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Case problem

Discussion in 'Otolaryngology' started by srabiei, Apr 18, 2007.

  1. srabiei

    srabiei 7+ Year Member

    Oct 10, 2006
    hello dear friends:

    What are doing for this case ( surgical approach ):

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

    thank you in advance
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  3. resxn

    resxn 10+ Year Member

    Oct 2, 2006
    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.
  4. srabiei

    srabiei 7+ Year Member

    Oct 10, 2006
  5. scalpel2008

    scalpel2008 beep beep beep...smash 2+ Year Member

    Apr 2, 2006
    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) :confused: 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..

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