Cleft Lip and Palate Repair

Repair of the cleft lip and cleft palate is a type of plastic surgery to correct abnormal development, aiming to restore function and make the appearance closer to normal.

Abnormal development

Leporine lip and cleft palate are among the most common congenital malformations affecting children. Incomplete formation of the upper lip (fissure) or roof of the mouth (palate) may occur individually or together. Conditions may vary in severity and may include one or both sides of the face.

Cleft, or separation of the upper lip and/or the inner palate, occurs very early in the development of the fetus. During fetal development, some components of the upper lip and the mouth sky do not form normally. Most cracks can be repaired through specialized plastic surgery techniques, improving the child’s ability to eat, talk, listen and breathe.

Both situations need to be corrected, as they harm the baby, especially during breastfeeding. The cleft lip prevents the child from being able to close the mouth and suck milk, while the cleft palate, in addition to interfering with feeding, impairs speech and increases the risk of infections.

Leporine lip and cleft palate: how surgery is performed

As we are talking about babies a few months old, plastic surgery for cleft lip and cleft palate is a delicate procedure, although it is considered simple and quite safe.

The surgery is conducted by a team of different specializations, including a plastic surgeon. It is done under general anesthesia with sedation and usually lasts less than 2 hours. Ideally, the child should stay at least one day in hospital and observation.

The procedure for correction of the leporine lip is focused on the reconstruction of the space between the gum and the lip and, if necessary, the nasal floor. Muscle reconstruction is also performed to ensure proper movement of the upper lip.

For the cleft palate, the tissue and musculature are replaced to close the cleft and ensure the proper development of speech. When the child presents both problems, usually the surgery of the leporine lip is done before.

Depending on the severity of the deformity and the affected area, there may be a need for more than one procedure. However, it is noteworthy that they do not happen in a row, but as the child’s growth is.

It is important to note that, usually, reconstructive surgery of the leporine lip (along with other affected structures such as nose and soft palate) can only be done from 3 months of age. The correction of the cleft palate (hard palate) is usually done only from the 15th month of life.

Postoperative

It is common for the baby to feel irritated after surgery for correction of the cleft lip and cleft palate. As the healing process results in itching and pain, usually children try to put their hand on the face.

It is important that parents stay alert and prevent this from happening, so as not to harm the results or cause bleeding. What many pediatricians recommend is the use of immobilizers for the elbows, helping to keep the baby’s arms stretched so that it does not touch the operated area.

The baby can resume breastfeeding normally after the first week. For older children, who do not feed exclusively on breast milk, a liquid or pasty diet should be maintained.

After 30 days, it is interesting to undergo evaluation by a speech therapist, as it may be necessary to perform exercises so as not to compromise speech. It is noteworthy that as the child grows, he may need retouch surgery, especially to make the scar more discreet.

If you are looking for plastic or reconstructive surgery, look for a professional you trust. Choosing a responsible and skilled plastic surgeon is the first step towards a well-done and safe operation.

Have you ever had an automobile, sports, or work incident and experienced deep pain that prevented you from opening or closing your mouth? Well, we regret to inform you that you were facing a case of Maxillary Fracture. Therefore, we recommend treating it immediately, otherwise, it can cause serious problems for your health.

In some cases when this type of event is suffered, it is suggested to undergo oral surgery, resulting in the repair of these maxillary fractures. At our hospital, we perform this type of surgery, and it is simply based on the placement of plates, screws or pins (as the case may be) on the outside and inside of the jaw, so that, the teeth are stabilized in their corresponding place. These plates should be kept for about six to eight weeks, to later be removed.

Maxillary fractures can be easily diagnosed with an X-ray or CT scan of the head. Sometimes, the patient is recommended to ingest a liquid to make it easier to perceive.

What Is A Maxillary Fracture?

To enter into context, a maxillary fracture is the result of a strong impact received by an accident or physical attack, thus causing intense pain that prevents you from opening or closing your mouth normally, in the case of being in the maxilla lower. If it occurs in the superior, it brings with it the same consequences, but adding variations in sight such as: double vision, pain in the eyeballs, among others. However, the most common cleft is the jaw.

This fracture needs extremely careful examination, as such an impact may also have damaged areas such as the neck, causing cervical injuries, or may also lead to a concussion. In general, it is usually accompanied by internal bleeding that can clog the airways.

This type of fracture needs immediate medical attention and rapid immobilization of the jaw. During this immobilization, all teeth should be fitted in place before the bandage is placed around the entire head and under the chin. For a minor injury, the jaw may heal on its own with pain relievers and a liquid diet.

