Craniofacial, Bilateral Cleft Lip Repair Workup

  • Author: Pravin K Patel, MD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Apr 13, 2009
 

Laboratory Studies

  • Perform a thorough physical examination, not limited to the head and neck region, to uncover associated anomalies in the infant presenting with a unilateral cleft lip with or without a palatal cleft. Additional workup is determined by physical findings that suggest involvement of other organ systems.
  • The child's weight, oral intake, and growth and/or development are of primary concern and must be followed closely.
  • Routine laboratory studies typically are not required, other than a hemoglobin study shortly before the planned lip repair.
  • Routine imaging is not indicated in a healthy patient with isolated cleft lip.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Pravin K Patel, MD  Associate Professor of Surgery, Division of Plastic Surgery, Northwestern University School of Medicine; Chief of Plastic and Craniofacial Surgery, Shriners Hospitals for Children; Head of Craniofacial Surgery, Children's Memorial Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Raja Ramaswamy, MS  The Chicago Medical School

Raja Ramaswamy, MS is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Mitchell F Grasseschi, MD  Assistant Professor, Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University; Private Practice, Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

David E Morris, MD  Assistant Professor of Surgery, Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago College of Medicine; Staff Surgeon, Shriner's Hospital for Children

David E Morris, MD is a member of the following medical societies: Chicago Medical Society and Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry Hollier, Jr, MD  Assistant Professor, Department of Plastic Surgery, Baylor University College of Medicine

Larry Hollier, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, AO Foundation, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

R Edward Newsome, MD  Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine

R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

References

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Bilateral cleft lip repair. (A) The prolabial width is typically set at 4-5 mm. (B) The prolabial flap is elevated to the base of the columella. The adjacent flaps are turned over to create a labial sulcus. (C) The orbicularis oris muscle, dissected from the overlying skin, is approximated across the midline. (D) The skin is approximated, and the Cupid's bow is created from the lateral vermilion flaps.
Intraoperative technique. (A) The anatomic landmarks are tattooed and the planned incisions are marked. (B) The orbicularis is dissected from the overlying skin and divided into bundles to allow interdigitation with its opposing element. Inferiorly, an element of the muscle is left attached with the triangular vermilion flap used to create a Cupid's bow. (C) The prolabial flap is developed. The lateral lip elements are discarded and the mucosal flaps are turned over to create a labial sulcus. (D) The lower lateral cartilages are freed from the overlying nasal skin from the base of the ala and columella. The nasal domes are approximated to each other and the cartilages are suspended from the upper lateral cartilages. (E) The series of interdigitating bundles of the orbicularis muscle are approximated to each other. (F) The skin is inset with a series of fine nylon sutures, which are removed 5-7 days postoperatively if a skin adhesive is not used. Xeroform gauze bolsters are placed as a temporary nasal stent.
Preoperative and postoperative images of a child born with a complete bilateral cleft lip and palate. Note that the prolabial width increases because of the tension. Ideally, the initial width should have been set narrower.
Preoperative and postoperative images of a child born with a complete bilateral cleft lip and palate.
Millard modification of Kernahan striped-Y classification for cleft lip and palate. The small circle indicates the incisive foramen; the triangles indicate the nasal tip and nasal floor.
 
 
 
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