Cleft Lip Repair Surgery Before & After Photos
Cleft Lip Surgery in Dallas
Cleft lip is a common facial birth defect that is characterized by a split or opening in the upper lip. Cleft lip occurs when the fetus is developing in the uterus, and the tissue in the mouth does not fuse together properly. It may occur on its own or with a cleft palate.
In most cases, a cleft lip only occurs in the upper lip and does not affect the lower lip. A cleft lip can be defined by different characteristics including whether it is unilateral or bilateral.
Unilateral Cleft Lip
The gap or opening is on one side of the upper lip, either under the left or right nostril. It may extend up into the nose.
Bilateral Cleft Lip
The openings occur on both sides of the upper lip. There may be a deep split that extends into both nostrils causing the nose to appear wider and shorter than normal.
Causes of Cleft Lip
Not all causes of cleft lip are known, however doctors believe some causes may be genetic. Other causes may be a result of the following during pregnancy:
- Use of certain medications
- Malnutrition or vitamin deficiency
- Exposure to certain chemicals
- Smoking and alcohol use
Cleft lip can cause problems with feeding, nursing and speech. Left untreated, children with cleft lip may experience dental problems and frequent ear infections.
Diagnosis of Cleft Lip
Cleft lip is commonly diagnosed before the baby is born through the use of an ultrasound. The doctor may notice an abnormality in the facial structures of the child when viewing and analyzing ultrasound images.
Treatment for Cleft Lip
Surgery to repair cleft lip and/or palate in infants can correct nursing, feeding and speech problems, and reduce future problems with ear infections.
The cleft lip procedure is usually performed between 3 and 6 months of age. While the infant sleeps under general anesthesia, the tissue and muscles are repositioned and the cleft is closed with absorbable stitches. The skin is then sewn over the correction with fine sutures to minimize scarring. Any resultant scar will fade over time.
After surgery, children may have bandages near their mouth. The physician will instruct parents about medication to control pain as well as instructions on feeding and caring for the procedure site.
The procedure creates a more normal appearance of the lip and surrounding area and the ability to eat and speak are greatly increased. After cleft lip correction surgery, children go on to live relatively normal lives.
- National Institutes of Health
- Centers for Disease Control and Prevention
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- S. Department of Health & Human Services
- S. National Library of Medicine
Dallas Cleft Lip Repair (Cleft Lip Surgery)
Which surgical procedures a patient who needs cleft lip (aka orofacial cleft) repair receives depends on the type and severity of the deformity. This birth defect is characterized by a separation in one side or both sides of the lip. An individual may have several defects. Multiple defects usually translate into the need for several procedures. These additional surgical procedures may include cleft palate repair and a cleft rhinoplasty. During the patient’s initial consultation at Law Plastic Surgery in Dallas, Dr. Huay-Zong Law determines which procedures will serve the patient best.
Cleft Lip Repair is Available in Dallas: What Causes this Birth Defect?
During early pregnancy, areas of the face develop separately and then join together. At around five to six weeks, the left side and right side of the lip should join together. At about 10 weeks, the left side and right side of the palate (i.e., the roof of the mouth) should fuse. If these fusions do not occur correctly, an opening may remain in the lip or in the lip and the roof of the mouth.
Some of the reasons for the development of an orofacial cleft include the mother:
- Being exposed to certain chemicals (e.g., pesticides).
- Taking specific medications (e.g., selective serotonin reuptake inhibitors [SSRIs]).
- Having a vitamin deficiency (e.g., vitamin B-6 or folate) or suffering from malnutrition.
- Drinking alcohol.
During the first few months of life, monitoring infants with an orofacial cleft is vital. With monitoring, any issues related to the infant’s ability to breathe while eating can be detected.
Characterizing a Cleft Lip
The procedures a patient needs depends on the characteristics of his or her orofacial cleft.
Unilateral vs Bilateral Cleft
This opening can affect only one side of the face (i.e., a unilateral cleft) or both sides of the face (i.e., a bilateral cleft).
Complete vs Incomplete Orofacial Cleft
When the orofacial cleft continues up to the nose, it is referred to as a complete cleft lip. When the orofacial cleft does not continue upward, it is considered an incomplete cleft lip.