Are There Signs That I Have A Maxillary Fracture?

If at any time you receive a very strong impact in that area, in the following days you should take into account if you observe any of the following signs:

• You have bruises and pain near your jaw.
• Deep pain when talking or moving the teeth. Also in the front part of the ear.
• Loss of dental pieces or that are broken.
• Problems pressing the teeth or opening and closing the jaw.

How Is A Jaw Fracture Treated?

The most advisable thing is to go immediately to your trusted plastic surgeon in Malad. However, they generally recommend:

• Medicines: such as pain relievers and antibiotics to prevent or treat any type of infection.
• A wire brace: This is used to hold the jawbone in place. It is important, because it helps the bones to heal properly and quickly.
• Oral surgery: its function is to return the jaw bone to its original position, as long as the type of fracture is serious. This is done so that the parts of the maxillary bone remain fused. Artifacts such as plates, screws or pins are used. The surgery serves the same way to repair deformities or damaged tissues in any area of ​​the mouth or blood vessels.

What can I do to deal with a broken jaw?

• Ice – will help reduce inflammation in the fracture and prevent tissue damage. It is recommended to use an ice bandage and place it on the patient’s face for fifteen to twenty minutes.
• Soft foods: if you have wire restraint you should have a diet based on soft or blended foods, and ingest them through a syringe or straw. In other cases, it is also recommended to eat soft foods such as gelatin, yogurt, pudding or among others. For better information, consult your trusted doctor.
• Hygiene: you must keep your mouth clean and rinse four to six times, this will help remove food debris. Also, adding Vaseline to the lips helps prevent cracks.
• Do not practice sports: it is advisable not to practice any type of exercise because the jaw may fracture again, bleeding or bruising may occur at the height of the jaw.
• Do not apply pressure: whatever the case, do not exert any type of force with your jaw. It is recommended that you sleep on your back to avoid any accident.

When Should You Go To The Specialist?

In the event that you feel that you may have a maxillary fracture, it is recommended that you make an appointment with your trusted plastic surgeon in Mumbai. Also, if you experience any of these issues:

• You have shortness of breath or fainting.
• When you cough or breathe you feel a deep pain in your chest.
• If any of your limbs are swollen and tender.
• If you have a fever or headache.
• If you have a stiff face.
• If the pain does not stop with medication.
• If you have questions about your care.

How Long Does It Take To Weld The Maxillary Bone?

Under normal conditions, the maxillary bone heals in an average of two or three months. This is the same time it takes to heal any bone fracture, although the mineralization visible on X-rays takes many months longer and can take up to a year to recover.

• Postoperative Instructions:

Taking care of your mouth is of the utmost importance in order to obtain an excellent recovery. It is likely that during this process you may have swelling, some kind of discomfort or limitations when using your jaw, but you must understand that it is absolutely normal. Here are some instructions regarding some situations that could happen to you:

• Bleeding: remove the gauze one hour after surgery, not before or after. It is important that you do not spit, rinse, brush your teeth and do not use straws for the first 24 hours, as this could trigger bleeding. It is normal to present a slight bleeding. But, if otherwise, it is excessive bleeding, you should place a folded gauze or a wet tea bag on the wound and press constantly for 30 minutes.
• Pain – Take all medications as recommended by the doctor. If you experience any allergic reaction, discontinue use and do not perform any tasks that require driving after taking the medications.
• Inflammation: apply an ice pack to the maxillary bone upon arrival at home, at intervals of 20 minutes and continue with this recommendation for the next 24/48 hours. This type of swelling is quite common on the second and third day after the operation.
• Diets: It is recommended that the day after surgery you eat a fairly strict liquid-based diet and in subsequent days switch to softer foods. Usually your diet will go back to what it was before.
• Nausea: do not take the treatment without something in the stomach. If nausea persists with sips of carbonated water, this sensation disappears. You can then have a mild tea or clear soup, along with easy-to-digest foods.
• Oral hygiene: the next day you can gently rinse your mouth with a salt solution and repeat this step after each meal and at bedtime.
• Smoking: Smoking delays healing and can cause bleeding. Specialists recommend smokers not to smoke for at least 3 or 4 days.
• Rest: Avoid all kinds of exertion, sports, exercise, or physical activity for at least 2 to 3 days.
• Dental Care: It is usually feasible to avoid all routine dental care for a minimum period of 2 weeks, all this always under the direction of the doctor.
• Infection: Symptoms will be increased pain and swelling, warmth, drainage of pus, or fever. If you have these symptoms, call your trusted doctor urgently.

