Primary lip repair for unilateral cleft lip and palate
Baby girl with unilateral cleft lip and palate presents for surgery This is a 3-month old baby girl from Guwahati born with a unilateral cleft lip and palate. Her parents were very disturbed over this. They decided to search the Internet for the best cleft lip and palate repair surgeon. This brought them straight to our hospital seeking treatment for her cleft deformity. They expressed their anxieties over their daughter’s condition. Patient examined and surgical plan presented to parents Cleft lip and palate repair specialist Dr SM Balaji examined the patient. His decision was to perform the modified Millard’s technique. The parents were in complete agreement with his treatment plan. Successful surgical correction of cleft lip Surgery for the little girl was a resounding success. Following surgery, she looked like any other baby girl of her age with minimal to no scar. The parents were very pleased with the results. Cleft palate correction surgery will be at a later date.
Single sitting simultaneous unilateral cleft palate and lip repair
A boy from Ladakh with unilateral cleft lip and palate The patient is a 10-month-old boy with unilateral cleft lip and palate deformity. He lives with his parents in Leh. His family is from a pastoral background. A Good Samaritan from Delhi happened on this little boy during a trek in Ladakh. He offered to help the child and the parents accepted his help. The Good Samaritan did extensive Internet research. This was to find the best cleft lip and palate surgeon who could perform a total cleft repair in one sitting. His search led him straight to our hospital. Treatment planning for simultaneous cleft lip and palate repair Dr SM Balaji examined the patient and ordered imaging studies. He explained to the parents that both cleft lip and repair would undergo surgery. He undertook the surgery after detailed presurgical planning. Simultaneous cleft lip and palate repair surgery performed Under general anesthesia, cleft palate repair was first undertaken. Bilateral palatal flaps were first raised based on the greater palatine vessels. The Levator palatine muscles were then detached from their abnormal positions. These were then reattached into normal position like a hammock. A two layer closure was then done. The nasal floor was first closed in a separate layer with the vomerine flap making a reverse knot. Oral layer was then sutured by vertical mattress sutures. The vertical mattress sutures produce a ridge of thick mucoperiosteum. Flaps were then approximated to each other in the midline. This technique repositions the levator muscle in a more favorable position. Greater palatine osteotomy was then done to mobilize the artery. This was from the greater palatine canal. The suction test performed at the end showed good results. Unilateral cleft lip repair was then performed with the modified Millard’s technique. This resulted in a very good lip seal producing good esthetic results. Parents satisfied with very good surgical results The parents expressed their immense gratitude before discharge from the hospital. Surgery Video
Upper jaw Advancement Surgery Unilateral Cleft Hypoplasia – Lefort 1 Advancement Surgery
Patient presents for maxillary advancement surgery This young lady had been born with a unilateral cleft lip and palate. She had undergone cleft lip repair at our hospital at the age of 2 months. Cleft palate repair was later performed at the age of 10 months. After this, she had rhBMP-2 surgery for uniting the two pieces of the maxilla into one single bone. The patient now has a hypoplastic retruded maxilla with anterior crossbite. This had been causing her cosmetic problems with a deficient upper jaw. She wanted to have this corrected through surgery. The patient has also been undergoing fixed orthodontic treatment for cosmetic teeth alignment. Le Fort 1 maxillary osteotomy planned for the patient Dr SM Balaji is a renowned cleft lip and palate patient rehabilitation specialist. He decided to perform a LeFort 1 osteotomy with maxillary advancement for the patient. Complete correction of the patient’s crossbite occlusion Under general anesthesia, a mucogingivoperiosteal flap was first raised in the maxilla. A LeFort 1 osteotomy was then performed. The maxillary bone was then advanced by 2 cm. It was then stabilized in place with four L-shaped four-holed plates. Occlusion was then checked and deemed to be in perfect alignment. The mucogingivoperiosteal flap was then sutured back in place. She would need further fixed orthodontic treatment to perfect her teeth alignment. Postoperative period was uneventful. The patient expressed her happiness at the results of the surgery before discharge.
