Fort Worth Cleft Lip Repair
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Fort Worth Cleft Lip Repair By Dr. Law
In the United States, one of every 700 babies is born with a cleft lip (aka an orofacial cleft), a cleft palate or both, making these craniofacial anomalies the most common birth defects in the nation. The good news is that an experienced plastic surgeon specializing in repairing craniofacial anomalies for babies, children and adults can repair these anomalies. At Law Plastic Surgery, Dr. Huay-Zong Law, who is a member of the American Cleft Palate Craniofacial Association (ACPA), uses his experience and surgical skills to provide these patients with beautiful, natural-looking results.
What Is a Cleft Lip?
When someone is born with an orofacial cleft, their upper lip didn’t fuse while in utero. This opening in the lip can range in size from just a small notch to a complete separation. Furthermore, an orofacial cleft can affect one side (unilateral) or both sides (bilateral) of the lip.
Although a cleft may also affect the alveolar ridge (i.e., the section of the gums where the teeth emerge), it doesn’t usually affect the lower lip.
How Does a Doctor Near Fort Worth, Texas, Diagnose a Cleft Lip?
A cleft lip typically develops during the fifth week of pregnancy. and a cleft palate usually occurs around the ninth week of pregnancy.
Once a mother reaches the 20th week of pregnancy (i.e., five months), a doctor can use an ultrasound (aka a sonogram) to establish whether a baby has an orofacial cleft. A doctor may also be able to see an alveolar ridge cleft.
Types of Cleft Lip
A unilateral orofacial cleft refers to an opening under either the left or the right nostril. This opening may extend into the nose.
A bilateral cleft lip refers to openings beneath both nostrils. With a bilateral orofacial cleft, there could be a deep split extending into both of the nostrils. When this happens, the nose tends to look short and wide.
A complete cleft lip extends to the nose and an incomplete orofacial cleft doesn’t.
Cleft Lip Repair Surgery Before & After Photos
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What Causes a Cleft Lip?
Most orofacial clefts result from environmental or genetic factors. However, sometimes the cause of this craniofacial anomaly is unknown.
Environmental factors during pregnancy that could result in a child being born with a cleft lip and/or palate include alcohol use, taking certain medications, smoking and exposure to certain chemicals. In addition, the likelihood of a baby having a craniofacial anomaly increases if the mother is suffering from malnutrition or a vitamin deficiency.
When it comes to genetics, a cleft lip, with or without a cleft palate, is most common in those with Asian or Native American ancestry. Whereas, a cleft palate, without an orofacial cleft, occurs equally amongst all races.
What Are the Goals of Cleft Lip Surgery Near Fort Worth, Texas?
The goals of orofacial cleft surgery are to close the lip and create the patient natural-looking results with minimal scarring.
What Are the Benefits of Cleft Lip Surgery?
It is easier for babies to eat following their orofacial cleft surgery near Fort Worth, Texas.
Since an orofacial cleft can cause a child to have difficulty speaking and feel self-conscious, having a surgeon repair this anomaly early on can reduce the likelihood of a cleft decreasing their self-esteem.
Cleft Lip Repair Surgery Before & After Photos
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When Does a Child Have Surgery for an Orofacial Cleft?
Since the surgical outcome of procedures performed during the first year of life offers more natural-looking results, Dr. Huay-Zong Law recommends seeking treatment as soon as possible.
Ideally, a child born with a cleft lip and/or palate typically has surgery during their first year. Circumstances affecting the timing of a child’s surgery include their diagnosis and the extent of their cleft.
Presurgical Treatments
If a cleft is especially wide, Dr. Law may recommend that the child wear an early intervention manipulation molding device. With these devices, he can maximize the positions of the tissue before performing the orofacial cleft repair. The device Dr. Law recommends depends on the baby’s unique clinical situation.
Presurgical Cleft Lip Manipulation Molding Devices
Lip Adhesion
Lip adhesion surgery occurs when a baby is approximately 3 months old. This procedure addresses an irregularly positioned nose.
During lip adhesion surgery, Dr. Law reduces the width of the cleft in the child’s lip and gums and improves the position of the nose.
Lip Taping
Lip taping addresses a complete unilateral cleft lip and a wide bilateral cleft with a protrusive maxilla.
To attain optimal lip-taping results, the patient must begin the lip-taping protocol during the early stages of treatment.
Dr. Huay-Zong Law provides his patients’ parents/guardians with a lip-taping demonstration. He also gives them detailed instructions to use as they change their baby’s lip tape at home. The child continues the lip-taping treatment until they have their orofacial cleft surgery.
The benefits of using lip tape early on include moving tissue towards the cleft as well as slightly manipulating the alveolar segments and nasal cartilage.
Lip taping doesn’t interfere with the child’s ability to eat.
Dr. Law may recommend using lip taping with some of the other presurgical techniques, including a manipulation molding device.
