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HEAD AND NECK
Paediatric Plastic Surgery, especially cleft lip and palate surgery, is one of the areas of special interest to Mr. João Nunes da Costa.
Cleft lip is a congenital disease that may also include the palate (cleft lip and palate). In most cases, it is not associated with other pathologies, although there are several syndromes that can include cleft lip as one of its characteristics. The cleft may exist only on one side (unilateral) or on both sides (bilateral), and may be complete (entire lip, including the base of the nostril) or incomplete.
Because it is limiting to feeding and an aesthetically and socially unacceptable problem, the ideal age to operate the child is around 3 months of age, although in the case of premature babies one may have to wait a few more weeks. At three months of life, lip structures are already large enough to be effectively treated, and there is as a lower anaesthetic risk than during the neonatal period. Surgical techniques that correspond to the state of the art are based on the reconstruction of the anatomical subunits of the lip, with special emphasis on symmetry and muscle function (orbicularis oris).
The gum is often also affected, with a cleft between the teeth that corresponds to the absence of bone. By age 9-11 it is possible to treat this problem by transferring bone from another part of the body (usually the iliac bone of the hip) to provide a better environment for dental development. Dentist monitoring (usually requiring brackets) is essential to achieve good results in these cases.
The deformity of the lip also leads to a deformity of the nose, which usually requires treatment. An initial approach can be taken at the same time as lip correction is completed, but the need for a formal rhinoplasty in the late adolescence/early adulthood is often rule, sometimes after performing orthognathic surgery to correct problems such as hypotrophy of the maxillary bone and dental malocclusion.
