The document discusses the timing of various surgical procedures for cleft lip and palate patients such as cleft lip repair at 3-4 months, cleft palate repair at 9-18 months, and pharyngoplasty at 3-5 years depending on speech development. Maxillary reconstruction with bone grafting is recommended between 6-9 years based on dental development. Cleft orthognathic surgery is performed between 14-16 years in girls and 16-18 years in boys. Cleft rhinoplasty is preferred after skeletal maturity following orthognathic surgery. The document also describes techniques for cleft palate repair and bone grafting procedures.

1. PRESENTED BY- Dr.TEJAL R RAGJI
3RD YR PG
OMFS

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

34. Nasalis

52. SUTURING OF VESTIBULAR BORDER
SUTURING OF VESTIBULAR LIP

55. Suturing the caudal muscle layer belong to the red part of the lip.

72. MAKE NO INCISION DEEPER THAN SUBMUCOSAL & SUBCUTANEOUS LAYER

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

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

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

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)

101. 1)Bifid uvula
2)Velopharyngeal
incompetence
3)Abnormal speech
4)Maxillary hypoplasia.
5)Dental malposition &
malalignment
6)Otitis media