How many surgeries to fix a cleft lip
The number of surgeries to fix a cleft lip depends on a number of factors, including the severity of your cleft and how much your lip is affected. If you have severe clefting, you may need as many as nine procedures to fix your lip.
The number of surgeries needed to fix a cleft lip depends on the severity of the cleft, but it’s usually anywhere between three and five. In this guide, we review How many surgeries to fix a cleft lip, cleft lip surgery for adults, what to expect after cleft lip surgery, and how successful is cleft palate surgery.
The first surgery is performed at an early stage in the healing process, before any permanent changes have been made to the child’s lips. This is called a laminectomy, which involves removing part of the upper lip and part of the lower lip so that they can be sewn together more easily.
After this surgery is performed, the patient will need another one within six weeks, which involves a procedure called a colpectomy. The surgeon will remove part of the palate in order to create space for the upper lip and lower lip to grow together properly.
The final surgery is performed after about two years—and only if there are complications from the previous ones!
There are three surgical options to correct a cleft lip:
1) A bilateral cleft lip repair: This involves suturing the lips together so that they can heal together. It is recommended for children who have a good-to-fair chance of speech development after the surgery.
2) A unilateral cleft lip repair: This involves suturing the lips together so that they can heal together. It is recommended for children who have a good-to-fair chance of speech development after the surgery.
3) A combined bilateral/unilateral cleft lip repair: This involves performing both procedures on one side at once, which reduces the risk of complications and allows for faster recovery time.
If you have a cleft lip, there are three options for how to fix it.
The first option is surgery. This can be done on an outpatient basis and is usually considered the safest option for fixing clefts. In this procedure, a plastic surgeon will use an incision in your mouth to make a new one. They will then move the tissue from your lip to create a better shape for your face. The scarring from this type of surgery can last up to two years, but it can be covered with makeup after that time period has passed.
The second option is to do nothing at all and let time heal the cleft. This may work well in some cases or not at all, depending on how much damage your body has already done and what other problems you have going on in your life at the time of diagnosis (such as developmental issues). If this approach works well for you, then you might consider waiting until past age 18 before considering any type of treatment.
The third option is to have reconstructive surgery performed later on by a specialist who specializes in treating clefts like scars or burns (like Dr. [name]).
Cleft lip repair is a procedure that can be performed to correct the malformation of the lip and make it look more natural. The surgery is often required in conjunction with other procedures, such as cleft palate repair or surgery to close the nasal passage.
The success rate of cleft lip repair depends on many factors, including:
-How old the child is
-Whether they have other health issues that complicate their case
-The extent of their cleft lips
How many surgeries to fix a cleft lip
The BLOG INTRO is a series of blog posts written by Dr. Lin, who is the Director of Oral Surgery at the [hospital name], a top plastic surgery center in the United States. The objective of these blogs is to educate patients on the most common issues related to cleft lip and palate surgery and what can be done about them.
The goal of these blog posts is not just to share information, but also to have a conversation with you about your concerns so that we can determine together what course of action will be best for you as an individual. These blogs are meant to be interactive, so feel free to comment below if you have any questions or concerns!
In this post, I will be showing you before and after photos of a cleft lip surgery procedure.
This is a very common procedure that can be done to treat a cleft lip and/or palate. The goal of this surgery is to create one or two new lips and to repair the palate if necessary. I will go over what type of surgery it is and take you through the entire process, including blood tests, pre-op instructions, anesthesia, recovery time, and follow-up visits.
I hope that this blog helps with your decision about whether or not this procedure is right for you!
A cleft lip is a condition that affects the lip and upper lip. It is characterized by a large gap between the two sides of the mouth. The bottom lip may be larger than the top, or vice versa. A cleft lip can also be identified by a large defect in the upper lip that extends to the nose bridge.
The most common cause of cleft lip is congenital (present at birth), but it can also occur as a result of trauma, infection, or surgery. In some cases, it’s caused by a tumor growth (malignant) in the tissues of the face or jawbone.
