After successful intubation, the surgery was done in three steps – the labial part, the orbital part and the nasal area.
In the labial part, the aim was to provide a good columella, philtrum, cupid bow with a near perfect vermillion surfaces. I employed a modified Paul-Black’s technique. With adequate reflection of mucosa, approximation was performed. The recreation of a perfect labial sulcus was crucial. Simultaneously, perfect muscle sling created by orbicularis oris muscle was performed. At the end of surgery, normal labial surfaces achieved at both halves of the face.
After the successful completion of the labial part, the orbital part was done. The incision was started from the lower eyelid. Excessive eye tags were incised, a part of which was utilized to recreate the outer canthus of eye. The excess tissues were removed. The lateral canthal ligament interposition was ensured.
In the next stage, the reconstruction of the nasal area along with the repositioning of the medial canathus of eye was performed. During this stage care was taken to ensure that the patency of punctum was preserved. Also efforts were drawn to keep the patency of the nasolacrimal duct intact. This would ensure proper wetting and lacrimation, an essential feature to save the vision in the right eye.
As the left eye was poorly developed, an artificial bio-compatible conformer was placed and the eyelids reconstructed as in the right side. Later a plastic shell, mimicking natural eye would be placed. By this the child would have a normal appearance and would not have any stigma attached.
By these procedures, the child would develop normal speech, normal social skills and peer interaction also this surgery would avoid social stigma attached with such defects. The child would have a normal childhood.