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Cleft Lip Revision

Secondary cleft lip deformities and their revision - The ULTIMATE Clinical pearls To achieve the ultimate result various aspects have to be considered. Ignoring one or more of these aspects will lead to suboptimal aesthetic and functional results. 1. As in secondary rhinoplasty, accurate aesthetic planning, drawings of lip deformity and the planned revision in CL, CLA, and CLAP are essential to predict post-operative outcome of skin and underlying muscles. 2. There are more than a hundred different possibilities and variations of surgical techniques to achieve optimal aesthetic results. As such, only a few examples could be shown in this chapter. To recognize and execute minor aesthetic deformities, surgeons often apply their understanding of art. Therefore, minor deviations from preparation and clinical planning may still be applied with the patient under general anaesthesia, before surgery starts. 3. The most important aspects for consideration: (a) scar presentation and eventual improvement; (b) does the scar mimic the philtrum edge and can the scar be repositioned to that location; (c) can the philtrum edge in unilateral cleft lip cases be raised to simulate the opposite natural one; (d) can an aesthetic philtrum dimple be created between the “philtrum edges�; (e) can the nasal sill and lip-nasal floor in unilateral cleft cases be raised equally and supported especially if compared to the opposite side? The latter may be adjusted by adding cartilage or by superiorly rotating scar tissue mobilised during muscle repair. 4. Achieve tension-free wound closure using non-soluble suture material that is as thin as possible. In muscles and the red-lip area, the use of resorbable suture material should be limited as it might create a tissue reaction which enhances hyperplastic scar formation. 323

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Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

Cleft Ultimate Treatment  

Book: Cleft Ultimate Treatment -- Oro-facial and Cranio-maxillo-facial Deformities (Second Edition) Authors: Dr. Kurt Butow and Dr. Roger Z...

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