Protocol
   Lip Surgery
   Palate
    Scar Revision
   Nasal   
 
 Treatment - Lip Surgery
    Unilateral Cleft Lip Surgery
   
The primary repair of the cleft lip is done at the age of 3 months. This timing can vary based on individual circumstances. In most cases, the tissue in the area around the the cleft is rearranged to close the opening. An important part of the surgery involves detaching and repositioning the muscle of the lip to recreate the circular muscle around the mouth that will allow the lips to pucker.

The incisions are normally planned and the natural shape of the upper lip (“cupid’s bow”) is reconstructed. The lip can be repaired in a single step or in multiple procedures, depending on factors such as the width and extent of the cleft. The surgeon may try to provide some additional support for the nose during the lip repair, but he/she will generally not attempt full nasal reconstruction on an infant.

In repairing a unilateral cleft lip, it can be difficult for the surgeon to make the repaired side exactly match the unaffected side. It may take more than one surgery to achieve the best possible appearance and function of the child’s lip. This is especially true because as the child grows, the scars from previous surgeries may not grow and stretch in the same way as skin without any scars. As your child’s face develops, there may be a time when it would be appropriate and beneficial to have a “touch up” surgery to improve the appearance of the lip. If your child is dissatisfied with the result of the initial repair, this additional surgery might be performed before he/she starts school. Multiple touch-up procedures are generally not recommended, though, because each surgery creates more scar tissue.
     
  Bilateral Cleft Lip Surgery
    Repair is done at 3 months of age. Correct muscle reconstruction is essential for normal lip and normal appearance. Therefore the lateral muscles must be connected between the prolabium (central segment of the lip) and the premaxilla. After the surgical closure of the bilateral cleft lip nasal appearance is flatter than normal in the antero posterior dimension. This is surgically corrected at 12 months of age. Attempts should never be made to resect the premaxilla either partially or in total, in order to achieve closure of a bilateral cleft lip, as this will lead to severe mid facial growth disturbances. Such a resection is never justified.
     
  Abbé - flap surgery:
    This is done in cases of thin upper lip with wide scars. The upper lip lying on the bony upper jaw lacks proper amount of forward projection In this surgical repair of the philtrum (a vertical groove in the middle portion of the upper lip) and correction of the whistling like appearance of the lip is done. An incision is made on the prominent part of the lower lip which is elevated and rotated into the upper lip and the sutures are placed. After 15 days of surgery, the sutures are removed which improves the aesthetic. The patient has to have a liquid diet during this time