Surgical
techniques
There have been many different surgical
techniques and sequences advocated in cleft lip and palate management. Cleft lip
repair is commonly performed between 3 and 6 months of age, whereas cleft palate
repair is frequently performed between 6 and 18 months.
The
Delaire technique and sequence (Table 37.1) is one of many regimes currently
practised.
Cleft lip
surgery
Skin incisions (Fig 37.7 and
Fig. 37.8) are
developed to restore displaced tissues including skin and cartilage to their
normal position, whilst gaining access to the facial, nasal and lip musculature.
Muscular
continuity is achieved by subperiosteal undermining over the anterior maxilla.
Nasolabial muscles are anchored to the premaxilla with non-resorbable sutures.
Oblique muscles of orbicularis oris are sutured to the base of the anterior
nasal spine and cartilaginous nasal septum. Closure of the cleft lip is
completed by suturing the horizontal fibres of orbicularis oris to achieve a
functioning oral sphincter (Fig 37.9 and Fig
37.10).
Cleft
palate surgery
Cleft palate closure can be achieved by one- or two-stage palatoplasty.
The surgical principle is mobilization and reconstruction of the aberrant soft
palate musculature (Fig. 37.11),