Cleft Lip Repair - Surgical Markings

Summary

This animation demonstrates a variation of the Millard rotation advancement technique for closing a left complete cleft lip. The procedure begins with precise markings on the lip to plan incision placement. The flap techniques involve both advancement and rotation, with attention to the proper alignment of the lip and nasal structures. After undermining the skin flaps, the orbicularis muscle is carefully detached and reattached. Special focus is placed on the white roll during muscle closure. This method, although the flaps are discarded in the animation, typically uses them for mucosal lining in actual surgery, ensuring an aligned, symmetric closure.

Takeaways

• 😀 The Millard rotation advancement repair is a widely used technique for closing a left complete cleft lip.
• 😀 Accurate marking of the lip and surrounding regions is crucial before making incisions to ensure proper placement.
• 😀 Key points to mark include the lip commissure, cupid's bow, lateral nasal ala, and the columella for proper incision alignment.
• 😀 Points on the lip are measured carefully to ensure symmetrical and aligned closure, with distances between various points being critical.
• 😀 The M and L lip flaps are discarded in the animation, though in practice, they help with mucosal lining during closure.
• 😀 The skin incisions are followed by undermining the skin flaps to prepare for muscle detachment.
• 😀 The orbicularis muscle is detached from the nasal sill region on both sides to facilitate proper closure.
• 😀 Special emphasis is placed on closing the muscle layers along the white roll to ensure aesthetic and functional results.
• 😀 The lateral cleft side flap functions as an advancement flap, while the non-cleft side uses a rotational flap.
• 😀 The back cut along the columella is adjusted based on the amount of additional length needed to drop the lip for alignment.
• 😀 The rotation flap never unfurls perfectly straight, so the distances between certain points (e.g., 4-8-9 vs. 5-6) may slightly differ.

Q & A

What is the Millard rotation advancement repair?

The Millard rotation advancement repair is a commonly used surgical technique for closing cleft lips, involving the rotation and advancement of tissue flaps to achieve a symmetric and functional lip closure.

Why is proper marking of the lip crucial before making an incision?

Proper marking ensures the precise placement of incisions and flaps, which is essential for achieving symmetrical and functional outcomes. The markings also guide the surgical team in planning the exact distances and angles necessary for the procedure.

What are the key anatomical landmarks marked on the lip before incision?

The key landmarks include points on the lip commissure, cupid’s bow (lateral edges and midpoint), the lateral aspect of the nasal ala, and various points along the columella. These points guide the placement of incisions and tissue advancement.

How is the distance between points 5 and 7 related to the placement of Point 2?

The distance between Point 7 and Point 5 should be equidistant to the distance between Point 7 and Point 2, ensuring proportionality and symmetry during the repair.

What is the significance of Point 9 in the Millard repair procedure?

Point 9 is variable and depends on how much additional length is needed to drop the lip down for a proper, aligned closure. Its placement is adjusted based on the surgeon's judgment to achieve the best possible result.

What does the back cut along the columella achieve in the procedure?

The back cut along the columella is used to add length to the lip, which helps in aligning the tissue properly for a symmetric closure. The extent of the back cut varies depending on the amount of length needed.

Why is the distance between points 4, 8, and 9 slightly longer than between points 5 and 6?

The distance between points 4, 8, and 9 is slightly longer because the rotation flap does not unfurl perfectly straight, thus requiring additional length to ensure the flap’s proper alignment during closure.

What role does the orbicularis muscle play in the Millard repair?

The orbicularis muscle is detached from the nasal sill region on both sides, allowing for better manipulation of the tissue. The muscle layers are then carefully closed to restore function and appearance.

How does the lateral cleft side flap differ from the medial non-cleft side flap?

The lateral cleft side flap is an advancement flap, while the medial non-cleft side is a rotational flap. The advancement flap provides tissue to close the cleft, and the rotational flap provides additional tissue for the medial side.

What is the primary goal of the Millard rotation advancement repair?

The primary goal is to achieve a symmetrical, functional closure of the cleft lip, restoring both aesthetic appearance and muscle function, which is critical for speech and facial expression.