What Surgical Care Is Recommended?

This type of maxillary fracture harm the work environment as well as the social environment for the patient, for approximately ninety days. In addition to the hospitalization period that is between one to seven days. Among the most frequent surgical care are:

• Liquid diet during the first 48 hours and 1 week. Progressively changing to a soft diet after fifteen or twenty days.
• Oral rinses with antiseptic mouthwash.
• Radiographic controls.

We are not only care about your dental aesthetics, but also take care of solving each of your concerns, and any problem that may arise. We are available with the best of attitudes to help you and ensure your health. We are your best ally in those moments of uncertainty that may arise after suffering a maxillary fracture.

With the evolution of surgical techniques, plastic surgery has become a great ally in the treatment of fractures, especially that of the face, a relatively sensitive region, which can suffer from severe trauma.

What types of fractures to the face would be?

The most common cases of facial fracture are in the nose, malar (cheek bone) and jaw. They are caused, most often, by falls, sports injuries, vehicle accidents and physical aggression. When untreated, the injury can lead to bone deviations, which in addition to compromising the aesthetic part can generate respiratory and masticatory problems.

How do you get it?

In our midst the most frequent cause of fractures and serious facial injuries is still the car accident. Other causes include gunshot wounds, assaults, domestic accidents (falls on stairs, gardens, school, square, etc.), work accidents and sports trauma. The most affected segments of the population are adolescents and young adults.

How do you make the diagnosis?

The diagnosis is made by clinical examination of the injuries and, in cases of suspected fracture, fundamentally by computed tomography. In skin injuries, facial movement and sensitivity should also be examined. It is important to always seek help at a specialized center so as not to let hidden lesions go undiagnosed.

Initial care in face trauma

We know that face injuries are very common. When they occur alone, most of the time they do not present a serious threat to life, and in these cases, their definitive care is left for a second moment, when the patient is already stabilized.

How does plastic surgery help in the treatment of these fractures?

Plastic surgery allows the recovery of fragile parts of the region, such as the skin and subcutaneous tissue — cellular tissue below the dermis. Through the modern techniques we currently have, we can correct the lesion, fixing the bone in the proper place and replacing its functionality.

Is any material applied in this procedure?

Among the treatments of proven efficacy are titanium plate treatments, which are made with metal compatible for magnetic resonance imaging. If before, in the postoperative period, it was impossible to perform the control of the patient with the steel plates, today we have this advantage, which allows excellent results in the short and long term. In most cases, with the use of these plates, we reached the expected goal with the performance of only one procedure.

After how long after the fracture is it possible to undergo the procedure? Are there contraindications?

Surgery is performed after the decrease in edema, which varies, on average, from 5 to 15 days. There are no contraindications; however, when the lesion is associated with other traumas, such as neurological and orthopedic, the surgical priority is for the resolution of these problems.

The face is a sensitive and more exposed region. Are the incisions more discreet?

The cuts to correct fractures are getting smaller and smaller, in addition to the use of modern materials that allow more safety. Complete corrections are a huge advance in complex cases, where conventional techniques do not provide the desired result. This can bring new hope to the great mutilated, for their return to social life.

How is the recovery period?

The recovery phase is usually 15 days, requiring weekly returns in the first month. The points are withdrawn in the first week. Sports practices and sun exposure should be moderate, according to the doctor’s guidelines.

Patients with oral cancer and other types of chronic diseases involving the jaw may require reconstructive jaw surgery to restore the shape, appearance, or function of the jaw after treatment. This procedure is planned in conjunction with other caregivers to time the surgery appropriately. The goal is to treat mandible malformations as soon as possible, without compromising patient care; for example, a cancer patient needs to be fully treated before reconstructive surgery can be performed.

Oral Cancer Surgery

The mouth is composed of several anatomical subdivisions, with different functions and characteristics.

Some of the structures that make up the mouth are the lips, gums, hard palate, retromolar area, floor of the mouth, oral mucosa and oral tongue.

Each of these regions has particularities, including with regard to the formation and evolution of diseases such as cancer.

Thus, mouth cancer surgery is performed according to the location of the tumor, and there are different techniques adopted according to the patient’s needs and the characteristics of the case.

First, it is necessary to evaluate the location of the tumor (what is called mouth, in fact oral cavity, is divided into several regions, namely: lip, floor, tongue, alveolar edge, palate and jugal mucosa), and for each part of these there are surgical procedures with their particularities.

Besides, you need to know the extent of the tumor, so we know how much it will be removed.

