Update in Unilateral Cleft Lip Surgery | Journal CME Article-Journal CME Article: Update in Unilateral Cleft Lip Surgery V5

Video Transcription

Once we have our cleft lip marked, we go ahead and tattoo the important points that we just made so that we don't lose them during the process of incising our cleft margin.  This is done with a 25-gauge needle, which in this picture, in this video, has a Q-tip attached to it, inserted inside of it to make for ease of handling.  We tattoo our bow points so that we don't lose them. We tattoo the gutter point, which happens to be the back cut point where our lateral advancing dart will go.  So we tattoo the two millimeters of advancement. We tattoo the top of the filth or column on the cleft side. We tattoo the sill closure point.  We tattoo the sill closure point on the lateral lip side.  We tattoo the point that closes to the top of the filth or column. Tattoo the top of the lateral advancing dart. Tattoo the point of it, the bottom point of it.  We tattoo the vermilion cutaneous junction point, and then the bottom of the vermilion or the wet-dry point.  We excise our cleft margin using a small ophthalmologic knife called a wick blade, making our medial lip cuts, which is coming down our short filth or column.  This is the gutter point. We want to make sure that at the top of the gutter point, the incision that we make through  the vermilion is straight, and we do not disrupt the muscle at this level. So we're using an 11 blade, that cut straight across the vermilion so that the relationship  between the muscle and the vermilion remains intact. You notice that we did not use any local during this part of the operation.  I don't like to use local straight away because I don't want to distort any of the normal lip markings.  It does bleed a little bit more, however, I feel easily controlled with pressure and electrocautery.  We use a 67 beaver blade here to make our mucosal cuts all the way up to the cleft, inside the cleft and the gingival buckle sulcus area.  We release the skin from the underlying muscle, release the muscle from the underlying mucosa, so that when we do our muscle repair, we have a good margin to work with.  We do not release the muscle from the edge of the vermilion, given the complex interconnections it has with that component of the lip.

Video Summary

The process of marking a cleft lip involves tattooing key points to prevent losing them during surgical incision. This is done using a modified 25-gauge needle. Essential points like bow points, the gutter point, and the vermilion cutaneous junction are tattooed. The cleft margin is excised with a wick blade, ensuring incision through the vermilion is straight to maintain muscle integrity. Local anesthesia is avoided initially to preserve natural lip markings despite increased bleeding. Utilizing a 67 beaver blade, mucosal cuts are made, and skin and muscle are strategically released for effective muscle repair.

Asset Subtitle

Straight Line Repair - Operative Details Part 1. Video 5 from "Update in Unilateral Cleft Lip Surgery" 148 (2) CME

Keywords

cleft lip surgery

tattooing key points

vermilion cutaneous junction

muscle integrity

67 beaver blade