32. PROCEDURE TIMING
CLEFT LIP REPAIR 3-4 MONTHS
CLEFT PALATE REPAIR 9-18 MONTHS
PHARYNGOPLASTY 3-5 YRS OR LATER BASED ON SPEECH
DEVELOPMENT
MAXILLARY/ALVEOLAR
RECONSTRUCTION WITH BONE GRAFTING
6-9 YR BASED ON DENTAL DEVELOPMENT
CLEFT ORTHOGNATHIC SURGERY 14-16 YR IN GIRLS
16-18 YR IN BOYS
CLEFT RHINOPLASTY AFTER 5YR BUT PREFERRED AT SKELETAL MATURITY
AFTER ORTHOGNATHIC SURGERY.
CLEFT LIP REVISION ANYTIME INITIAL REMODELLING & BEST TIMING IS
PERFORMED AFTER 5 YRS
84. INCISION IS GIVEN & BIPEDICLED ELEVATION OF MUCO-PERIOSTEAL FLAP IS DONE.
STEP 1
85. ELEVATION OF MUCOPERIOSTEAL
FLAP WITH SEPERATION OF
NASAL & ORAL MUCOSA.
RELEASE OF SOFT PALATAL
MUSCULATURE WITH ABNORMAL
ATTACHMENT TO PALATINE BONE.
NASAL SIDE CLOSURE IS
ACHIEVED FROM INCISAL
FORAMEN TO UVULA.
STEP
2
86. ORAL SIDE CLOSURE IS
COMPLETED WITH SIMPLE
INTERUPTED SUTURE FROM
INCISAL FORAMEN TO UVULA.
LATERAL PALATAL FLAP
SUTURED TO ORIGIN TO
PREVENT EXPOSED BONE
WHICH HEALS BY SECONDARY
INTENTION.
STEP 3
87.
88.
89. INCISION IS MADE TOWARDS
PALATAL SHELVES TO ALLOW FLAP
ELEVATION
FULL THICKNESS FLAP IS
ELEVATED
CARE TO BE TAKEN TO PRESERVE
GREATER PALATINE VASCULAR
PEDICLE. SOFT TISSUE
MUSCULATURE IS TAKEN OFF
WITH ABNORMAL ATTACHMENT.
NASAL MUCOSA IS
SUTURED WITH WATER
TIGHT CLOSURE FROM
INCISAL FORAMEN TO
JUNCTION OF HARD & SOFT
PALATE.
SOFT PALATE
MUSCULATURE IS SUTURED
ACROSS MIDLINE FROM
SOFT PALTE TO INCISIVE
FORAMEN
OTHER MUCOPERIOSTEAL
FLAP IS SUTURED BACK
90.
91. LOCATION OF PLANNED
INCISION
FLAPS ELEVATED NASAL CLOSURE IS ACHIEVED BY
OPPOSING Z-PLASTY FLAPS OF
HARD & SOFT PALTE
ORAL CLOSURE OF
HARD & SOFT PALATE
92.
93.
94.
95.
96.
97. PRIMARY ABG
(<2YRS & BEFORE
PALATAL REPAIR)
SECONDARY ABG
(> 2YRS)
EARLY
SECONDARY
ABG
(2 YRS <6YRS)
SECONDARY ABG
MIXED
DENTITION(6-
9YRS)
LATE
SECONDARY
(> 12 YRS)