What is Cleft Lip Repair in Dallas?
When treating a patient with an orofacial cleft, Dr. Huay-Zong Law may work with other medical professionals and specialists (e.g., orthodontists).
Orofacial cleft repair is an ongoing process with general timelines. These timelines are based on the child’s development. Procedures to correct a cleft lip continue throughout childhood and sometimes into early adulthood.
Since every patient is unique, each plastic surgery procedure must be custom-designed to meet the needs of a specific patient. At Law Plastic Surgery in Dallas, Dr. Law takes the time to create surgical plans that are tailored to meet a particular patient’s needs.
A child born with an orofacial cleft usually has his or her first surgery to correct it between the ages of three to six months. This first orofacial cleft surgery concentrates on repairing the separation of the lip.
Although there are several techniques that surgeons use for orofacial cleft repair, the most common technique is rotation advancement repair.
Rotation Advancement Repair Surgery in Dallas — The Procedure
Orofacial cleft repair surgery takes between two to six hours. The length of surgery depends on the type and severity of the orofacial cleft that Dr. Law is addressing.
To ensure the patient remains comfortable during cleft lip repair surgery, he or she receives general anesthesia. This anesthesia consists of medications designed to put the patient to sleep.
During rotation advancement repair surgery, Dr. Law makes an incision on each side of the cleft. These incisions run from the lip to the nostril.
Dr. Huay-Zong Law collects tissue from the area and uses it to rearrange the lip before closing the cleft with absorbable stitches and the skin using very fine sutures. Using these very fine sutures minimizes the visibility of the resulting scar.
Besides closing the lip, Dr. Law realigns the lip muscle to provide the infant with normal lip function. This realignment improves the infant’s ability to suckle.
Some infants need another rotation advancement repair surgery. For example, infants who have a bilateral cleft lip usually require another surgery. Dr. Huay-Zong Law performs this second surgery about a month after the first.
Primary Nasal Repair
Dr. Huay-Zong Law frequently performs the primary nasal repair surgery at the same time he performs the patient’s first lip repair procedure.
During this nasal repair procedure, Dr. Law liberates some nasal elements and then realigns them. He uses sutures or stents to improve the patient’s nasal configuration. To maintain these changes, Dr. Huay-Zong Law usually performs nasoalveolar molding after surgery.
Presurgical Manipulation Molding Devices
If an individual has a protrusive premaxilla or an exceptionally wide cleft, Dr. Law recommends early intervention with presurgical manipulation molding devices. Using these devices, Dr. Huay-Zong Law maximizes the tissue positions before he performs the infant’s cleft lip repair. The device Dr. Law chooses to use depends on the patient’s specific clinical situation.
The presurgical manipulation molding devices available at Law Plastic Surgery in Dallas include:
Dr. Huay-Zong Law usually uses lip taping when a patient has a wide bilateral cleft that includes a protrusive premaxilla and for patients with a complete unilateral orofacial cleft. To achieve the best results possible, Dr. Law uses lip taping during the early stages of the patient’s treatment plan. Parents/Guardians receive a demonstration of lip taping, as well as instructions to help them remember the correct way to use the tape.
The parent/guardian needs to place the tape, under some tension, across the cleft. The benefits of early taping include the tissue moving toward the cleft (i.e., tissue creep) as well as limited manipulation of the nasal cartilage and both alveolar segments.
Lip taping will not interfere with the baby’s ability to eat. Taping is inexpensive, simple, and continues until the patient has cleft lip repair surgery. Many times, Dr. Huay-Zong Law uses taping in conjunction with a variety of other techniques, including presurgical molding for wider clefts.
Some patients experience skin irritation brought on by the tape. In a case such as this, Dr. Law can provide the patient with a product designed to protect the skin.
Dr. Huay-Zong Law usually performs this surgical procedure when the infant is about three months old. During this surgery, he narrows the cleft in the lip and gums. To address the irregular position of the nose, Dr. Law sets it during the lip adhesion procedure.
The Latham Appliance
When a large cleft or significantly displaced segments of alveolar bone are present, the patient needs a Latham appliance. Dr. Law places this appliance once the infant reaches four or five months of age. Placing the Latham appliance does require the use of general anesthesia.
