This little girl had a congenital bilateral cleft lip and palate deformity. Her parents were counseled regarding her cleft deformities at the time of her birth.

She was brought to our hospital for surgical correction when she was 8 months old. Her bilateral cleft lip deformity was addressed first. She had a very wide cleft with a mobile premaxilla. Her prolabium was also very tiny along with a very short columella. There was also very minimal tissue for reconstructing the lip.
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She underwent a single stage repair utilizing Paul Black’s technique. No cross incision was made at the prolabium. Available prolabium and columella were utilized for reconstructing the philtral column and Cupid’s bow.

This was followed by creation of the nasal floor and vermillion. Bilateral C-flaps were utilized for this. Extreme care was taken as there was very minimal tissue available. This was followed by meticulous three layer closure of the cleft lip under loupe magnification. Orbicularis oris muscle was approximated at the midline. This was followed by approximation of the subcutaneous tissue and skin.
Her parents were extremely happy with the results of the surgery.

She presented with a complaint of backwardly placed upper jaw. This gave her an aged look. She was also unhappy with her face. The patient wanted to have a more pleasing face. She was unable to bite and chew food.

A local dentist had mentioned that her upper jaw was small at a young age. He stated that she will have orthodontic problems in the future. He started noticing the difference when she was in a mixed dentition period. He had suggested that she would require orthognathic surgery at a later age or risk developing jaw joint pain.

He had reviewed her at about 18 years of age. During which he noticed that she did not have a proper bite relationship. The upper and lower teeth were completely malaligned. She had a lot of dental issues. There was also a noticeable anterior crossbite. The roof of her mouth was normal after surgical correction of cleft palate.​

​She had an abnormal bite. The upper and lower jaw was in an abnormal position. Every single tooth including the upper molars was also abnormally placed. She had an anterior and posterior crossbite. This is also known as a complete crossbite. The patient had a more curved facial profile. Her profile was concave. This showed that she needed advancement of the maxilla.

​Radiological evaluation revealed backwardly placed upper jaw. This was due to restricted growth of maxilla. The growth of mandible was normal. Since the maxillary jaw growth was restricted, the mandible looked longer. The upper front teeth were placed inside the lower front teeth.

​Maxillofacial surgeon Dr.S.M.Balaji advised upper jaw surgery by bringing the maxilla forward.   Maxillary advancement was planned by Le Fort I osteotomy. The segment was to be fixed using Ti plates and screws. An incision made in the maxilla. Flap elevated. Bone cuts made above the apices of the teeth. Pterygomaxillary dysjunction done.  The maxillary segment was mobilized. The maxilla was pulled forward. It was brought in occlusion and fixed using Titanium plates and locking screws (Ti L plate). The maxillary vestibular region was sutured.

​The patient was greatly satisfied with the results. The surgery was successfully performed. The maxilla was successfully brought forward. The anterior crossbite and posterior crossbite was corrected. The patient will, however, require post-surgical orthodontic treatment for minimal teeth alignment.

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.

This is a case of 3 months old baby boy with incomplete bilateral cleft lip from Bangladesh. Maxillofacial Surgeon Dr. S.M. Balaji surgically corrected the cleft lip defect by following Paul Black's technique. Results are  immediate. Immediate postoperative view following suture removal shows negligible scar formation.  ​

A 3-month-old baby boy born with bilateral cleft lip and palate was brought to our hospital by his parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery using Paul Black’s technique to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child. 

A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child. 

A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
​
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery using Paul Black’s technique to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child. 

A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery using Paul Black’s technique to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child. 

A 17-year-old girl from Bangladesh reported to our hospital seeking to correct her lip and nose defect to enhance her appearance. Previously she was operated elsewhere for bilateral cleft lip & palate. Also the Abbe flap treatment done elsewhere had failed. As a result she had a very thin upper lip and her nose was broad & flattened giving her an unpleasant appearance.

Maxillofacial Surgeon Dr. S.M. Balaji performed a combined correction of the lip and nose defect. A costochondral rib graft was harvested and used to reconstruct the dorsum. A columellar strut graft was used to elevate the nose tip & reshape the nose. Immediately after surgery the nose appeared more sharp and defined. 

In the specialized abbe-flap technique, a flap of tissue was taken from the lower lip, rotated across the mouth and sutured to the central, thin portion of the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, after about 3 weeks the flap will be divided making the upper lip more proportionate enhancing the appearance.