The Nasoalveolar Molding (NAM) Device
Babies born with a unilateral orofacial cleft or a unilateral cleft lip and palate may benefit from presurgical treatment with a NAM device. When necessary, Dr. Law typically recommends NAM therapy for a patient before they reach 3 months of age.
This appliance helps align the gums and creates symmetry between the lip and the nose. The NAM’s nasal stents can also help reposition the tip of the nose.
Cleft Lip Repair Surgery Before & After Photos
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What Is the NAM Device?
This device consists of a nasal stent and palatal plate. To create a NAM, Dr. Law takes an impression of the patient’s mouth. The lab uses this impression to create a custom-tailored NAM device.
Parents/Guardians must clean this device every 12 hours. Dr. Law gives them instructions on removing and reapplying their child’s NAM device. The patient returns to Law Plastic Surgery for weekly adjustments.
What Can a NAM Device Accomplish?
This device shortens the patient’s columella, creates the patient a nose that appears more symmetrical, and slowly brings the palate and lip together.
The patient wears their nasoalveolar molding device until they’re ready to have orofacial cleft repair surgery.
Nasoalveolar Molding Device: Treatment Time
Babies with unilateral clefts wear their NAM for about three months. A baby with a bilateral cleft lip may need to wear their NAM for approximately six months.
An Initial Consultation for a Cleft Lip Repair Near Fort Worth, Texas
At the initial consultation, an assistant or Dr. Law measures and weighs the baby. Dr. Law compares the patient’s results to the national growth charts from the CDC.
Dr. Law examines the patient’s mouth and performs an oral evaluation to determine which type of orofacial cleft they have.
During this examination, he will also determine if the patient needs additional procedures (e.g., a cleft rhinoplasty or cleft palate surgery) to achieve optimal results.
Parents/Guardians need to let Dr. Law know if their baby has any medical conditions, or special needs or takes medication.
Cleft Lip Repair Surgery Before & After Photos
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An Oral Evaluation To Assess a Cleft Lip
During this oral evaluation, Dr. Law determines how severe the baby’s cleft is. This evaluation includes assessing the effect that the cleft is having on the functioning and strength of the baby’s ability to feed, the oral anatomy and feeding reflexes.
Dr. Law or one of his assistants also takes photos of the baby’s mouth.
Assessing the Oxygen and Respiratory Rate
Dr. Law uses an oxygen saturation monitor to assess the baby’s respiratory rate before, during and after their feeding. This assessment is vital because if there’s an issue with the baby’s oxygen saturation and respiration rate during feeding, corrective treatment must begin as soon as possible.
If the baby needs a feeding device, Dr. Law determines which one will serve the patient best (e.g., a nasogastric tube, special bottles or nipples).
Patients Receive a Personalized Orofacial Cleft Treatment Plan
After this examination, Dr. Law creates a personalized treatment plan for the patient. He uses the photographs of the patient’s mouth for reference as he creates their custom-designed treatment plan.
The custom-designed treatment plan that Dr. Law creates will include his recommendations for managing the patient’s cleft lip throughout their childhood and, if necessary, into the early years of adulthood.
What To Expect on the Day of Surgery
If the patient has a blanket or stuffed animal that they use for comfort, parents/guardians are encouraged to bring it to the hospital with them on the day of surgery.
Cleft Lip Surgery Near Fort Worth, Texas
Although several techniques for addressing an orofacial cleft are available, Dr. Law usually uses the rotation advancement repair option.
Rotation advancement repair takes from two to six hours: Surgery length depends on the severity and type of cleft lip the surgeon is addressing.
The patient will receive general anesthesia, these medications cause the patient to fall asleep. The patient also receives fluid via an intravenous (IV) catheter. This IV ensures the baby remains hydrated during surgery.
The Procedure:
- Dr. Law creates an incision that extends from the lip to the nostril on both sides of the cleft.
- Dr. Law will collect tissue from the site. He uses this tissue to rearrange the patient’s lip.
- To help the baby’s lip function properly, Dr. Law realigns their lip muscle. Realigning this muscle helps improve the baby’s ability to suckle.
- Dr. Law uses absorbable stitches to close the cleft. However, to reduce visible scarring, he uses very fine sutures when closing the skin.
Some babies will require additional rotation advancement repair surgery (e.g., babies with a bilateral cleft lip). Dr. Law usually performs the second rotation advancement repair surgery a month later.
Cleft Lip Repair Surgery Before & After Photos
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Primary Nasal Repair Surgery
As Dr. Law performs a patient’s first orofacial cleft repair, he may also perform their primary nasal repair surgery. With this procedure, Dr. Law can realign the baby’s nasal elements, improving their nasal configuration.
Typically, to maintain these changes, a baby receives a custom post-surgical NAM to wear.
Directly Following Surgery: The Recovery Area
A team member escorts the parents/guardians to the recovery area so they are present when their baby awakens.
The baby does have armpads in place. This ensures they don’t touch or rub the surgical site. Parents/Guardians should expect to see bruising, blood (around the stitches) and inflammation.
