Update in Unilateral Cleft Lip Surgery | Journal CME Article-Journal CME Article: Update in Unilateral Cleft Lip Surgery V6

Video Transcription

Here we are making a back cut in the lip element, in the shorter filth roll column. This is a two millimeter back cut.  It's important to look at this and make sure that you're achieving the correction or the cupid's bow rotation that you're looking for.  You want to make sure that the cupid's bow sits naturally when that back cut is totally open. Then we move to our lateral lip element and we make the same cuts with the weck blade,  going from our seal closure point to the length of our short side filth roll column, to our lateral lip element dart, and then to our vermilion cutaneous junction.  Bring the 11 blade back and use the 11 blade to make our cut through our cleft margin at the vermilion.  Once again, to keep the integrity of the muscle in continuity with the vermilion itself. And then we use a 67B blade to make the remainder of the mucosal cuts.  You release the skin from the underlying orbicularis oris muscle and we do this all the way up into the base of the nose.  More of this work is done in a complete cleft lip because we have to reorient the position of the muscle as to recreate the nostril shape.  This is best done with correcting the underlying muscle. From the lateral lip position, we do a super cartilaginous dissection of the cleft side  nasal ala to help reposition these components. Then using a 40PDS suture, we recreate the orbicularis oris muscle sling around the nose and the lip.  This can often be thought of as three components to the muscle, a nasalis component, a marginalis  component which is around the lip margin, and then a commonus part or the main substance within the substance of the lip itself.  We then close the mucosa with 4-Vicryl inside along the gingival buccal sulcus. We use 7-O-Proline for the skin itself.  We'll occasionally use a 5-O-Monocryl for repositioning of the skin. One or two of these. It's important not to use too much suture as to create some distortions and the skin  should come together tension-free. This is the lip repaired and we'll go ahead and put a nasal stint in for three months to help with the nasal shape.

Video Summary

The video transcript outlines a surgical procedure for repairing a cleft lip. The process involves creating strategic cuts in the lip to adjust and align anatomical elements like the cupid's bow and the vermilion cutaneous junction. The surgeon uses various blades to release the skin, reposition muscles, and achieve desired lip and nasal shapes. The procedure also involves suturing the orbicularis oris muscle and the mucosa to maintain the lip's natural position. A nasal stint is applied for three months post-surgery to aid in shaping the nose. The goal is to repair the lip tension-free and ensure natural alignment.

Asset Subtitle

Straight Line Repair - Operative Details Part 2. Video 6 from "Update in Unilateral Cleft Lip Surgery" 148 (2) CME

Keywords

cleft lip repair

cupid's bow

orbicularis oris

nasal stint

surgical procedure