Cleft Orthognathic Surgery, LeFort I Advancement for Bilateral Cleft Lip and palate Surgery
Young Nepali girl with extreme crossbite of the jaws This teenage girl from Kathmandu, Nepal was born with a bilateral cleft lip and palate. Her parents brought her to our hospital for correction of her deformities. She had undergone cleft lip repair at two months of age and cleft palate surgery at 10 months of age. She had surgery with rhBMP-2 for repair of her cleft alveolar bone at 4-1/2 years. This was to repair and unite the maxilla, which was in three segments. She had developed an anterior crossbite due to deficient growth of the maxilla. As a result, she has had difficulty with eating and speech all her life because of her crossbite. Her parents decided to get her problem corrected through surgery. They then brought her back again to our hospital for correction of her problem. Treatment planning for crossbite correction Prof SM Balaji, Cranio-maxillofacial surgeon, examined the patient. The patient was very familiar to him as he was her surgeon since her infancy. He ordered a 3D axial CT scan and other pertinent studies. Once he had decided on the treatment plan, he explained it to the parents and the patient. They were in complete agreement with his plan of treatment. Surgical correction of the patient’s crossbite A maxillary vestibular incision was first made after induction of general anesthesia. A maxillary osteotomy was then performed. The osteotomized maxilla was then advanced forwards to correct the anterior crossbite. This was done utilizing two plates on each side with four screws per plate. It was for stabilizing the maxillary bone during the healing period. The bite was then checked and there was complete correction of the crossbite. Incisions were then closed with sutures. The patient expressed complete satisfaction with the results of the surgery. Surgery Video
Unilateral Cleft Lip and Palate Rhinoplasty
The patient presents for rhinoplasty This young child was born with a right sided cleft lip and palate. She had undergone corrective surgery of her cleft lip as an infant. She now presents for rhinoplasty for correction of her nasal deformity. Surgical correction utilizing rib grafts Under general anesthesia, an incision was first made. A rib graft was then harvested from the patient. Valsalva maneuver demonstrated patency of the thoracic cavity. The incision was then closed in layers. The graft was then crafted for use as a strut graft and an alar cartilaginous graft. Attention was next directed towards the nose. Intranasal incisions were then made to avoid scar formation. The cartilaginous graft was then tunneled into position and stabilized with sutures. Scar revision and alar skin removal procedure Attention was next turned to the scar from the old cleft lip surgery. Scar tissue was first marked and then removed. A small strip of tissue was then incised and removed from the outer aspect of left alar region. This was then closed with sutures. The procedure resulted in establishment of symmetry of the nostrils. Surgery Video
Unilateral Cleft Lip Correction Surgery – Dr. SM Balaji, Maxillofacial Surgeon, India
Baby boy is born with a unilateral cleft lip and palate: This baby boy is the grandson of a famous merchant in Bangalore, Karnataka. He was born with a severe form of unilateral cleft lip and palate. There was a wide cleft space with ill developed segments. Balaji Dental and Craniofacial Hospital, a world-renowned cleft surgery centre: The family searched far and wide for the best cleft surgeon in India. They made enquiries all over the country, including all metro cities. Friends too joined in the search for the best hospital. One friend finally zeroed in on Balaji Dental and Craniofacial Hospital in Chennai. Further enquiries revealed it to be a world-renowned centre for cleft correction. The parents then made discreet enquiries about the hospital. Once satisfied, they presented at our hospital for repair of the cleft deformity. Dr SM Balaji, Cranio-maxillofacial surgeon, examined the baby. He decided to perform a modified Millard’s Technique to repair this baby’s cleft lip defect. Dr Balaji explained this to the parents in detail. The parents consented to the operation. Perfect adaptation of the cleft halves of the upper lip: A modified Millard’s technique leads to less scarring. It also gives better functional and esthetical results. Customization of the approach depends upon the degree of cleft and muscular involvement. Being ambidextrous (the ability to work with both hands) is an advantage for this surgery. A modified Millard’s flap was first employed. The C flap was then used to recreate the nasal sill while the M flap was next used to create the floor of the nose. All tissues were well used in the reconstruction and there was no tissue wastage. There was a perfect adaptation of the two halves of the cleft. Need for further surgeries explained to the parents: The need for further surgeries was then explained to the parents. This would be necessary for the complete rehabilitation of the baby’s deformities. Surgery Video
Velopharyngeal insufficiency (Hypernasality) Nasal Speech Correction Surgery for Cleft Palate- Pharyngoplasty with positive suction test
