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Surgical correction of  the upper lip and nose defect in bilateral cleft lip and palate patient using Abbe Flap technique

14/11/2017

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Successful reconstruction of the upper lip attempts to maintain the anatomic and physiological relationship of the philtrum (central portion of upper lip) and the base of the nose.

This is the case of secondary cleft lip and nose deformity in a 22 year old boy from Nepal. He is a known bilateral cleft lip and palate patient where the primary cleft lip and palate surgeries where done elsewhere in his hometown. He had defective appearance of the nose and lip due to which he lost his self confidence and he was very conscious about the appearance.
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Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected both the nose and lip defect together using Abbe flap technique. In the first stage a flap of tissue was taken from the lower lip, rotated across the lips and used to reconstruct the thin central portion of the upper lip, with the base of the flap still attached to the lower lip. Simultaneously in the same procedure itself, reduction rhinoplasty was done to correct the broad nose. After blood supply was established in a few days, the second stage surgery to divide the flap was done. The defect was corrected giving the upper lip a more natural, enhanced form. Results are immediate, both the nose and upper lip defect are corrected giving improved appearance and this boosted the boy’s confidence.
Preoperative facial view showing defective lip and nose due to bilateral cleft lip and palate
Worm's eye view showing depressed dorsum of nose and ill defined columella
Preoperative profile view showing depressed dorsum of nose with defective upper lip and ill defined tip of the nose
Rib cartilage harvested to reconstruct the dorsum of nose
Immediately after suturing using Abbe flap technique showing improved appearance
Postoperative view immediately after suture removal with the lower lip tissue attached to that of upper lip
3 weeks postoperative view following abbe flap division showing enhanced appearance of the nose and lip
Postoperative columellar view showing corrected nostrils shape and size with raised columella of nose
Postoperative profile view showing raised dorsum and tip of the nose with corrected lip profile
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Successful cleft nose and lip correction using Abbe flap technique

15/6/2016

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A 16 year old boy born with bilateral cleft lip and palate came to our hospital for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip and broad flattened nose for which he sought treatment.
Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply was established, the flap will be divided giving the upper lip a more natural, improved form.
Simultaneously, the broad nose was reshaped to make them more proportionate and balanced. Following surgery, the nose appeared sharp & defined with more proportionate profile.
Preoperative view showing broad flat nose with defective upper lip
Profile view showing ill defined columella of nose with depressed nasal tip and defective upper lip
Columellar view showing ill defined columella and depressed dorsum of nose with defective upper lip
Immediately after suturing showing raised defined dorsum with corrected lip alignment
Postoperative profile view showing enhanced appearance
Postoperative view showing enhanced appearance of nose and lips without much visible scars on the face
Postoperative profile view following 1 week after suture removal showing enhanced appearance
Columellar view showing corrected dorsum and alar shape with defined columella of nose
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Successful cleft nose and lip correction with Abbe flap

9/5/2015

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A 22 year old boy born with bilateral cleft lip and palate came to our hospital for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip and broad flattened nose for which he sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose was reshaped to make them more proportionate and balanced. Following surgery, the nose appeared sharp & defined with more proportionate profile.
Preoperative view showing broad flat nose with defective upper lip
Profile view showing ill defined columella of nose with depressed nasal tip and defective upper lip
Intraoperative view showing raised columella of nose and correction of upper cleft lip defect
Immediately after suturing showing corrected nose and lip defect using Abbe flap technique
Postoperative profile view showing raised dorsum of nose with nasal tip giving pristine appearance
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Successful cleft nose and lip correction with Abbe flap

25/3/2015

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A 22 year old girl born with bilateral cleft lip and palate came to our hospital for expert cleft treatment. She was operated elsewhere for primary cleft lip and palate. She had a thin upper lip and broad flattened nose for which she sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose was reshaped to make them more proportionate and balanced. Following surgery, the nose appeared sharp & defined with more proportionate profile.
Preoperative facial view showing defective cleft nose and lip
Preoperative profile view showing depressed nasal tip due to missing columella and missing upper lip prominence
Costochondral rib graft harvested to reconstruct the defective cleft nose
Immediately after suturing
Immediately after Abbe division showing enhanced appearance of nose and upper lip without much surgical marks
Profile view showing augmented nose profile and columella and proportionate lips were obtained giving enhanced appearance
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Combined jaw correction & lip and nose defect correction with Abbe flap technique & rehabilitation with implants for bilateral cleft lip & palate

10/11/2014

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A 19-year-old boy reported to our hospital seeking to correct his nose, lip and jaw defect and to replace his missing upper front teeth. He was previously operated for bilateral cleft lip and palate elsewhere where his entire premaxilla was removed. His upper lip was very thin in the middle, his lower jaw was severely protruding and his nose defect affected his facial profile giving an unpleasant appearance. Also because of his missing upper front teeth he was unable to bite and eat properly. 