In addition, it is often necessary to make an extension of the surgery to the neck, in order to remove cervical lymph nodes affected by the tumor (the so-called cervical emptying surgery, which can be of various types and extensions depending on each case).

For many cases it is necessary a protective tracheostomy and some kind of reconstruction (with removal of other parts of the body to cover the surgical defect, the so-called flaps). All this means that, especially for the more advanced cases, these surgeries can be very complex, time-consuming, and require multidisciplinary staff (such as plastic reconstructive surgery).

Surgical techniques for the treatment of oral cancer

To define which surgical technique will be adopted to treat oral cancer, a thorough investigation of each case is carried out. The purpose is to know the characteristics of the tumor, the location and extent of the disease.

In any case, the initial treatment is done by removing the tumor, and it is important to remove a lot of healthy tissue around it, a safety margin. Surgery is usually performed in a hospital environment with the patient under general anesthesia, but minor procedures may occur under local anesthesia and/or sedation.

In case of more advanced tumors, depending on the surgical extension, it may be necessary to perform a tracheostomy, to serve as an alternative to allow breathing after surgery. In addition,lguns patients use nasogastric tube to bring food directly to the stomach until the tissues of the mouth are fully recovered.

Remembering that these approaches are performed according to the case, because the treatment is personalized for each patient. The following are the techniques that are adopted for different locations of oral cancer.

Glossectomy

This surgery is intended for patients who have developed mouth cancer on the tongue. In it, the tumor and a part of the tissue of this organ are removed, so that the disease is fully treated.

When the tumor has smaller dimensions, it is possible to have partial glossectomy, in which only part of the tongue is removed along with the tumor. However, in the most severe cases and tumors that already occupy an extensive part of the tongue, it is necessary to have full glossectomy, removing the entire tongue.

Mandibulectomy

This surgical technique for mouth cancer is also called mandibular resection. As the name suggests, the procedure is adopted for cases where the cancer affected the jaw, the bone that forms the lower contour of the face, containing the chin.

The extent of this surgery depends on the invasivity of the tumor. When the tests do not indicate an infiltration inside the bone it is possible to remove only part of it, along with the tumor (marginal mandibulectomy). But there are cases where it is necessary to remove an entire “slice” of the jaw. In such cases, reconstruction may be indicated using a bone graft, plates and screws, or even skin, muscle, bone and/or other components to replace the mandible.

Maxilectomy

As we explain, mouth cancer can also develop in the hard palate, i.e. the bone part of the mouth sky. In such cases, total or partial maxilectomy is performed to remove the tumor and a section of the tissue from the sky of the mouth.

There are also techniques for rebuilding the palate to maintain the functions of the oral cavity.

Multidisciplinary service

As you saw, surgery for mouth cancer can often bring functional and aesthetic sequelae to the patient, which depends on the type of tumor and the extent of surgery required to remove it. Therefore, it may be necessary for the patient to receive care from a multidisciplinary team.

It involves, for example, the plastic surgeon, clinical oncologist, radio-oncologist, nutritionist, speech therapist, physiotherapist, nurse and other professionals. All work for functional recovery and oncological outcome for the patient.

In any case, the treatment aims to control the disease, maintain the functions of speech, chewing, swallowing and breathing, in addition to the aesthetics of the patient.

Orthognathic surgery is one of the surgical processes behind corrections of anomalies that affect the jaw bones, and thus the alignment of the dentition.

When the jaw, jaw and turbinates are not properly positioned, there is the negative impact not only of facial aesthetics, but also on the essential functions of their movements.

What is orthognathic surgery?

As stated, orthognathic surgery is the solution to abnormalities as to the position of teeth and bones that form the jaw. These anomalies can assume different degrees of asymmetry, affecting the approach to be made.

Since this positioning is not correct, the proper functioning of the joints that act on the bite, breathing and good condition of periodontal tissues.

The variations that are departing from this placement are called dentofacial anomalies and are commonly related to the growth of the jaws, and can lead to disorders of bite, joints and breathing.

Orthognathic surgery is capable of providing safety and satisfactory results, and thus, in the best quality of life of the patient, taking into account the significant improvement of self-esteem.

Finally, this procedure provides a more harmonic face, in addition to softening the scar marks, since the approach is performed on the inside of the mouth.

When is orthognathic surgery indicated?

Considering that this surgical procedure has not only aesthetic purpose, it is also indicated in cases of weaknesses involving the structures involved. Weakness that has genetic causes.

Thus, orthognathic surgery is indicated in cases of exaggerated growth and in the face of an abnormal disposition, besides being a treatment option for temporomandibular joint dysfunctions (TMT).