The Latham appliance remains pinned into the patient’s alveolar bone for a period of four to six weeks. During this time, the surgeon or the child’s parents/guardians slowly turn the appliance’s screw a certain amount every day. By turning the screw, they are activating the Latham appliance so that it moves the alveolar bones into the desired position.
The Nasoalveolar Molding (NAM) Device
If necessary, before surgery, at some point between the ages of one week to three months, the patient receives a NAM appliance. This procedure may be beneficial for babies who are born with a unilateral cleft lip and palate, or just a unilateral orofacial cleft. The nasoalveolar molding device is especially useful for a patient with a large cleft.
Besides aligning the alveolar ridge (i.e., gum), nasal stents are used to create symmetry between the nose and the lip. In addition, these stents may reposition the tip of the patient’s nose.
Patients do not need general anesthesia during placement of their nasoalveolar molding device.
The child continues wearing the NAM device until he or she is ready to have cleft lip repair at Law Plastic Surgery in Dallas.
What Does the Nasoalveolar Molding Device Do?
The NAM device slowly brings the lip and palate together, shortens the columella (i.e., the space between the upper lip and base of the nose) and creates a more symmetrical-looking nose.
The nasoalveolar molding device consists of a palatal plate and nasal stent. This device is custom-tailored for the infant and is created using an impression of his or her mouth. The parent/guardian applies the NAM, using tape and rubber bands to increase the tension on the treatment area. Patients return to the Dallas office for weekly adjustments.
NAM treatment time:
A baby with a unilateral cleft wears the nasoalveolar molding device for about three months, whereas an infant with a bilateral cleft may need to wear the NAM for about six months.
The presurgical changes the nasoalveolar molding device makes helps Dr. Huay-Zong Law provide his patients with optimal surgical results.
The Role of the Parent/Guardian in Orofacial Cleft Repair
A child relies on his or her parent/guardian for comfort before and after a nonsurgical treatment or a surgical procedure. Therefore, a child’s parent/guardian is an essential part of this treatment process. However, understandably, there are times when parents/guardians feel overwhelmed. To help decrease this feeling, Dr. Law and his staff are happy to answer any questions the patient’s parents/guardians have.
During the initial consultation, Dr. Huay-Zong Law determines the type and severity of the child’s orofacial cleft. He must also determine whether the child needs additional surgical procedures to address a cleft palate or issues related to the nose that require a cleft rhinoplasty. Following this evaluation, Dr. Law creates the patient a preliminary treatment plan.
For most parents/guardians, once they receive an outline explaining their child’s potential treatments and surgeries, they feel more at ease. This outline includes information related to how Dr. Huay-Zong Law plans to manage the infant’s cleft lip throughout childhood, into his or her young adulthood.
Presurgical Restrictions: A General Guideline
Since the patient is receiving general anesthesia, Dr. Law provides the parent/guardian with important rules related to presurgical eating and drinking. For the safety of the infant, these rules must be followed.
For children who are older than 12 months
On the night before surgery, the child needs to begin fasting at midnight. This means that he or she cannot have any solid foods or liquids with color.
Non-Clear liquids include:
- Juices that have pulp.
In addition, during this time, the patient cannot have hard candy or chewing gum.
For infants younger than 12 months
Parents/Guardians can feed a baby that takes formula for up to six hours before the scheduled surgery.
A breast-fed baby can nurse up to four hours before his or her scheduled surgery.
On the Day of Surgery, Bring a Comfort Item
If a child has a comfort item, such as a stuffed animal or blanket, parents/guardians should feel free to bring it with on the day of the cleft lip repair surgery in Dallas.
What to Expect Following Cleft Lip Repair
Inflammation, blood around the stitches and bruising are likely. Dr. Law removes the fine sutures within five to seven days of surgery. There is no need to remove the absorbable stitches.
Irritability following surgery is common; this is usually linked to mild pain. Dr. Law may give the patient a prescription for medication to help relieve this pain.
Dr. Huay-Zong Law places padded restraints on the infant’s elbows. These restraints keep the patient from rubbing his or her surgical site.
To keep the patient hydrated, he or she receives fluids via an intravenous (IV) catheter.