Cleft Lip Surgery
If you are experiencing symptoms due to a cleft lip deformity, we can treat these issues with surgery. We offer an array of surgical options including:
• Lip repair: This involves repairing tissue damage from trauma or congenital conditions such as this one with your own tissue from another part of your body. This procedure will close off any open areas so that you have a more natural look once completed; however this method does not always guarantee 100% success because there is still some scarring involved and results may not look exactly like how you envisioned them when first thinking about undergoing this type of treatment; however they will
The cleft lip surgery is a reconstructive procedure that is often used to repair the deformity of a cleft lip. The surgery is performed with the use of a special device called an excimer laser and involves reshaping the soft tissue on both sides of the mouth. It is typically done in children who have not yet reached puberty and after they have received treatment for conditions such as cleft palate, cleft lip and palate, or other associated conditions such as otitis media (ear infections).
Cleft lip is a type of cleft lip in which the upper lip and nose is not joined. It is usually caused by the failure of one or more structures to fuse together during early pregnancy.
The majority of children are born with a cleft lip and palate, but some do not have a complete cleft, while others have a partial cleft. Cleft lip affects 1 in every 1,000 people.
Cleft lips are often found in young babies and toddlers, but they can also appear as adults. The causes of clefts are not fully understood, although there are several factors that may contribute to their development.
One cause of cleft lip is environmental, such as smoking or drinking alcohol during pregnancy. A second cause might be genetic – this means that someone who has one child with a cleft may pass it on to subsequent children born to them (known as familial inheritance).
The first surgery to fix a cleft lip is called an excision. In this procedure, the surgeon cuts out the excess tissue from the lip. The second surgery is called a second excision and it involves closing up the wound made by the first surgery.
After multiple surgeries, your doctor may prescribe you with speech therapy or physical therapy in order to help with your speech and eating. You will probably also need to use speech devices like a speech generator or even a stoma tube to help you talk with your lips.
The number of surgeries necessary to fix a cleft lip depends on the severity of the cleft, as well as other factors.
If your child has a cleft lip and palate, there are several ways to repair the damage done to their lip and palate during birth. In most cases, this involves several surgeries over time, but there are also some less invasive options that can be used in conjunction with traditional treatment.
A cleft lip is a birth defect of the lip. It can be fixed by plastic surgery, but it’s often recommended to have the surgery while your child is still young. The good news is that your baby’s lip will grow back in time, so you won’t feel like you’re doing anything more permanent than giving your child an ice cream cone!
There are a few different types of surgery options available for fixing a cleft lip. Each option has its pros and cons, so it’s important to find one that works for you and your family.
How many surgeries to fix a cleft lip
Surgery Options:
– Lip Plasty: Lip plasty involves reshaping your baby’s upper lip to give it a more natural appearance. This is usually done when your baby is between 2 months and 6 months old, before the tissue has fully healed from its injury during birth.
– Reshaping Surgery: Reshaping surgery involves reshaping the whole upper lip or just part of it to restore symmetry between sides of the mouth. This surgery usually takes place between 2 months and 6 weeks after birth (when full healing has occurred), though there are exceptions—some people may need this surgery as early as 3 weeks old!
The cleft lip is a condition that affects the lip, which is the tissue that separates the nose and mouth. It can occur at birth, but it’s also common in adults.
The surgery to fix the cleft lip involves removing excess tissue from one side of your face, so that you’ll have an even appearance. The surgeon will also take care of any loose or missing teeth, as well as any problems with your tongue or jaw.
During this procedure, you will be given general anesthesia. You’ll remain asleep during the surgery and wake up after it has finished.
When you’re born with a cleft lip, the doctor will likely recommend surgery. This is because a cleft lip doesn’t heal well on its own. If you don’t have cosmetic surgery, you won’t be able to eat or speak properly and may need speech therapy.
Surgery can help improve your appearance by repairing the cleft and creating an illusion of symmetry between the two lips. The surgery also allows you to eat and drink more comfortably, which can make things easier for your whole body.
