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Cleft lip and palate surgery

 
>> Free cleft surgery for children of poor countries<<

Cleft lip surgery

   
Partial unilateral cleft   Complete unilateral cleft   Bilateral cleft

Surgical Anatomy

Normal lip anatomy.
Lip musculature. A) Normal musculature with fiber decussation to form the philtral columns. B) Cleft musculature with abnormal muscle insertions into the base of the nose.

Cleft lip surgery

The rotation-advancement (Millard)
Unilateral Cleft Lip Surgery

 
Cutting design for the unilateral cleft lip surgery according to Millard.   Final flap positioning after cutting for the unilateral cleft lip surgery according to Millard.
antes
despues
Before unilateral cleft lip surgery according to Millard. After unilateral cleft lip surgery according to Millard.

The triangular flap (Tennison-Randall)
Unilateral Cleft Lip Surgery

 
Cutting design for the unilateral cleft lip surgery according to Tennsion-Randall.   Final flap positioning after cutting for the unilateral cleft lip surgery according to Tennison-Randall.

 

 
Before Cleft lip surgery according to Tennison-Randall.   After Cleft lip surgery according to Tennison-Randall.

 

Bilateral Cleft (Millard)

In a bilateral complete cleft lip, both sides of the abnormal orbicularis muscle must be brought together across the prolabial segment. If it appears that either side of the cleft is too wide to close, with risk of muscle dehiscence due to too much tension, a ‘lip adhesion’ can be done, bridging the defect by reapproximating skin only. This allows the short soft tissues to stretch while often ‘molding’ the protuberant premaxilla into a more anatomical position and a narrower defect for later definitive closure. The most common repair is based on Millard’s design.

 

 
Cutting design for the unilateral cleft lip surgery according to Millard.   Final flap positioning after cutting for the unilateral cleft lip surgery according to Tennison-Randall.
 
Bilateral cleft before   Bilateral cleft after

What about the cleft nose?

Traditionally, the initial cleft nose repair was done as a secondary procedure when the child was older and nose growth had reached its final development. Recently, the trend has been to fix the nose primarily along with the lip. At the time of the lip repair, the alar cartilages can be freed from their abnormal configuration and repositioned to reshape the nasal tip and nostril, restoring better symmetry at an earlier age. A nasal stent may also be used to reshape the nostrils. As the child grows, septoplasty and further revisions may be required to achieve more tip projection and columellar length.

 

After The Surgery For Cleft Lip 


  • During the surgery, and for a short time after surgery, your child will have an intravenous catheter (IV) to provide fluids until he/she is able to drink by mouth.

  • Your child's upper lip and nose will have stitches where the cleft lip was repaired. It is normal to have swelling, bruising, and blood around these stitches.

  • For a day or two, your child will feel mild pain, which can be relieved with a non-aspirin pain medication. A prescription medication may also be given for use at home.

  • The stitches will be removed after approximately one week.

  • The scar will gradually fade, but it will never completely disappear.

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