After Dr. Law completes the patient’s lip and palate procedures, the focus shifts to dental care. Seeking dental care early on frequently reduces the amount of dental treatment a child with an orofacial cleft needs, thus decreasing the overall cost of dental care.
What Happens if a Child Does Not Receive a Cleft Lip Repair?
If left untreated, a child may experience a variety of problems.
Potential problems include:
- Difficulty feeding.
- Poor growth and development.
- Chronic ear infections.
- Hearing difficulties.
- Irregularities in facial appearance.
- Difficulty speaking.
Cleft lip repair surgery in Dallas provides the patient with the best results when it is performed early on (between the ages of three to six months). Nonetheless, Dr. Huay-Zong Law can improve an orofacial cleft for patients of any age.
An Initial Consultation for Cleft Lip Repair in Dallas
To determine how healthy an infant is, Dr. Law, or one of his assistants, weighs and measures the child. Dr. Law compares the child’s information to the growth charts that outline the ideal weight, head circumference and length of an infant (based on his or her age).
Since photographic documentation is an important part of the orofacial cleft repair patient’s medical record, Dr. Huay-Zong Law will need photos of the patient’s mouth.
An Orofacial Cleft Repair in Dallas: The Surgical Evaluation
Dr. Law determines the grade of the infant’s orofacial cleft and then counsels the parent/guardian about cleft lip repair. He outlines what the parent/guardian can expect during the first year of orofacial cleft repair. In addition, Dr. Huay-Zong Law discusses the benefits and risks of the procedure.
If the parent/guardian decides to move forward with treatment, Dr. Law discusses whether the patient needs any procedures to prepare for his or her future orofacial cleft repair. This preparation may include the insertion of a palatal device or lip taping.
The Oral Evaluation
An oral evaluation assesses the severity of the orofacial cleft as well as the effects it has on the function and strength of the infant’s oral anatomy, ability to feed, as well as his or her feeding reflexes. These reflexes include suck initiation, transverse tongue reflex and rooting. In addition, he needs to know about the infant’s swallow and non-nutritive suck skills. These skills include central grooving of the tongue, ability to achieve lip seal, suck strength, suck burst and the suck-to-swallow ratio.
Using an oxygen saturation monitor, the infant’s respiratory status is determined. The infant’s respiratory rate is monitored before, during and after feeding. This evaluation is critical because if there is a problem with the infant’s respiration rate and oxygen saturation, these issues need to be addressed right away.
The information that Dr. Huay-Zong Law obtains from these examinations helps him determine which feeding device will serve the infant better (e.g., special nipples and bottles or a nasogastric tube).
Parents/Guardians, please inform Dr. Law if the patient having cleft lip repair surgery has any health issues or special needs.
A Nasal Retainer
Dr. Law may place a nasal retainer during surgery. This retainer serves as a splint, helping to reshape the patient’s nose as it heals. This retainer can remain in place for up to three months.
The Recovery Area
Parents/Guardians will move to the recovery area, this way they are present when their infant wakes up.
General anesthesia affects children in various ways. Some children cry, seem confused or fussy. The patient may feel nauseous or vomit. All of these reactions are normal. As the anesthesia wears off, these side effects will go away.
Once the infant wakes up, he or she may receive pain medication every four to six hours. Also, to prevent infection, for the first couple of weeks following cleft lip repair surgery, Dr. Law may prescribe an antibiotic.
After cleft lip repair, the patient remains in the recovery area until he or she awakens.
To keep the child from touching the surgical area, he or she receives arm pads.
Before Dr. Huay-Zong Law releases the patient to head home, parents/guardians learn how to feed their infant as well as how to clean the surgical area.
The IV remains in the infant’s arm until a nurse removes it, which usually occurs directly before the patient heads home.
Parents/Guardians should expect their infant to have inflammation around the lips and eyes following cleft lip repair surgery. This inflammation usually looks the worst on the day after surgery. As time passes, this swelling resides. However, it can take several weeks for this inflammation to dissipate completely.
At-Home Care Following Cleft Lip Repair
Parents/Guardians receive a list of instructions to follow at home.
