Cleft Lip

INTRODUCTION
  • Clefting of the lip and/or palate is felt to occur around the eighth week of embryogenesis, either by failure of fusion of the medial nasal process and the maxillary prominence or by failure of mesodermal migration and penetration between the epithelial bilayer of the face.
  • A midline cleft lip is present when there is failure of fusion between Medial nasal processes
  • Left side unilateral cleft is common
  • The cause of orofacial clefting is felt to be multifactorial.
  • Cleft of the upper lip that extends upward toward the left nostril and left anterior cleft of the primary palate just deep to the cleft lip. These defects are most likely due to a failure of Maxillary process to fuse the medial nasal process
  • Commonest type of cleft lip is Combined with cleft palate
  • Unilateral cleft lip is associated with Posterior displacement of alar cartilage
  1. In cleft lip operation all the stitches are removed on 4th day
  2. Factors that likely increase the incidence of clefting include:
  3. Increased parental age
  4. Drug use(Isotretinoin)
  5. Infections during pregnancy
  6. Smoking during pregnancy
  7. Family history of orofacial clefting.
CLASSIFICATION:
  1. Extent of the cleft: Complete versus incomplete
  2. Location of the cleft: Unilateral versus bilateral
  3. Alveolar segments
  4. Narrow versus wide cleft
  5. Collapse versus no collapse
ASSOCIATED SYNDROME:
  • Patau syndrome/Trisomy 13:Cleft lip, cleft palate, polydactyly, microcephaly with holoprosencephaly, ectodermal scalp defect 
INTERVENTION:
  1. Initial evaluation for associated anomaliesConsultations
  2. Genetics, 
  3. Social work
  4. Feeding/nutrition. 
  5. Otolaryngology
  • Preoperative taping
  1. Bring the segments closer together to facilitate a tension-free repair
  2. Steri-Strip tapes applied across both segments of the lip.
  • Lip adhesion operation
  • Suturing the edges of the cleft together once the segments have moved closer together.
  • Repair
  • Rule of tens: For increased anesthetic safety, an infant should

  1. a. Be 10 weeks old.
  2. b. Weigh 10 pounds.
  3. c. Have a hemoglobin level of at least 10 mg/dL
  • Straight-line repair
  1. Z-plasty-based techniques
  2. Rose-Thompson repair
  • Quadrangular flap
  1. Cupid's bow is derived from the lateral lip.
  2. 90-degree Z-plasty.
  3. Violates Cupid's bow and philtral dimple.
  4. Has a tendency to produce a long lip.
  • Triangular flap/Tennison's method
  • Skoog repair
  1. Consists of two Z-plasties.
  2. Violates Cupid's bow and the philtral dimple.
  • Rotation advancement or Millard repair
  • Bilateral cleft lip repair
  1. Le Mesurier's method
  2. Dissect the prolabium to maintain a central skin flap to resemble the philtrum.
  3. Deepithelialize the remainder of the prolabium.
  4. Columellar lengthening 
  5. Use the prolabial vermilion to create a labial sulcus

Exam Question
  • Cleft of the upper lip that extends upward toward the left nostril and left anterior cleft of the primary palate just deep to the cleft lip. These defects are most likely due to a failure of Maxillary process to fuse the medial nasal process 
  • Isolated cleft lip and palate is Multifactorial
  • Cleft lip, cleft palate, polydactyly, microcephaly with holoprosencephaly, ectodermal scalp defect is seen in Trisomy 13
  • Repair of cleft lip should be undertaken at 10 weeks
  • Millard repair is used for treatment of Cleft lip
  • A midline cleft lip is present when there is failure of fusion between Medial nasal processes
  • Drug likely to be consumed by the mother causing cleft lip is Isotretinoin
  • Commonest type of cleft lip is Combined with cleft palate
  • In cleft lip operation all the stitches are removed on 4th day
  • Unilateral clefts are most common on Left side
  • Le Mesurier's method,Tennison's method, Millard's method are used in cleft lip surgery
  • Unilateral cleft lip is associated with Posterior displacement of alar cartilage

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