The type of surgery that works best for your case depends on how much of your lip is missing and what problems it causes (such as speech difficulties). If there’s only a small amount missing, lip lifts are often performed; this involves reshaping the upper lip so that it looks like a normal one. If there’s more than just a small amount missing, then a dermoidectomy may be needed; this entails removing all or part of the tissue from inside your mouth so that there isn’t any longer left over after surgery is complete.”
cleft lip surgery for adults
With advancement of medical services in developed countries and awareness among the patients, it is rare to find an adult with an unoperated cleft lip and palate. However, the scenario is totally different in developing countries. Working as a part of a team in developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal, the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic multidisciplinary care, the priority is getting treatment for all cleft patients. In such situation, the management of cleft lip and palate demands changes of approach, techniques and philosophy.
Aims and Objectives:
The deformed anatomy especially the facial bones and dentition is described. Due to well established deformities, the approach for management is individualized. The procedures and modification of procedures has been described.
Results and Outcome:
The outcome of the primary repair is adults certainly have less than satisfactory outcome for obvious reasons. The expected outcome and expectation of patients and families following primary surgeries in cleft lip and palate has been discussed. Though all adult patients got some improvement in speech after palate repair, achieving normal speech was difficult. The naso-labial appearance was not perfect, but well accepted by the patients and families. There are many psychosocial problems in these patients, the objective evaluation could not be done due to too many variables. However, primary repair of cleft lip and palate is justified and beneficial for the patients.
INTRODUCTION
In developed countries, with the advancement of medical services and awareness among patients, it is rare to find adults with un-operated cleft lip and palate. However, the scenario is totally different in developing countries. Working as part of a team in a developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal and the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic, multi-disciplinary care, the priority is getting treatment for all cleft patients. In such situations, the management of cleft lip and palate demands changes the approach, technique and philosophy.
Facial Bones and Dentition
The growth and deformities of facial bones in a cleft lip and palate patient is uniquely affected by failure of fusion of bones and matrix due to cleft starting from embryonic phase to complete growth. As expected, the facial bones have a normal potential to grow, though mal-positioned in cleft patients. Growth disturbances, especially mid-face retrusion, in cleft lip and palate patients following surgical treatment is a common finding.[1,2] Many details have been written in literature about the growth of facial skeleton in un-operated cleft lip and palate patients. Studies on un-operated adult cleft patients showed that majority of them have normal growth potential without any maxillary retrusion and actual protrusion of maxilla on non-cleft side. The protrusion of maxilla on non-cleft side in unilateral cleft lip and protrusion of pre-maxilla in bilateral cleft lip is mainly because of the absence of normal lip musculature and their forces. In addition, tongue positioning itself into cleft, rotates the alveolus with teeth into more anterior, superior and lateral position. It has showed normal SNA, SNB and ANB angle in un-operated cleft individual as compare to normal control group.
Some variations which are secondary to the cleft, though not directly affected by it, have been noticed in mandible. Though mandible has a normal length of ramus and body, the gonial angle is obtuse and mandibular angle to cranial base has increased. These changes put mandible in retruded position with increase in lower facial height. Obviously, due to cleft, there is proclination, rotation and mal-position of anterior maxillary teeth which also alters the mandibular teeth. Often these teeth are permanent and with cleft, compromised bone stock, it is often difficult to realign these teeth orthodontically before surgery [Figure 1]. These skeletal and dental changes demand modification of approach and technique.
Cephalogram and dental deformities in unoperated cleft patient
Protocol and plan
Treatment plan is individualized according to age, problem and modified to suite the social condition. Majority of these patients seek quick solutions without frequent visits to the hospital and financial burden of the treatment. In older patients, the surgeon fights with more pronounced soft tissue deformity, wider clefts and unmolding skeletal structure. Functional rehabilitation is the main priority followed by appearance. For all patients older than one year, undergoing primary surgery, the cleft palate is repaired earlier than lip repair. Un-repaired lip forces patients to come back for the surgery and during these few visits, we counsel and treat them for speech and dental deformities. For majority of the patients, the improvement after primary surgery is satisfactory. Primary surgeries provide them enough improvement and majority of the patients do not follow up for secondary correction in spite of counseling and free services which include travel cost. The social circumstance and environmental interaction of these patients is often limited to the family and village.
