Surgical Processes ACHEBE JU HONORARY CONSULTANT PLASTIC SURGEON UNTH

1. ACHEBE JU
HONORARY CONSULTANT PLASTIC SURGEON
UNTH

2.  Common congenital abnormality of the face
 Involves the lips, nose and mouth
 Produces functional or aesthetic problems or
both

27.  Structures that will form the face present about
4-6wks of gestation
 Frontonasal process, paired maxillary and
mandibular prominences
 Bilateral nasal placodes form from the
frontonasal process
 They have medial and nasal processes
 Upper lip formed by fusion of medial nasal
process with each other and maxillary
prominence
 These events occur in the first trimester.

30.  Structures destined to form the palate by
8wks
 Two palatal shelves of the maxilla, initially
vertical with the tongue in between
 Palatal shelves rotate to become horizontal
while the tongue descends
 Palatal shelves start fusion from in front and
proceeds backwards

31.  Failure of fusion
 Lack of mesodermal infiltration after fusion
 both

32.  CLEFT LIP --unilateral- complete or incomplete
 bilateral -complete or incomplete
 median
CLEFT OF THE PALATE----- extent
 CLEFT OF THE LIP AND PALATE—unilateral or
bilateral—complete or incomplete
 SUBMUCOUS CLEFT.

34.  Cleft of primary palate anterior to incisive
foramen –eg cleft lip
 Cleft of the secondary palate- posterior to
incisive foramen-eg cleft palate

35.  White ancestry : 1 in 1000 live births
 Asian ancestry : 1 in 500 live births
 African ancestry : 1 in 2000 live births
 Cleft palate no racial bias 1:2000 live births

36.  White population CLP > CP > CL
 NIGERIA 8o’s CL > CP > CLP
 NIGERIA now CLP > CL > CP
 CL and CLP different entity from CP
 CL and CLP more common on the left and
males
 Isolated cleft palate more common in females
 Associated anomalies including syndromes
more common in CP

37. Environmental teratogens
phenytoin
steroids
alcohol
smoking
GENETIC FACTORS
positive family history
syndromes with cleft—Van der Woudes
pierre robin sequence
velocardiofacial syndro
trisomy 21
Cleft lip and cleft lip and palate gentically different from isolated
Cleft palate

38.  From childhood to adult
 Multidisciplinary team

39.  PLASTIC SURGEON
 ORAL SURGEON
 ENT SURGEON
 ORTHODONTIST
 PEDIATRICIAN
 SPEECH THERAPIST
 CHILD PSYCHIATRIST
 PEDIATRIC NURSES

40.  History antenatal , family and social history
 Immediate problem feeding, and airway
 Nasal regurgitation of food
 Examination also look for associated abnormality
 Examine the mouth
 Baseline investigation
 Clinical photograph
 Reassure parents and outline management
programme
 Submucous clefts could be missed
 ANTENATAL ULTRSOUND SCAN

47. For cleft palate assess the ear
Higher incidence of sensorineural and
conductive hearing loss

48.  MICROGNATHIA
 CONGENITAL HEART DISEASE
 LIMB ABNORMALITIES
 LIP PITS
 CONGENITAL HERNIA

51.  Cleft lip from 3months
 Cleft lip and palate lip repair as from 3mths
palate repair 10-12mths
Cleft palate palate repair 10-12mths
Pierre Robin’s sequence palate 18 months

52.  RULE OF TEN
 >10wks
 >10 Ibs
 >10gms

53.  Normal appearance of lip, nose and face
 Normal speech
 Normal dentition
 Normal facial development

54.  PRE-OP EVALUATION
 DEFORMITY
 RULE OF TEN
 CLEFT
 ORBICULARIS ORIS
 NASAL DEFORMITY
 MAXILLARY
HYPOPLASIA
 DENTAL PROBLEM

58.  ROTATION ADVANCEMENT TECHNIQUE
[MILLARD]
 STRAIGHT LINE CLOSURE

67.  ASSOCIATED
PROBLEM
 SPEECH
 MIDDLE EAR
INFECTION
 PIERRE ROBIN
SYNDROME
 FEEDING PROBLEM

68.  Adequate mechanism
 Hearing
 Intelligence
 Stimulating environment

69.  consonants
 Hyper nasality
 Nasal escape
 Omission
 substitution

70.  Poor aeration of middle ear
 Secretory otitis media with hearing loss
 Myringotomy and ventilating tubes

71.  10mths ----- 12mths

72.  PRE-OP ASSESMENT
 TIMING OF REPAIR
 METHOD OF REPAIR
 V-Y PALATOPLASTY
 LANGENBECH PALTOPLASTY
 FURLOW TECHNIQUE
 BARDACH TECHNIQUE

80.  HEMORRAGE
 AIR WAY OBSTRUCTION
 BREAK DOWN OF REPAIR
 FISTULA
 VPI
 MAXILLARY HYPOPLASIA

81.  History
 Physical exam
 Nasendoscopy
 videofluroscopy

83.  REVISION OF LIP 4-6yrs
 PHARYNGOPLASTY 6-9yrs
 ALVEOLAR BONE GRAFT 8-11yrs
 MAXILLARY OSTEOTOMY 15-18yrs
 ORTHODONTIC PROCEDURE
 RHINOPLASTY 15-18yrs

87.  LACK OF OTHER SPECIALISTS IN THE CLEFT
TEAM
 Speech language pathologists
 Orthodontists
 Maxillofacial surgeons interested in clefts
 Limited involvement of ENT surgeons in cleft
care
 Poor follow up
 poverty

88.  Functional reconstruction of cleft lip
 Functional reconstruction of cleft palate
 Primary nasal repair at the time of lip repair
 Charity organizations that sponsor cleft care
in the developing countries