Many adults cleft deformities have not had the benefit of being treated with the modern techniques described in this booklet. To help these individuals, may surgical techniques are available to improve their appearances and / or to achieve better speech production. One is never too old to benefit from recent advancements in the multidisciplinary management of clefts.
Secondary Correction of the Lip Deformity
This surgery can be performed at any age and will benefit the patient aesthetically and functionally. Among the surgical procedures that may be used to correct secondary lip deformities, it is important to mention the Abbe flap procedure. It may be necessary for people who have a tight upper lip and who do not wish to undergo maxillary adavancement surgery. This operation helps to relieve lip tightness which may be present after advancement procedures. It also increase the fullness and length of the upper lip by moving a portion of the lower lip tissue into the center of the upper lip. At the same time, surgery may be helpful in lengthening a short columella.
Marking and minimal muscle dissection is done on the cleft sides.
Lower lip dissection is done to raise the Abbe Flap.
Abbe Flap is sutured to create a columella and prolabium.
Flap is depediclised after three weeks.Secondary Surgery of the Palate
Careful evaluation by a highly experienced plastic surgeon and by a speech pathologist may determine the possibility of performing palatal surgery to achieve complete closure of the palatal defect and, at the same time, to retain normal speech production.
Individuals who have had cleft palate surgery, but have palatal fistulas, may have the fistulas closed at any time in life. At an older age, palatal fistulas present a serious nuisance and can be closed with a prosthesis to avoid fluid leakage and to keep food from entering the nasal cavity. Fistulas may also affect speech production.
Anterior palatal fistula.
Closure of the nasal layaer and extent of tongue flap.
Tongue flap raised.
Tongue flap sutured in place and depediclised after three weeks.Mid palatal Fistula closure
Pre op
Immediate post op
3 months post opSurgery for Improvement of Speech.
Surgical procedures such as pharyngeal flap or pharyngoplasty, Modified Furlows ‘Z’ Plasty with Levator Myoplasty can correct long-standing cases of velopharyngeal insufficiency. Combined with intensive speech therapy, even adults can achieve more normal speech.
Incision marking.
Closure of nasal layer with Levator Myoplasty
Closure of nasal layer with Levator Myoplasty
Pre op
Immediate post opAlveolar Bone Grafting
As of now alveolar cleft defect grafting include autologous bone grafts, as none of the current modalities in practice can replace autologous bone graft and iliac crest is the most commonest donor site. It allows tooth eruption through grafted bone, Stabilization of maxillary arch, improving the condition for prosthodontic treatment such as crown, bridges and implants, providing bony support for orthodontic closure of teeth in cleft region.
Cortico cancellous bone graft harvested from iliac site.
Cortico cancellous bone graft harvested from iliac site.
Crevicular Incision extending around the defect to reflect the mucoperiosteum
Sharp dissection to separate the nasal layer from oral layer
Cortico-cancellous Bone mixed with PRP, grafted into the defect.
V-Y Closure increase vestibular length with water tight suturing
PRE OP OPG
POST OP OPGSecondary Correction of Nose
This surgery can be performed at any age to improve the appearance of the nose and / or nasal breathing.
Incision marking.
Dissection of columella
Dissection of lower lateral cartilages and septo-maxillary ligament.
Dissection of upper lateral cartilage and isolation of septum.
Harvesting septal graft and septoplasty.
Repositioning of lower lateral cartilages and approximating upper lateral cartilage.
Placement of strut and wedge incision to reposition ala of nose.
Final suturing and finishing.Orthognathic Surgery
Surgery on the jaws (orthognatic surgery) can help to reduce the flattening of the face which is characteristic of severe cleft deformity. By using modern osteotomy techniques along with bone and cartilage grafts, the upper and lower jaws and facial skeletal framework are moved and appropriately reconstructed. Presurgical orthodontic treatment is usually recommended.
Incision marking
Osteotomy
Miniplate fixation
Immediate post opDistraction Surgery
The latest development in correcting the facial skeletal framework is by using devices known as Distractors. These devices work by incrementally pulling or pushing the bone 1mm at a time over a period of two to three weeks. This slow increase in bone width will result in fresh bone forming in the gap created while the distraction is going on.
Immediate post op
Rigid external distraction device in situ
Rigid external distraction device in situ
Anterior maxillary distraction deviceOther Therapies
A Number of surgical, orthodontic and speech related therapies are available to adults who desire additional treatment. In addition, psychological and social consultations can help people deal with the impact of cleft lip and/or palate problems.