Utensil and Straw Restrictions
After surgery, and for several weeks thereafter, patients cannot use utensils or straws. The child can only consume semi-liquids and liquids from a cup or a bottle. These precautions should continue until Dr. Law says it is okay to use these items again.
Upon returning home after cleft lip repair surgery, the infant can drink any type of liquid. He or she can also eat any food that can be liquefied and then consumed via a bottle or a cup (e.g., pudding or yogurt). In addition, he or she can eat anything ground down in a blender that is as smooth as baby food.
Parents/Guardians need to remember that the straw and utensil restrictions remain in effect until Dr. Huay-Zong Law removes this restriction.
Caring for the Surgical Incisions
Since the parent/guardian needs to care for the incisions, purchasing the items listed below before surgery is helpful.
Items to purchase include:
- Hydrogen peroxide.
- Antibiotic ointment.
- Cotton swabs.
Cleaning the treatment area:
- Fill a clean jar (that has a lid) with equal amounts of hydrogen peroxide and distilled water.
- Dip a new, unused cotton swab into the hydrogen peroxide and distilled water solution.
- Use this cotton swab to gently clean the lip area. Refrain from dipping a used cotton swab into the solution; get a new cotton swab instead. Use this same procedure while cleaning the nasal retainer.
These cleanings need to be done at least twice a day.
The arm padding remains in place for at least two weeks. Nonetheless, parents/guardians should check the pads every two to four hours to ensure that the pads are not too tight.
Arm Pad Removal
For proper arm development, these pads need to be removed briefly a few times a day. Since the arm pads keep the infant from touching the treatment area, consider removing the pads during feedings. That way, someone is present to make sure he or she does not touch the treatment area.
When to Seek Medical Attention
If any of the symptoms listed below are present, please seek medical attention right away:
- Difficulty breathing.
- Changes in skin color (e.g., gray, blue or pale).
- A fever above 101.4˚F.
- Any of the signs that indicate dehydration. These signs include eyes that look sunken in, a dry mouth, lethargy, lack of urination (i.e., fewer wet diapers).
Contact Law Plastic Surgery if there is:
- Foul-smelling drainage from the infant’s nose or incisions.
- Bleeding from the nose or the incisions.
- Redness, inflammation, or an in-and-out movement of the nasal retainer.
The Post-Surgical Visit
This visit occurs four or five days after orofacial cleft surgery. The infant should arrive at this appointment hungry because Dr. Huay-Zong Law removes the sutures as the child eats. This helps the infant remain distracted during the removal process.
Following removal of the stitches, continue cleansing the area with the peroxide and water mixture. For the next two days, after cleaning the area, use a new cotton swab to apply a thin layer of antibiotic ointment to the treatment area.
At some point, Dr. Law may recommend a scar cream or moisturizing lotion to use while massaging the resulting scar.
Orofacial Cleft Repair in Dallas: The Results
Dr. Huay-Zong Law carefully positions the incisions he creates during surgery within the natural contours of the patient’s nose and upper lip. As time passes, these scars do fade, however, for the most part, they will always be somewhat visible.
Final Touch up Surgeries During Adolescence or Adulthood
Throughout childhood, the patient may need secondary palatal, speech or lip procedures. The patient’s appearance, function and scarring determine the need for these procedures.
Once a child with an orofacial cleft becomes a teenager, Dr. Law may recommend scheduling a definitive rhinoplasty. Ideally, all an individual’s orofacial cleft repair procedures are completed by the time he or she reaches the age of 18. However, cases that are more complex may require additional procedures, extending treatment into the patient’s early 20s.
Dr. Huay-Zong Law knows that a child’s cleft lip repair must be adjusted to meet his or her overall medical needs. This is one of the reasons that Dr. Law places such an emphasis on continuity of care, long-term planning, setting goals and properly timing each cleft lip repair procedure.
If you are looking for an experienced, compassionate, board-certified and highly skilled plastic surgeon, contact Law Plastic Surgery today. Dr. Huay-Zong Law is dedicated to providing each of his patients with exceptional care and natural-looking results. To schedule an appointment for a cleft lip repair consultation with Dr. Law, please call (972) 331-1900. The address for Law Plastic Surgery in Dallas is 7777 Forest Lane, C-528.