Initial Presentation This young man from Yangon, Myanmar, had been born with a cleft lip and palate and had undergone cleft repair as an infant. He had subsequently developed velopharyngeal incompetence, where there is escape of air through the nose during speech. This had lead to him having difficulty pronouncing certain words well and he also had a nasal twang to his voice. He had very limited mouth opening. He presented to Balaji Dental and Craniofacial Hospital, Teynampet, Chennai for surgical correction of his speech difficulties. He had been referred to a speech pathologist who advised him for a sphincter pharyngoplasty surgery to correct his velopharyngeal incompetence/hypernasality. Treatment Planning and Surgery Dr SM Balaji, Cranio-Maxillofacial Surgeon, examined him and advised him that he needed a pharyngoplasty surgery for correction of his problem. The patient agreed to this and was scheduled for surgery. This surgery is performed for the creation of a dynamic sphincter in the pharynx by repositioning of the palatopharyngeus muscle. The patient was taken to the operating room and underwent general anesthesia without complications. Incisions were made to release the posterior faucial pillars, including the palatopharyngeus muscle. These were then crisscrossed and sutured together on the posterior pharyngeal wall. This formed a sphincter along with the formation of a small opening or “port” for the patient to breathe through his nose. Though his mouth opening was very limited, his sphincter pharyngoplasty was very successful. Successful Positive Suction Test Demonstrates Successful Surgery Successful demonstration of a positive suction test at the completion of the surgery revealed a dynamic velopharyngeal sphincter action thus indicating successful correction of his velopharyngeal incompetence. The patient was then extubated and recovered from general anesthesia without complications.
Unilateral Cleft Lip Correction Surgery – Suture Removal on 7th day
Initial Presentation: This is a 2-month-old baby boy from Sri Lanka who was born with a unilateral cleft lip and palate defect. His parents related that his elder sister had also been born with the same condition. She had been operated on elsewhere in India, but the surgery had left behind ugly residual scars. So when their son too had been born with a similar deformity, they wasted no expense in searching far and wide for a cleft lip repair specialist. They finally zeroed in on Balaji Dental and Craniofacial Hospital, Teynampet, Chennai after extensive research done over the Internet and meeting parents of previous patients. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the child needed primary cleft lip repair surgery using the modified Black’s technique in order to recreate a tight lip seal. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the boy at the hospital for suture removal. There was perfect vermillion border approximation, good columellar form and good overall appearance. There was negligible scar formation, which would slowly fade away over time. The baby was also feeding well. Both esthetic as well as functional outcomes of the surgery were good. Complete Rehabilitation: It was explained to the parents of the boy that he would need further surgeries in the future, which would have to be planned out in a phased manner for further correction of his cleft defects.
Bilateral cleft lip correction surgery suture removal on 7th day
Surgical Planning: This is a 2-month-old baby girl from Bahrain was born with bilateral cleft lip and palate. Her parents were referred to Balaji Dental and Craniofacial Hospital, by a close friend of theirs whose daughter had been operated upon by Dr. Balaji with very good results. Dr. S. M. Balaji, Maxillo-Craniofacial Surgeon, explained to them that the goal of this primary surgery is to recreate the lip seal. The parents consented and the child was scheduled for surgery. A modified Black’s technique cleft lip repair was done. Suture Removal: Seven days after the surgery, the parents presented with the baby for removal of sutures. There was very good approximation of the vermillion, structural appearance of the columella and nice overall appearance to the nose. She was taken to the operating room where the sutures were removed. There was very negligible scar formation and the final appearance of the baby girl was good with satisfactory functional outcome. It was explained to the parents that subsequent phased surgeries will have to be done for correction of the other defects.
Primary cleft lip repair for a child with unilateral cleft lip and palate
A Baby with Unilateral Cleft Lip and Palate A 3-month old baby boy born with unilateral cleft lip & palate was brought to our hospital by his parents seeking the best treatment for cleft lip and palate. The parents were greatly disturbed on seeing their firstborn son’s condition. Primary cleft lip repair Maxillofacial Surgeon Dr. S.M. Balaji performed the primary repair surgery for unilateral cleft lip using Modified Millard’s technique. Following surgery, the baby appeared to be like any other baby of his age with minimal to no scar. The parents were overjoyed with the results. Consecutively cleft palate correction surgery will be done at a later date.