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Author
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Message
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Susan
S
Admin
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Posted
on Tuesday, January 16, 2007 - 05:33 pm:
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Submitted
by Goran J, Zambia
This is a 14-months-old child with Tessier III cleft face, bilateral.
Scheduled for surgery on Thursday.
Any suggestions or warnings would be welcome.
Goran J, Lusaka, Zambia
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Gary
F (MA, US)
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Posted
on Tuesday, January 16, 2007 - 05:45 pm:
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good
luck! i've forwarded this to our craniofacial surgeon, janice l and
hopefully she will respond
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Amy
W (CA, US)
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Posted
on Tuesday, January 16, 2007 - 10:40 pm:
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Dear
Goran- You may want to approach this as a soft tissue cleft and a boney
cleft. You can address the underlying boney defect at a later age But at
this age you should plan to close the soft tissue cleft. I approach these
Like a bilateral cleft lip and close the lip with a Modified Manchester
closure. Then I close the cleft along the nasolabial fold in multiple
layers making sure to approximate mucosa muscle and skin. I would then wait
until the child is older-8-10 at the minimum to close the boney cleft with
bone graft. You will need to suspend the medial canthus to the medial
orbital wall and place a stent into the lacrimal duct if you can find it.
If you cannot find the duct then anatomic approximation with a medial
canthopexy of the lid will close the defect and correct the ectropion. Good
luck!
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Goran
J (Zambia)
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Posted
on Tuesday, January 16, 2007 - 11:15 pm:
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Thanks
Amy,
Will let you know how it ended. I was suggested that I should use Mustardee
flaps bilat. to close the defect? Apparently Done by Dutch Surgeon 2 years
ago in Amsterdam. There is no literature about bilat. Tessier III.
Will send pictures on Thursday.
Goran
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Puneet
P
(India)
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Posted
on Wednesday, January 17, 2007 - 12:40 am:
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Hi
Goran,
I think this case is almost similar to Tessier cleft 4 . Generally the
tissue is available but what you need is wide mobilisation and the right
markings . Afterwards , everything fits like jigsaw puzzle . What I
recommend is do one side first and go for the other side after 3 months.
Please see the attatchment for markings and this case had excellent results
, if you want I can post pre and post also
Dr. Puneet P
Jalandhar
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Goran
J (Zambia)
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Posted
on Wednesday, January 17, 2007 - 04:31 am:
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Thanks
Punit,
I appreciate your photo.Please send me postop pict. if you have.I have one
article with unilateral Cleft but not for bilat.
Goran
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Gary
F (MA, US)
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Posted
on Wednesday, January 17, 2007 - 06:24 am:
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Dear
Goran:
I am the CFC surgeon at UMass that Gary talked about. I'm using his entry
codes because I can't find mine right off the bat. Anyway, I agree with
preparing family for one side at a time. I think modified Mustarde flaps
are going to be more applicable to your case than the Tessier 4 markings
outlined as the medial canthal distortion in your case doesn't exist - just
quite severe colobomas. The key unfortunately is the modified part as the
lower eyelids and nasolabial area are going to be your biggest challenge -
you can actually repair the bilateral cleft part by your simplest mode
possible. One 'off the cuff' idea - after you mark out the columella, if
vascularity permits, use the elements lateral to that to swing into the
maxillary area - providing more soft tissue.
Good luck
Janice L
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Goran
J (Zambia)
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Posted
on Wednesday, January 17, 2007 - 08:45 am:
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I
will do my best. If there is oxygen in OT tomorrow I will operate and send
immediate postop. pictures. I am still more of a doing it bilaterally at
the same time. Closing bil. cleft as well as the face using bilat.
Mustardee flap.
Goran
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Kevin
H (TX, US)
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Posted
on Wednesday, January 17, 2007 - 12:30 pm:
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Dear
Goran,
I agree with Dr. Lalikos about your markings. I can't see on the AP photo,
but you may have some lateral nasal tissue that you can use as a
superiorly-based flap and rotate it into the lower eyelid. The use of the
excess lateral prolabial tissue for the maxilla is a good idea as well.
Doing both sides at the same time shouldn't be an issue. I had a similar
case recently (posted below). Good luck!
Kevin H
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Kevin
H (TX, US)
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Posted
on Wednesday, January 17, 2007 - 12:42 pm:
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Here
is the photo
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Goran
J (Zambia)
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Posted
on Wednesday, January 17, 2007 - 01:40 pm:
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Thanks
for the photos Dr. H.
I think that I will have enough tissue in the prolabium to use to move it
to nasolabial fold and higher towards eyelids.
I hope I will manage to operate the child tomorrow.
Goran
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Puneet
P (India)
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Posted
on Thursday, January 18, 2007 - 12:02 am:
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Goran,
Hi . Here are the pre and post op photos
Puneet P
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Pius
A (Ghana)
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Posted
on Sunday, January 21, 2007 - 09:45 am:
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Goran,
I agree that you consider the problem as a bilateral cleft lip and follow
the same principles of bilateral lip repair. Thus you repair the defect
lips at the same OP. This should be possible. I am looking for the photos
of a bilateral cleft lip I did some time ago. I will send you the photos as
soon I get the time.
Good luck, Goran.
Pius.
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Goran
J (Zambia)
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Posted
on Wednesday, January 24, 2007 - 11:34 am:
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Here
are photos. It took almost 3 hours but I think it was worth it.
Hope postop period goes well.
Regards to all and thanks for your support.
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Paul
R (MO, US)
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Posted
on Wednesday, January 24, 2007 - 02:35 pm:
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Dear
Goran,
That looks beautiful. You do excellent work! Congrats and best wishes.
Sincerely,
Paul R
St. Louis, MO
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Janice
L (MA, US)
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Posted
on Wednesday, January 24, 2007 - 05:00 pm:
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Kudos
to you -
And it ONLY took 3 hours.
Big long distance high five.
Janice L
Worcester, MA
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Puneet
P (India)
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Posted
on Thursday, January 25, 2007 - 12:29 am:
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Great
job, Goran .
Puneet
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Kevin
H (TX, US)
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Posted
on Thursday, January 25, 2007 - 10:17 am:
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Dear
Goran,
Beautiful work! Did you rotate any of the extra prolabial soft tissue?
Kevin
Kevin H
Corpus Christi, TX
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Goran
J (Zambia)
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Posted
on Thursday, January 25, 2007 - 11:20 am:
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Thanks
you all for your kind words. Credit also goes to my assistant,
anaesthesiologists, scrub nurses and paediatritian and to all of you that
contributed and did everything possible preoperatively that things go well.
To Dr. Hopkins, yes I used a bit on both side. I will take new photos
tomorrow. Child was OK today but a bit swallen so I thought it would be
better to take new photos tomorrow after some of the swelling goes down
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Albert
P (Ghana)
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Posted
on Thursday, January 25, 2007 - 12:39 pm:
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Excellent
result. Well done Goran
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Goran
J (Zambia)
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Posted
on Friday, January 26, 2007 - 12:46 pm:
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Hi
everyone.
Just to send first update on the child.
He is OK, Eating and behaving normal (only cries when he sees me!!!).
Here is also first follow up photo taken today.
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Goran
J (Zambia)
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Posted
on Thursday, February 01, 2007 - 02:37 pm:
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Dear
Colleagues,
I discharged little one today.
Here are his final pictures.
Thank you all once again for your support.
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