SURGICAL PROCEDURES FOR UNILATERAL CLEFT LIP AND PALATE
Cleft palate repair
The complete cleft of palate was repaired by two flap technique with intravelar veloplasty as described by Sommerlad. In incomplete cleft of secondary palate, Von Langenback technique with intra-velar veloplasty was done. We also preferred alveolar extended palatal flap, which helps to avoid post-alveolar fistula. The specific problems faced in adult cleft palate repair are:
Vertically oriented shelves make paring incision very difficult. We often raise the muco-periosteal flap from the lateral incision and then take paring incision under direct vision from inside out. Adherent periosteum is likely to bleed more giving rise to more possibilities of raising flap in wrong planes. A good nasal layer repair will prevent fistulae like in young children. Cleft palate repair before lip repair allows good exposure to anterior palate region and nasal layer repaired up to the nostril floor.
Post-operatively, all adult patients are started on a semi-solid diet with proper hygiene. Liquid diet like juices and milk shakes are more expensive and unaffordable by many patients. A large quantity of liquid diet is necessary to satiate the hunger in an adult patient. This forced us to change to soft, well-cooked diet immediately post-operatively, from day one, which is much cheaper and easily available.
Aggressive speech therapy is necessary[5,6] but not possible in majority of the patients for logistic reasons which are also the likely reasons for late primary treatment. However, all patients are counseled for home speech therapy. Velo-pharyngeal incompetence correction is done only when patients are motivated and followed up for speech therapy and likely to follow up for speech therapy in future.
Cleft lip repair
Six months after the palate repair, lip repair is done. Either straight line repair for minor cleft, classical Millard for incomplete, or Mohler’s modification of Millard’s repair for complete cleft is done. The wide cleft often demands extensive sub-periosteal dissection, up to the zygoma, to mobilize cheek muscles. Primary nose correction is done either as closed nose for minor correction or with the help of marginal incision on the cleft side to position lower lateral cartilage more medially and superiorly with dome to dome suturing to the opposite.
Too much septal work during primary lip repair is avoided because most of the patients need final rhinoplasty. Mal-positioned and mal-rotated teeth often pose the problems of breaking the mucosal suture line [Figure 2]. However, eventually the mucosa heals. Very rarely, to avoid trauma, we need to put the lining between mucosal suture lines and protruding teeth.
Unilateral cleft lip and palate repair
MANAGEMENT OF UN-OPERATED BILATERAL ADULT CLEFT LIP AND PALATE
In addition to problems faced in unilateral cleft lip repair, bilateral cleft lip has the most noticeable and difficult problem of pre-maxilla. The protruding and twisted pre-maxilla add to the problems of surgical management of complete bilateral cleft lip and palate in older patients. The protruding pre-maxilla, unrestrained by either of the maxillary alveoli, is only attached to nasal septum by a septo-maxillary ligament. In normal children, the cartilaginous septum must slide forward in relation to the pre-maxillary region due to the restraint on pre-maxilla by lip musculature and lateral maxillary segments. In the bilateral cleft, the pre-maxilla is carried forward at the same rate as that of the growing septum to which it is firmly held. The pre-maxilla has only one restraining connection, the vomer. This restrain is realized as a tension between these bones borne by the vomero-premaxillary suture, thus creating the condition for bone formation. Often there is disproportion between the size of the pre-maxilla and the gap where it should lie between the maxillary segments.[8,9]
Protruding pre-maxilla in older patients coming for the primary treatment is usually protruding and often rotated. This prevents proper bilateral cleft lip repair. Pre-maxilla in adults is unlikely to mould and re-align under the pressure of repaired lips. In adults, when pre-maxilla is protruding more than 8-10mm, compared to the lateral arch and if other condition permits, pre-maxillary set back is planned with cleft palate repair. Our protocol for bilateral adults’ cleft lip and palate is as shown in flow Chart 1.
