.Results Millard repair showed significantly greater medial lip width symmetry (p = .014). No significant differences were found for vermilion height, prolabial height, lateral lip width, or lip area. Subjective assessments consistently favored Millard, showing higher satisfaction and fewer negative ratings. Inter-rater reliability across evaluators was high (ICC = 0.82).Conclusions Both techniques produced stable long-term outcomes, but Millard yielded superior medial lip symmetry and higher esthetic satisfaction. These findings support its continued clinical preference and highlight the importance of long-term evaluations. Larger prospective studies are needed to confirm these results.