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Successful rehabilitation of multiple cleft defects in a single surgery

2/4/2014

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A 15 year old boy with unilateral cleft lip and palate from Tirupur reported to our hospital wanting to correct his nose and alignment of his teeth. Primary lip and palate repair was done in his hometown itself during his childhood. He and his parents were more upset regarding his scar results after lip repair which affect his moustache growth as well as his broad asymmetrical nose made his face look disproportionate. 

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his cleft defects to overcome the future growth huddles. Considering their level of distress they had in the results of previous surgeries, multiple cleft defects were planned to be corrected in a single surgery. Deviated nasal septum was aligned through intra oral approach using chondral graft obtained from his rib. Thus his nose defect was shaped to normal shape and size.

His cleft alveolar defect was closed with miracle protein rhBMP-2. His lip defect which was due to incorrect approximation of mucosal flaps leaving the vermillion of the lip defective. Thus, vermillion defect was corrected and scar formed due to incorrect technique was removed precisely with very minimal scar formation.

Results are immediate showing enhanced appearance of his face due to pristine nose correction and scar revision.
Pre operative view showing asymmetrical nose and lip repair done elsewhere with massive scar results
Flat profile view due to defective vermillion repair
Pre operative view showing disproportionate upper jaw due to the cleft defect
Intra oral view showing alveolar cleft defect
rhBMP-2 placed for closure of the defect
Complete closure of the cleft defect using rhBMP-2
Cartilage graft harvested from the rib
Cartilage graft used to correct the nose defect - Intra oral approach
Cartilage graft approximated and sutured with nasal cartilages and stabilized
Immediate post operative view showing pristine nose and vermillion correction with minimal scar
Post operative view showing symmetrical nostrils and well blended nasal cartilage correction
Profile view showing enhanced nasal appearance with well shaped cartilage adaptation
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