Our plan of managing protruding premaxilla in unoperated adults
When pre-maxillary is protruding more than 8-10mm, the lip repair becomes very difficult and closure of peri-alveolar oral and nasal layer is compromised. These patients are likely to undergo multiple secondary surgeries which also include repair of oro-nasal fistulae in anterior region of protruding pre-maxilla. To achieve optimal results with fewer surgeries, the present technique of palatal repair and pre-maxillary setback as the primary operation in a single stage was adopted. Padwa et al. suggested that a protrusive pre-maxilla could be surgically repositioned after six to eight years without deleterious effects on mid-facial growth. Freihifer et al. also noted that the development of maxilla by this age (8 to 13 years) is far advanced and the growth disturbance at this age by pre-maxillary setback has only a relatively restricted negative influence.
Cleft palate repair
Bilateral cleft palates, like unilateral, are usually very wide with vertically oriented shelves. Vomer is usually unattached to any shelf and hanging in the middle from the cranial base. Often this is complicated by protruding pre-maxilla and very short vomer lying deep away from lateral shelves. The two-flap technique with alveolar extension is routinely done with intra-velar veloplasty. Mucosa on vomer is cut in midline and two flaps were raised. All efforts are made to utilize the vomer flap for nasal lining repair. If pre-maxilla is protruding more than 10mm or severely mal-positioned, not amenable for the orthodontic treatment, set back is done at the same time as palate repair.
Mucoperiosteal flaps are raised on both the palatal shelves. The nasal mucosa is separated from the palatal shelves and vomerine flaps raised. Bilateral vomerine flaps are sutured to nasal layer of palatine shelves to repair nasal layer up to the junction of hard and soft palate and intravelar veloplasty carried out.
The required amount of bone is then removed anterior to the vomero-premaxillary suture. The nasal septum is separated from the superior aspect of pre-maxilla and aligned with the lateral maxillary segments. The pre-maxilla is held in a new position and fixation is done with “K” wire. For additional stability we have carried out gingivoperiosteoplasty on the side which is closely aligned and where the alveolar defect was minimal [Figure [Figure3A,3A, ,3B].3B]. Simultaneous bone grafting of the cleft alveolus has been avoided in all the patients due to inconsistency of obtaining watertight closure.
what to expect after cleft lip surgery
A cleft lip is a birth defect that results when tissues of the lip and bone of the upper jaw fail to fuse during early development of the fetus. This failure occurs during the 4th and 6th week of gestation. The condition varies from a small notch in the red part of the lip (Fig. 2) to a wide gap in the lip and gum line extending into the nostril of the nose (Fig. 3). A cleft lip may occur on the left side, the right side, or both sides (Fig. 4). Cleft lip surgery is required to repair a cleft lip.
How common are cleft lips?
Roughly 1 out of every 1000 children are born with a cleft lip. About 70% of these children will also have a cleft palate. The other one third will have only a cleft lip. Cleft lip is more common in certain ethnic groups. It is more common in Asians, Latinos, and Native Americans and much less common in Africans.
What causes a cleft lip?
Fig. 2 – Small incomplete cleft lip
It may surprise you to know that despite years of research we still do not have a great understanding of why cleft lips occur. Most doctors and scientists agree that clefts are a combination of genetic as well as environmental factors including drugs, infections, maternal illness, and possibly vitamin deficiencies. There is recent medical evidence to suggest that mothers with diets rich in folic acid (fruits, vegetables, and other high folate containing foods) who take folic acid supplements during pregnancy have a lower risk of having a baby with a cleft lip.
Other birth defects can occur in children with cleft lips. Some of these defects are obvious and some are more difficult to detect. However, most children born with a cleft lip and/or palate are otherwise normal, healthy children.