For its realization, it is necessary to carry out a series of evaluations of the dentist in advance, soon after the diagnosis of the condition in which the patient is established.

Generally, in children there is the correction of the problem by the use of orthodontic and orthopedic appliances, which are also able to act in the control of bone growth. However, if the patient is an adult, the orthodontic approach is not enough, since the process of stretching the structures of the face has already been completed.

Moreover, in the face of more severe cases, surgery can be performed at the end of bone growth, when the patient is a child. However, this form of action is considered when the identified malformations are more serious and result in aesthetic deformations that lead to loss of self-esteem and psychological problems.

For the treatment of these more severe conditions, a second corrective session may be required, shortly after ending the growth of the individual.

How is orthognathic surgery done?

Preparation for orthognathic surgery usually begins through orthodontic treatment, since the use of the device contributes to the correct repositioning of the bones of the inner part of the face and thus the dental arches.

In this part of the treatment, the joint of the teeth of the upper arch and those belonging to the lower arch are aimed primarily at the junction of the teeth of the upper arch and those belonging to the lower arch, thus solving the problem of dental occlusion. Thus, the orthodontist prepares the dental arches so that the surgeon solves occlusion once and for all in the surgical process. That’s for the locomotion of the support bones.

Soon, after the preparation of the arch, the surgery can be simulated by means of an approach technology in a computer. Therefore, the patient can align his expectations with his dentist, such as being able to visualize the final result of the procedure.

Finally, in the postoperative period some care should be taken for the success of the procedure and the patient’s quiet recovery. This care in turn should be aligned according to the professional’s guidelines and are related to phonation, diet, and oral hygiene.

How is the recovery from orthognathic surgery?

Recovery from orthognathic surgery requires some specific care to avoid the incidence of complications. Food should be based on liquid foods that do not require much chewing. It is therefore necessary, a balanced and healthier diet.

It is common during the first weeks of adaptation to generate a certain discomfort, but with the passage of 1 month the patient will already be able to gradually return to their daily activities.

The improvement and the definitive result of the procedure is achieved in the sixth month after surgery and contact with your dentist is decisive throughout the postoperative process.

After this period the patient is submitted to the realization of treatment with the orthodontic appliance, and thus, the repair of the smile bite, a process that can last from 3 to 6 months. It is only after the noticeable improvement of the treatment that will have the removal of the device.

Orthognathic surgery, before and after

The orthonotic surgery before and after has as final result a more harmonic face with better positioning of the jaw and chin, in addition to a more harmonic smile provided by the alignment of the teeth.

In addition to the aesthetic result, the performance of orthognathic surgery renews the self-esteem of the person, giving more confidence and thus improving their relationships.

If you suffer from this type of anomaly and are interested in this renovation, look for a specialist dentist and resolve the abnormalities that involve your facial skeleton and smile.

It is worth mentioning that right after treatment it is already possible to perceive changes in contour and facial symmetry, such as tape functions and dental occlusion. Keep in mind that performing the surgery goes beyond aesthetics, but also aims at a better quality of life.

What are the risks of orthognathic surgery?

Among the risks of implementing this procedure are:

• Nausea;
• Vomiting;
• Pain;
• Bleeding;
• Excessive edema;
• Sensitivity in nerves;
• Dental fractures;
• Mandibular movement and impaired recurrence;
• Infection.

However, these complications only develop in cases where postoperative care is not followed.

In addition, the postoperative period can last up to three months to ensure the definitive result. Among the difficulties to be observed are the limitation in mouth opening. The adhering of physical therapy exercises may contribute to the return of jaw function and to the control of swelling (edema).

What are the risks of the lack of this procedure?

Finally, those who suffer from these problems and do not seek treatment can further compromise the execution of routine activities, bringing a series of complications.

Among these more recurrent complications in whom treatment neglect are aesthetic changes, in addition to functional and respiratory problems. This in view of the direct relationship of the surgery and the quality of life of the patient.

In addition, pain and problems regarding chewing can be perceived in the absence of the procedure, since the facial musculature and jaw are equally compromised.

Even with the surgery, since postoperative care is not taken into account, the patient is susceptible to the same problems, and it is important to consider the dentist’s guidelines throughout the recovery period. As well as the balanced diet and the adhering to physiotherapy sessions.

In a sense, as occurs before the surgical process, the orthodontic treatment approach can be performed at the end of the process, such as the application of dental implants and other types of procedures that seek a better aesthetic effect and the optimization of the final result of orthognathic surgery.