Surgical Lip Repair

Question 1

Timing of Lip Repair

Answer 1

Rule of 10’s
Hemoglobin 10 g/dl Weight – 10 lbs
4.5 kg
Age – 10 weeks old

Question 2

Goals of Lip Reconstruction

Answer 2

Restoration of Anatomy

Question 3

Lip Anatomy

Answer 3

– Cutaneous
• Reorientation of philtrum and cupid’s bow • Establishment of nostril sill and lip length
– Cartilaginous
• Reorientation alar complex
– Muscular
• Release of abnormal orbicularis insertion • Establish orbicularis oris integrity

Question 4

Millard Rotation Advancement Cheilorhinoplasty

Answer 4

• 1957 Described two flap technique that placed the surgical scar line with the philtrum
• Most common contemporary technique.
There’s also Bilateral Cheilorhinoplasty

Question 5

Repair of the Cleft Palate

Answer 5

•Anatomy
•Surgical Management of Cleft Palate
–Von Langenbeck Repair
–Bardach’s V-Y Pushback Repair
–Furlow Palatoplasty (Double Opposing Z-Plasty)
•Velopharyngeal Incompetence
–Evaluation –Management

Question 6

Goals of Cleft Palate Repair

Answer 6

Separation of Oral and Nasal Cavities Posterior to incisive canal
Achieve Velopharyngeal Competence
Intravelar Veloplasty
Normal speech development

Question 7

Timing of Palatal Repair

Answer 7

SPEECH
Early Repair
Improved speech
Less compensatory articulation
• GROWTH
– Late Repair
• Less growth restriction

Question 8

Techniques

Answer 8

• Von Langenbeck Repair
• V-Y Pushback Repair
• Furlow’s Double Opposing Z-Plasty

Question 9

Von Langenbeck Repair

Answer 9

• Indications:
– U-shaped cleft palate • Posterior hard palate • Soft palate
Elevation of Hard palatal and nasal mucosa
Intravelar veloplasty: Detachment and Reorientation of abnormal
insertion of palatal musculature
Hard Palate 2-layered closure
Soft Palate 3-layered closure

Question 10

V-Y Pushback Repair

Answer 10

• Indications
– Unilateral palatal cleft
– Wide U-shaped cleft of Hard and Soft Palate
Flaps are repositioned posteriorly

Question 11

Furlow Repair

Double-opposing z-plasty

Answer 11

• Indications:
– Soft Palatal Cleft
– Velopharyngeal Insufficiency • Submucous Cleft
– Unilateral Cleft Lip and Palate
Z-Plasty Incision – landmarks: cleft margin and hamulus
Elevation of Oral Myomucosal Flap
Incision of Nasal Mucosa to create Anteriorly based Mucosal Flap
Elevation of Anteriorly based Oral Mucosal Flap Incision of Posteriorly based Nasal Myomucosal Flap

Question 12

Surgical Treatment of VPI

Answer 12

Superiorly-based
Pharyngeal Flap

Sphincter
Pharyngoplasty

Question 13

Superiorly-based

Pharyngeal Flap

Answer 13

Severe VPI
> 4 mm gap
Immobile velum
Adequate lateral pharyngeal mobility
• Originally described in 1876
• Common-place in 1950’s
• Creates midline subtotal obstruction
• Bilateral ports to allow air passage
• Lateral pharyngeal wall movement creates valve effect to allow:
• Closure during non- nasal consonant production
• Remains open at rest and during nasal consonant production
• Contra-indications
– Velocardiofacial Syndrome
• Anomalous internal carotid arteries
• MRA
– OSA
• Mueller’s Maneuver

Question 14

Sphincter

Pharyngoplasty

Answer 14

Moderate VPI

•