To overcome the shortcomings of initial surgery and to correct certain problems where the development is complete during puberty.
Secondary alveolar bone grafting:
After the eruption of incisors are completed, within 6 -7 yrs bone grafting is done. It helps in the eruption of the retained canine and also in the further orthodontic treatment. Even after the surgical closure of the palate at the age of 6 months, there is a hole between the nose and the mouth. To close this gap and to avoid the disturbance in speech bone grafting is done.
Surgical repair of the cleft lip and palate is performed first at the age of 3 months to make suckling easier and then at the age of 6 months for proper speech. The third surgery is done along with bone grafting at the age of 6 years. In this procedure the graft is taken from the rib and placed in the cleft region.
Lip revision surgery:
The surgery is performed at the age of 16 years for scar removal. When the surgical repair of the cleft is done, vermillion border which is a junction between skin and lip is also corrected. To give a proper lip contour suturing should be perfectly done. When the lip revision came into practice, as the vermillion border was not sutured properly the patient demanded the penalty of one million dollar. Hence the suture came to be known as million - dollar suture.
The following aspects are important in this surgery.
Closure of the oro nasal fistula (bony gap between the mouth and the nose)
Correction of the floor of the nose.
Changing the contour of the lip.
Scar removal and proper approximation of the lip helps in growth of mustaches in males.
Changing the shape of the cupid’s bow ( natural shape of the upper lip) .
Adjustment of the unbalanced lip volume as the patient with the bilateral cleft has very thin or very atrophic lip.
Reconstruction of the dry - wet junction of the lip, as it gives the whistling appearance
In unilateral cleft lip, revision and nasal correction is done simultaneously but this reconstruction is more difficult than the bilateral cleft correction.
In bilateral cleft deformity single surgery is not possible because of the insufficient blood supply to the lip.
