Operative Findings (Lip Closure)

Figure liki_18a_n.jpg and liki_18b_n.jpg: A possible schedule for surgery is closure of the lip at 3 to 4 months and total closure of the palate combined with ear microscopy at age 8 to 12 months in order that the esthetic appearance, feeding and speech development become as normal as possible. Figure liki_18a_n.jpg: After the preparation of the nasolabial muscles close to the cleft lip on the right, the latter are sewn on the midline structures of the lip, starting underneath the nasal septum (Delaire); the first sutures at the floor of the nose are tied, while the following sutures are layed out. Figure liki_18b_n.jpg: The closure of the skin consists of a modified Z plasty (in this case according to Le Mesurier). Also, in closure of the palate the local soft tissue is mobilized with the aim to move the soft palate backwards and to close it in two layers.