40720 Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure

Name of the Procedure:

Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure

Summary

This surgical procedure involves correcting a cleft lip and nasal deformity. It is a secondary operation, meaning it is performed after an initial surgery, focusing on improving both function and appearance by recreating and then closing the defect.

Purpose

This procedure addresses congenital cleft lip and associated nasal deformities. The goals are to enhance nasal symmetry, lip function, and facial aesthetics, contributing to improved speech, eating, and self-esteem.

Indications

• Residual or secondary cleft lip deformities after primary repair
• Nasal asymmetry or other deformities affecting nasal function or appearance
• Functional issues related to speech or eating due to a cleft lip/nasal deformity
• Emotional or psychological distress due to appearance

Preparation

• The patient is advised to fast for at least 8 hours before the procedure.
• Medication adjustments may be necessary, particularly with blood thinners or anticoagulants.
• Pre-operative assessments include physical examinations, blood tests, and imaging studies like X-rays or CT scans to plan the surgery.

Procedure Description

1. Administration of general anesthesia to ensure the patient is asleep and pain-free.
2. The surgeon makes precise incisions to recreate the cleft defect.
3. Scar tissue and other deformities are carefully dissected.
4. The recreated cleft is meticulously closed with fine sutures, aiming for optimal cosmetic and functional results.
5. Nasal reshaping may involve adjusting cartilage or bone to achieve symmetry and proper function.

Tools used include scalpels, fine sutures, and specialized instruments for soft tissue and cartilage manipulation.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

Performed in a hospital or surgical center operating room with sterile conditions.

Personnel

• Plastic or reconstructive surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant

Risks and Complications

• Infection
• Bleeding or hematoma
• Scarring or keloid formation
• Asymmetry or dissatisfaction with cosmetic results
• Anesthesia-related risks
• Rarely, complications like airway obstruction

Benefits

• Enhanced facial appearance and symmetry
• Improved nasal function, which can help with breathing
• Better lip function for eating and speaking
• Positive impact on self-confidence and psychological well-being

Recovery

• Initial recovery in the hospital for monitoring, usually 1-2 days.
• Swelling and bruising are common and may last several weeks.
• Pain management includes prescribed medications.
• Stitches typically removed or dissolve within a week or two.
• Follow-up appointments to monitor healing and progress.
• Restrictions on strenuous activities and certain foods for a few weeks.

Alternatives

• Non-surgical options like prosthetics (less effective cosmetically and functionally)
• Non-invasive aesthetic treatments (limited applicability in severe cases)
• Speech therapy or orthodontic interventions (adjunct supportive measures)

Patient Experience

• Post-procedure discomfort managed by pain relief measures.
• Swelling and bruising expected, subsiding gradually.
• Psychological support may be beneficial due to changes in appearance.
• Overall, patients often report high satisfaction due to improved aesthetics and function.