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed a combined jaw, lip and nose correction. An Obwegeser’s bilateral sagittal split osteotomy was done reshaping the lower jaw bone and bringing it into proper alignment with the upper jaw. Dental implants were placed in the upper jaw to replace the missing teeth. In the Abbe flap technique, a flap of tissue was taken from the lower lip, rotated across the mouth and sutured together with the thin upper lip with the base of the flap still attached to the lower lip to maintain blood supply. The flap was taken with hair follicles to ensure proper moustache growth. After 3 weeks the flap was divided giving the upper lip a normal form and function. Ceramic crowns were fixed to the implants. Following complete rehabilitation, his appearance and self-confidence improved greatly and he is very happy with the results.

Preoperative facial view showing defective cleft lip and nose due to bilateral cleft defect
Preoperative intraoral view showing incorrect bite due to removal of premaxilla leading to missing teeth in upper front region of jaw
Reconstructed columella and shape of the ala of the nose by Abbe flap technique
Immediate postoperative view showing corrected bite by following Obwegeser's bilateral sagittal split osteotomy in mandible and lip revision by Abbe flap
Postoperative image showing corrected bite and missing teeth replacement with dental implant prosthesis
Postoperative facial view showing corrected lips, nose and missing teeth replacement giving enhanced appearance
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Simultaneous correction of lip defect with Abbe-flap technique & nose defect 

4/8/2014

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A 19-year-old boy from New Delhi, with unilateral cleft lip & palate was brought to our hospital by his parents for expert correction of his nose & lip defect. His cleft lip and cleft palate correction was done elsewhere in his childhood. Now his nose was disproportionately large & upper lip was too thin. He wanted to correct the shape & form of his nose & lips to improve his appearance.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed a combined correction of the nose & lip defect. A medial & lateral osteotomy of the nose was done to reduce the large nose. With this the nose was reshaped & given a more proportionate, balanced form. The lip defect was corrected with Abbe-flap technique. A flap of tissue was taken from the lower lip, rotated across the mouth & sutured to the upper lip with the base of the flap still attached to the lower lip to maintain blood supply. The flap was taken with hair follicles to ensure moustache growth. After 3 weeks once blood supply is established, the flap will be divided, giving the lips an enhanced form, function & appearance. 
Preoperative frontal view showing broad, flattened nose with defective upper lip due to cleft defect
Preoperative profile view showing bulky nose with thinning of upper lip due to defective primary cleft lip repair
Reduction rhinoplasty done to reduce the bulkiness of the nose
Immediate postoperative view showing corrected upper lip defect with Abbe flap
Immediate postoperative profile view showing enhanced appearance of the face without much surgical marks
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Defective cleft lip and nose correction using prolabium and Abbe flap technique

4/6/2014

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A 12 year old boy with bilateral cleft lip and palate reported to our hospital with the complaints of defective upper lip and ill-defined nose tip with depressed nasal bridge. His parents were not happy with the boy’s appearance and he was not able to spell few words due to defective upper lip which made him more depressed. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planed to correct his upper lip defect as well as his ill- defined tip of the nose by following Abbe flap technique. Surgery was done in two stages. In the first step, prolabium was raised to increase the columellar length and nasal tip projection. And the cleft lip defect was corrected with Abbe flap technique were lower lip tissue was raised and attached to the upper lip defect region. In the second step, achieving good healing after 25 days the upper and lower lip was surgically separated and thus nose as well as lip defect correction was done simultaneously without many surgical scars. The boy and his family was very happy to see the enhanced appearance of the nose and well aligned upper and lower lips without any surgical scars.
Pre operative view showing very thin upper lip and flattened nose defect in a cleft child
Pre operative profile view showing over stretched upper lip with depressed nasal bridge and ill-defined tip of the nose
During procedure - Prolabium was raised to increase the colmellar length and nasal tip projection
Abbe flap technique- flap taken from lower lip and used to reconstruct defective upper lip
In the second stage, Abbe flap was divided and upper and lower lip was separated
Immediate post operative view showing improved profile appearance after nose & lip reconstruction
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