"The medical team initiated consultations on the case during the prenatal stage due to the detection of a cleft lip through ultrasound imaging. Further examination revealed a significant skull defect, with brain matter protruding, alongside several other anomalies. Post-birth examinations confirmed that the child had bilateral cleft lip and palate, along with a left-sided facial cleft. Additionally, she suffered from blindness in her right eye and profound deafness."
"The ocular examination revealed intricate details of the cleft, along with regions of the face that exhibited shortening, displacement, and rotation. Notably, the upper lip had rotated approximately 45 degrees, and certain areas around the nose, where it connected to the lower face, had also undergone rotation and were positioned near the eye. Moreover, the lower left eyelid was notably shortened."
"As the patient underwent additional surgeries to address the skull defect and other issues, the craniofacial team deliberated on the most effective next steps. The primary objectives were to reposition parts of the nose downward toward the upper lip, close the lip, address the eyelid closure, and align structures like the eye and nose. The team decided to approach the treatment in stages, commencing with taping at 2 months of age to optimize tissue and bone positioning in preparation for upcoming surgical interventions."
"At the age of 4 months, Patient 1 underwent a comprehensive facial cleft repair procedure, which involved the collaboration of all three surgical specialists and a combination of techniques from their respective disciplines. To ensure precise and coordinated surgery, the structures requiring closure were marked on the patient's face in advance through tattooing. The surgical plan was strategically designed following a 'top-down' approach, dividing the surgery into three distinct elements: nasal reconstruction and repositioning of the ala, cheek and eyelid repair, and bilateral cleft lip repair.
In summary, the surgical techniques encompassed the use of the dorsal-nasal (Reiger) flap to level the nasal ala, the Teпzel semicircular flap for mobilizing the medial aspect of the lower lid, the Mitek anchor for medial canthopexy, cheek advancement flaps, and a conventional bilateral cleft lip repair employing fork flaps, as described by Millard, to provide additional tissue for creating a nasal sill and other associated advantages."