How is a cleft lip repaired?
Fig. 4 – Bilateral cleft lip
The repair of a cleft lip requires surgery and general anesthesia. Many different techniques have been developed over the years to repair cleft lips. Different techniques are appropriate for different kinds of cleft lips. Your doctor will select the type of corrective surgery for cleft lip that is most appropriate for your child’s type of cleft lip.
When is the right time for cleft lip surgery?
Some parents wonder if their baby’s cleft lip can be repaired right away. Some even want it done before they take their baby home from the hospital. However, it is best to wait until your child is at least 8 to 12 weeks old before having a cleft lip surgery procedure to repair the lip.
Waiting a short period of time after birth has many advantages. This short period of time allows your child to establish a good pattern of feeding and weight gain which is important during cleft lip repair recovery. It also allows you and your family to adjust your lifestyles to the joys and stresses of welcoming a new child into your family. It is important to establish the parent-child bond during the first weeks of life before having to cope with the cleft lip surgery recovery. Also, there is no advantage to repairing the lip any sooner. The results will be the same either way.
Can I breast feed my child with a cleft lip?
Fig. 3 – Complete unilateral cleft lip
That depends! If your child does not have a cleft palate, then he/she can and most likely will successfully nurse at the breast. A cleft lip does not prevent a child from breast feeding successfully (even a wide cleft lip involving the gum line, Fig. 3).
However, if your child also has a cleft palate then he/she does not have the ability to generate an effective “suck” and will not be able to breast feed successfully. Some well-intentioned friends and/or medical professionals may encourage you to try and breast feed your child anyway. Unfortunately encouraging a mother to breast feed a child with a cleft palate only sets mother and baby up for failure. But rest assured, there are ways to successfully feed a child with cleft lip and palate. More specific information is available on our cleft lip and palate feeding page.
Are there any instructions I need to follow before cleft lip surgery?
Your child must have a physical examination by his or her pediatrician or family doctor within 7 days before surgery to make sure he or she is in good health. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.
For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child’s surgery will be cancelled.
What can I expect after cleft lip surgery?
A cleft lip repair usually takes between 2 and 3 hours. Your doctor will talk to you as soon as the surgery is over.
Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour. When your child is awake, he or she will be admitted to the hospital for an overnight stay. You can accompany your child when he/she is transferred to your hospital room. Your may begin feeding your child (breast or bottle) as soon as you get settled. One or both parents can stay with your child the entire time he/she is in the hospital. In fact, we encourage at least one parent to stay with your child during the hospitalization.
After surgery, your child will have soft splints wrapped around the arms. These splints prevent your child from rubbing the lip. These splints can easily be removed when you are holding your child and have the ability to prevent your baby from rubbing the lip. The arm splints should be worn at all other times for 2 weeks after the cleft lip procedure.
Children can almost always go home the morning after surgery. In some cases a child may have trouble feeding or need a little more time in the hospital to control pain.
how successful is cleft palate surgery
Cleft palate surgery is generally considered to be a very successful procedure. According to the American Society of Plastic Surgeons, the success rate for cleft palate surgery is approximately 90%. However, the success of the surgery can depend on a number of factors, including the severity of the cleft and the age of the patient.
Cleft palate surgery is typically performed between the ages of 6 and 18 months, and is often done in conjunction with cleft lip surgery. During the procedure, the surgeon will close the gap in the roof of the mouth by repositioning the tissue and muscles in the area. The surgery usually takes a few hours to complete and is performed under general anesthesia.
After the surgery, the patient can expect some discomfort and swelling in the affected area. Pain medication may be prescribed to help manage any discomfort, and the patient will be advised to eat soft foods and avoid anything that could irritate the surgical site. In most cases, patients are able to return to normal activities within a few weeks.
While cleft palate surgery can be a complex and challenging procedure, advances in surgical techniques and technology have greatly improved the success rate and outcomes of the surgery. With proper care and follow-up, most patients are able to achieve excellent results and lead normal, healthy lives.
