Case problem

[srabiei]

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hello dear friends:

What are doing for this case ( surgical approach ):

cleft palate and lip, central remnant attach firmly to nasal tip

http://www.entiran.com/cases/153.jpg
​

thank you in advance

 

[resxn]

Little outside my scope of practice--I don't do clefts anymore.

I would imagine with the primary palate that far displaced anteriorly that it will need to be separated from the nasal tip first before anything can be done.

The question is how to reconstruct that defect before even considering the lip and palate. With a lack of skin to begin with in these bilateral clefts, finding new skin for reconstruction will be difficult at best. Obviously rotating it in would be the best option, but from the picture, I have a hard time seeing that there is enough to do so.

I have tried several things to reconstruct the columella when skin is removed and I've never been happy with much. The best match I've found is in helical cartilage composite graft from the ear--the helical rim graft with associated skin is a pretty good match--but that graft is very difficult to keep alive.

tough case that I probably can't help much with. Sorry.

 

[srabiei]

Thank you dear Resxn

Anterior component is attach firmly to nasal tip anteriorly and abnormal elongated inferior turbinate posteriorly (http://www.entiran.com/cases/151.jpg).

I think the blood supply from the posterior attachment is enough and my plan is using anterior attachment for making a columella (http://www.entiran.com/cases/152.jpg ) and then other remnant for cleft lip repair (2 at http://www.entiran.com/cases/152.jpg).

The patient' mother is dead 🙁

I'll do my Best for repair

 

[scalpel2008]

Thank I think the blood supply from the posterior attachment is enough and my plan is using anterior attachment for making a columella (http://www.entiran.com/cases/152.jpg ) and then other remnant for cleft lip repair (2 at http://www.entiran.com/cases/152.jpg).

The patient' mother is dead 🙁

I'll do my Best for repair

I would think that the "anterior attachment" i.e. #1 in your figure has to be used for the lip. Perhaps I misunderstood you but I got the impression you are going to make a columella out of #1 and lip out of #2 (primary palate) 😕 I'm by no means telling you what to do but rather am trying to learn. Have only been involved with a handful of cases so far..