Cleft lip surgery should ideally be done at:
Ans. B. 5 - 6 months. (Ref. LB 25th/pg. 660)"Cleft lip repair is commonly performed between 3 and 6 months of age whereas cleft palate repair is frequently performed between 6 and 18 months".Cleft lip:Embryology & pathogenesis:# Unilateral cleft lip results from failure of the maxillary prominence on the affected side to fuse with medial nasal prominences. The result is called a persistant labial groove.# A unilateral cleft lip, commonly on the left side, is more common than a bilateral cleft lip.# Single gene defects that are associated with cleft lip include: Van der Woude syndrome, Opitz Syndrome, Aarskog syndrome, Fryns syndrome, Waardenburg, and Coffin-Siris syndrome.# Medications that can cause it if taken antenatally include alcohol, steroids, antiseizure drugs, vitamin A, and oral anti- acne medications (such as Acutane) taken during the first trimester.# Risk of cleft lip increases with paternal age, especially over 30 yrs at the time of conception.# When the affected child has unilateral cleft lip and palate, the risk for subsequent children increases to 4.2%.# A complete cleft involves the entire lip, and typically the alveolar arch. An incomplete cleft involves only part of the lip.Incidence:# Cleft occurs in somewhere between one in 600 and one in 800 births.# Cleft lip occurs more commonly in males, while cleft palate is more likely to occur in females.Surgical procedure: Patients are: (Rule of 10)# Operated at 10 weeks of age,# With 10 pounds weight, and at# Hb of 10gm%.- "Cleft lip repair is commonly performed between 3 and 6 months of age whereas cleft palate repair is frequently performed between 6 and 18 months".- Operations done for cleft lip are Millard procedure and Mirault-Blair operation.# The Millard procedure begins with an incision on the edge of the cleft side of the philtrum, and the cutting continues upward, medially, and to the side. A second incision extends to the buccal sulcus. The length of this incision depends on the size of the gap to be closed. In this second incision, the surgeon frees soft tissue, which allows him or her to completely lift the lip from the underlying bone. Advantages of the Millard rotation advancement technique include: It is the most common procedure (i.e., surgeons more familiar with it). The technique is adaptable and flexible. It permits construction of a normal-looking Cupid's bow. A minimal amount of tissue is discarded. The suture line is camouflaged. The disadvantage of the Millard rotation advancement technique is the possible development of a vermilion notch (shortening of the entire lip in the vertical direction), resulting from contracture of the vertical scar.Cleft palate occurs due to failure of fusion of medial nasal process to the two palatine processes of maxillary process.Operations for it include Langenbeck's operation. WardilVs four flap operation and VY repair
2 - 3 months
5 - 6 months
10-12 months
12-24 months
Cleft Lip & Palate