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This little boy is from Gwalior in Madhya Pradesh, India. He was born with a unilateral cleft lip and palate deformity. There were no other craniofacial defects associated with it. He had a split upper lip. There was a hole in the roof of the mouth.
This palatal defect was very wide. His parents required counseling at the hospital as they were very upset. The counselors explained that their child would get to lead a normal life with surgery. Parents were then informed on what to expect during the process of rehabilitation. This helped them accept the situation and plan ahead.
There are many varieties of cleft deformities in children. They can range from the horrific facial clefts to simple cleft lip. Cleft lip is the most common birth defect in children. Plastic surgeons also perform cleft lip and palate correction.
They were also informed about the timeline of required corrective surgeries. Cleft lip surgery is at 3 months and cleft palate repair is at 11 months. Bone grafting for alveolar cleft surgery is at 3-1/2 years of age.
Once the parents accepted the situation, they were then referred to us for surgery. Scores of children have undergone cleft repair with us over the last three decades. Many of them are now married with children of their own. Our hospital has even operated on some children born with the same defect to these parents.
We are a referral centre for cleft and craniofacial deformity in Southeast Asia. Many international organisations refer cleft patients to us. We are the Southeast Asian affiliate for the World Craniofacial Foundation, USA.
Our Cleft Lip and Palate Research Unit has many innovations to its credit. These surgical innovations are standard practices around the world today.
Our hospital has a dedicated facial cosmetic surgery unit. The facial trauma surgery unit is also a part of this unit. We are a tertiary care unit for patients with traumatic facial disfigurement. Many overseas patients also find a new lease of life with us.
Dr SM Balaji, Cleft Lip Surgeon, examined the patient in detail. He had a unilateral cleft lip and palate with a wide palatal defect. He explained the surgical procedure in detail to the parents. They agreed to the treatment plan and signed the consent.
Patient and theater personnel safety was paramount as this was at the height of the pandemic. New ventilatory systems ensured constant flow of fresh oxygenated air into the theater. Special filters ensured safe environs for successful surgical outcome.
He decided to perform the modified Millard’s technique. The floor of the nose and nasal sill were first reconstructed using a C-flap. This was then followed by reapproximation of his vermillion border.
There was meticulous reapproximation of the cleft lip with a three layer closure. The three layers included the orbicularis oris, subcutaneous tissue and skin. Use of a surgical loupe aided in this perfect alignment. Muscles were approximated using the Delaire’s principle.
His parents were very pleased with the results of the surgery. They also expressed their understanding to return for cleft palate surgery.
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