الفهرس 
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Abstract
The goal of cleft lip operation is to attain a perfectly symmetrical lip and nose. The symmetry and appearance of the nasolabial region is also seen as one of the principal characteristics when evaluating the results of any facial surgery.
Mishra technique that called ”White Roll Vermilion turn down Flap” (WRV Flap), an adjustment in the Millard’s technique is an effort to prevent these secondary deformities as “paramedian scars over the vermilion in continuation with the philtral line scar are often visible and scar contracture, vermilion notching is visible in close up view, sometimes medial hypoplastic vermilion or partial loss of medial vermilion” during the primary cleft lip surgery. WRV flap aims to focus on the importance of accomplishing a near normal look of the cleft patient.
Our study findings show that after three months of post-operative follow-up; a very good cosmetic results “ matching white roll, symmetric alar base, and symmetric cupoid’s bow” were obtained in the majority of the patients. Most of the parents were happy or satisfied by the look of their children’s. Asher-McDade aesthetic Index was ranked as very good appearance or good appearance in most of the patients. Early post-operative complications were observed in less 2% of the patients. While late complications like wound scaring and lip notching were observed in only five patients.
Best results are achieved when the whole multidisciplinary team believe and take part in the program and individual interventions are implemented altogether.
Surgeons should feel confident in using whichever technique they are comfortable with keeping in mind the advantages and disadvantages of each technique.
Our results concluded that Mishra technique is a very good technique regarding cosmosis, less secondary deformities, less early and late complications, high parents satisfaction, and good aesthetic results.
We recommend more randomized controlled trials to compare between Mishra technique and the two mostly used techniques “ Millard Rotational Advancement and Tennison-Randell techniques” for more consistent results to guide the surgeons for the best technique with no bias.