Cleft Lip Repair, Primary Unilateral Before & After Case 1
Anatomic repair of the muscles in the lip, and of key landmarks on the lip, restore balance and symmetry.
Cleft Lip Repair, Primary Unilateral Before & After Case 2
Repair of the orbicularis muscle of the lip guides the alveolus (or gum line) to realign and narrow the cleft, even in the absence of nasoalveolar molding (NAM).
Complete treatment of the muscle at the first operation is also key for preventing future problems.
Release of the muscle from the septum helps to reduce the deviation typically seen as patients get older, improving both breathing and appearance.
The lip scar and nasal symmetry will continue to improve over time, especially with optimal scar care and massage.
Thank you for trusting our team with the care of your loved ones!
Cleft Lip Repair, Primary Unilateral Before & After Case 3
One month after cleft lip repair, this girl is thriving.
Cleft lip repair is normally done between 3 and 6 months of age, though for the right patient, it is reasonable to discuss performing surgery at as early as 4 weeks of age.
Factors to consider include:
– prematurity, which increases the risk of apnea after surgery
– weight and feeding, to minimize risks of anesthesia and of postoperative problems
– width of the cleft, as additional nasoalveolar molding may be recommended before going ahead with surgery
Cleft lip surgery can safely be done as a same day surgery, though patients and families sometimes choose to be observed in the hospital overnight.
Cleft Lip Repair, Primary Unilateral Before & After Case 4
A few things I think about during this repair:
Pic #2 – The white roll (at the border between the skin and dry mucosa) draws attention if there is a break in that light reflex, so creating continuity with good quality white roll is priority number 1 to reduce unwanted attention.
Pic #3 – The muscle fibers not only need to be repaired, they must be reoriented back to their original direction. This is similar to what we have learned from our cleft palate repairs, as the muscle action has a vector that should be returned to normal anatomic direction as possible. Judicious backcuts help to unfurl the muscle and bring the noncleft side down.
Pic #5 – The septal deviation is due to the muscle imbalance, with the noncleft side muscle pulling unopposed. The septum here is straightened without any resetting or unseating of the cartilage; rather, it was achieved by balancing the forces on the septum by releasing the muscle on that side.
Pic #5 – The release of that muscle can be achieved underneath and separately from the skin, so that the scar on the surface stays along the philtral column without adding scar at the base of the columella if one chooses.
Cleft Lip Repair, Primary Unilateral Before & After Case 5
Extreme care is taken to align the vermilion (or red) margin of the lip, as even a stepoff of 1mm is noticeable in conversation.
Cleft Lip Repair, Primary Unilateral Before & After Case 6
Making the Cupid’s bow peaks of the lip even requires reorientation and repair of the orbicularis muscle in the lip.
Cleft Lip Repair, Primary Unilateral Before & After Case 7
Her primary lip and nose repair were performed earlier, for most patients usually at 3-6 months of age.
The cleft palate is then repaired usually in a single stage at 9-12 months, as babbling begins and speech development starts taking off.
This timing tries to balance scarring (which can restrict growth of the palate and midface), with optimizing speech development.
Cleft Lip Repair, Primary Unilateral Before & After Case 8
The scar for this repair usually falls along the normal philtral column, making the scar less noticeable in conversation.
Slight asymmetries in the red part of the lip may be touched up as needed, including at the time of other procedures like the cleft palate or cleft rhinoplasty repair.
Cleft Lip Repair, Primary Unilateral Before & After Case 9
The scar is more likely to be thicker and/or darker early on for patients of certain ethnicities (African-American, Hispanic, Asian), but does soften and fade with time and scar care.
The first year often includes:
– Prenatal visits for when the cleft is seen on ultrasound, to talk about expectations and timing. Most children have otherwise very normal childhoods and lives! Almost all clefts we see are random, and not caused by anything that the mother or father did during pregnancy.
– Day 1 working with our speech therapist @monicakemp and the team at the hospital where you deliver, to immediately get on track with feeding and weight gain.
– Cleft lip repair between 3 and 6 months.
– Cleft palate repair between 9 and 12 months. That seems to be the best balance between waiting for the child to grow as much as possible, and before speech begins taking off.
Cleft Lip Repair, Primary Unilateral Before & After Case 10
This sweet girl is one month after her cleft lip repair.
Normally surgery is done between 3 and 6 months of age.
This is a good balance when weighing anesthesia safety, scarring, activity level, and time to heal before the palate surgery.
Afterwards, children may continue breastfeeding or bottlefeeding the same as before surgery.
Most of our cleft lip patients also go home the same day after their lip repair.
After cleft palate surgery, patients usually stay 1 or 2 nights until we are confident the child is feeding well.
She has done beautifully, with a scar that will soften and fade over time.
Cleft Lip Repair, Primary Unilateral Before & After Case 11
She has an infectious smile and magnetic spirit that brightens our day every time she comes to visit.