A child’s reaction to general anesthesia varies. Some babies cry or are fussy. Others seem confused. Vomiting or feeling nauseous is possible. These are all normal reactions to anesthesia medications. As these medications wear off, the side effects subside as well.
Upon waking, the baby may receive pain medication. This medication can be administered every four to six hours. To prevent the incisions from becoming infected, Dr. Huay-Zong Law may also prescribe an antibiotic.
Before releasing the patient, Dr. Law shows the parents/guardians how to feed their baby and clean the surgical site.
Cleaning the Treatment Area
Before their child has surgery, parents/guardians need to purchase:
- Antibiotic ointment.
- Cotton swabs.
- Hydrogen peroxide.
- Distilled water.
How To Clean the Treatment Area
Parents/Guardians need to clean the treatment area and the baby’s nasal retainer at least two times a day.
- Create a cleaning solution by pouring equal amounts of peroxide and distilled water into a clean jar with a lid.
- Dip an unused cotton swab into the solution.
- Gently clean the lip area.
- Don’t re-dip the used cotton swab, get a new one instead.
Parents/Guardians can use this procedure to clean the baby’s nasal retainer as well.
Checking the Arm Pads
The arm pads remain in place for at least two weeks after surgery. Parents/Guardians need to check their baby’s arm pads every couple of hours to make sure they aren’t too tight.
Removing the Arm Pads
To ensure proper arm development, parents/guardians must remove the arm pads several times a day. However, since these pads keep the baby from touching their face, consider removing them while the baby eats.
Post-Surgical Inflammation and Bruising
After their cleft lip repair surgery, the baby will have swelling around the eyes and lips. This swelling usually looks the worst the day after surgery. With time, this inflammation subsides. Nonetheless, it may take several weeks for it to diminish completely.
The Follow-Up Visit After Cleft Lip Surgery With Dr. Law
The post-surgical office visit occurs about five days after their orofacial cleft surgery near Fort Worth, Texas.
Parents/Guardians need to make sure the baby is hungry when they arrive at this appointment because Dr. Law wants to remove the external sutures while the baby is eating. Removing them in this manner helps keep the baby distracted.
Cleaning the Treatment Area After Suture Removal
After Dr. Law removes the baby’s sutures, parents/guardians need to continue gently cleaning the area with the peroxide mixture. However, for two days following the removal, they need to clean the area and then, using a new cotton swab, apply a thin layer of the antibiotic ointment as well.
Cleft Lip Repair Surgery Before & After Photos
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Dr. Huay-Zong Law May Recommend Scar Cream or a Moisturizer
As the incision heals, moisturizing lotion or scar cream may be useful. These creams help the parent/guardian as they massage the treatment area. They may also help reduce the visibility of the resulting scar.
Post-Surgical Symptoms Requiring Immediate Medical Attention
There are a few symptoms that require immediate medical attention.
These symptoms include:
- Trouble breathing.
- Skin color changes (e.g., blue, gray or looking pale).
- Eyes that appear sunken in, lack of urine output, lethargy or a dry mouth. These are signs of dehydration.
- A fever higher than 101.4˚F.
When To Contact Law Plastic Surgery
Parents/Guardians should call Dr. Law’s office at (972)331-1900 if their child has any of the following symptoms:
- Fresh bleeding from their incisions or their nose.
- A foul-smelling drainage that comes from the baby’s incisions or nose.
- The baby’s nasal retainer is moving in and out or is causing inflammation or redness.
Future Surgeries To Address an Orofacial Cleft
Some patients need to return for additional procedures during their childhood, adolescence or early adulthood. The patient’s appearance, scarring, and oral and nasal function help Dr. Law determine whether additional procedures are necessary.
Problems Children Who Don’t Receive Cleft Lip Repair May Experience
If a child has an orofacial cleft and doesn’t receive treatment, they may experience a variety of problems.
These potential problems are:
- Eating difficulties.
- Chronic ear infections.
- Speaking difficulties.
- Poor development and growth.
- Difficulty hearing.
- An irregular facial appearance.
Surgeons attain the best orofacial cleft surgery results when they perform the primary cleft lip repair surgery for a patient between the ages of 3 and 6 months. However, as an experienced craniofacial anomaly surgeon, Dr. Law can improve a cleft lip for a patient of any age.
How Much Will Orofacial Cleft Surgery Near Fort Worth, Texas, Cost?
Since each patient is unique, the only way Dr. Law can determine how much orofacial cleft surgery costs is to examine the patient.
Does Health Insurance Cover Cleft Lip Surgery?
Yes, health insurance companies typically cover surgery for craniofacial anomalies.
To learn more about the cleft lip procedure that Dr. Huay-Zong Law performs near Fort Worth, Texas, contact his office today. To schedule an appointment, please call (972)331-1900. Law Plastic Surgery’s address is 7777 Forest Lane, Suite C-528 in Dallas.
Cleft Lip Repair Surgery Before & After Photos
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