Fisher Unilateral Cleft Lip Repair: Surgical Tutorial for Professionals

A left unilateral complete cleft lip is repaired with the Fisher technique, which employs anatomical subunit principles to guide repair.

This tutorial for medical professionals was developed to supplement learning of a common surgical technique and is not intended to replace formal surgical training.

This slideshow is primarily intended for use on tablets or larger screens. Some detail might be lost on mobile screens.

This surgical tutorial illustrates the steps in Fisher unilateral cleft lip repair.

Mark midline at the columellar base.

Mark the height of the non-cleft philtral column at the columellar base.

Mark the height of the cleft philtral column at the columellar base. This is a mirror image of the previous mark – caliper may be used.

Mark the trough (nadir) of cupid’s bow.

Mark the peak of cupid’s bow on the non-cleft side.

Measure the distance between these points and transpose to create the other peak of cupid’s bow.

Above each cupid’s bow peak place a mark at the white roll-cutaneous junction.

Mark a proposed cutaneous back cut. This point is 1-2mm from the cleft side peak of cupid’s bow and oriented perpendicularly to the philtral column. This back cut will receive a small cutaneous triangle from the lateral lip element to lengthen the cleft side aspect of the medial lip element if that is necessary.

Mark the wet-dry border on the vermilion. This is perpendicular to each point that was marked on the white roll.

Mark a vermillion back cut, which will receive a vermillion triangle from the lateral lip.

Mark each alar base. In the operating room, the lateral lip side alar base can be manually rotated in to ensure symmetric marking.

Mark the non-cleft nostril sill. This area has a distinctive convexity.

Now mark a symmetric point on the nasal floor in the cleft. This will be the site of nasal floor closure. The aim is to produce a sill of the same width and a nasal aperture of the same size and shape. This marking can be manipulated in the event that there is insufficient tissue to obtain a symmetric nasal floor.

Total lip height is measured on the non-cleft side from the columellar base to the white roll. In the operating room this is done with the lip at rest.

Greater lip height is measured on the cleft side of the medial lip element. In the operating room this is done with gentle traction on the lip to give a true length.

Lesser lip height is calculated by the following: Total lip height – greater lip height – 1mm. This value will be the base width of the cutaneous triangle from the lateral lip element.

Lateral lip element markings will be more variable than the medial lip to accommodate for differences in lateral lip height.

Mark the white roll where it still has full thickness at a point where the vermillion has begun to thin (Noordhoff’s point). The white roll should be normal and the vermillion should retain near normal thickness to avoid central vermillion deficiency.