Patient 2 was remarkably similar, although her cleft was less severe and was on the right side of her face. She also had massive hydrocephalus identified prenatally and was born by folded cesarean section at 38 weeks. He also passed perological procedures before undergoing craniofacial repairs.

At one month of age, a lip adhesion was performed using the Seibert technique. Of course, in connection with Tessier’s cleft, VP shυp-iпdυc craпiosyпostosis developed in this patient, which ultimately required total remodeling of the cranial vault with advancement from orbit to orbit. After the ocloplastic examination, the team noted that patient 2’s eyelid was lowered and turned downward. Unlike patient 1, there was an island of soft tissue between the oral and ocular portions of the cleft. He had thick goofy features on the prolabium that proved resistant to tapping, requiring initial labial adhesion surgery.

Similar to Patient 1, a “top-down” approach was chosen with the design of a dorsalpasal Reiger flap based superlaterally on the left side with a modest posterior cut.

The bilateral lip repair was performed similarly to patient 1, with the exception of the lip adhesion already performed and the premaxilla still very protrusive, which required a vomer setback to better align the premaxillary segment with the lateral segments and reduce the stress of lip repair.

This labial adhesive tissue was released from the lateral labial flaps and prolabial tissue and then joined together to form the premaxilla creating a separation of the labial mucosa.

Patient 2’s early postoperative course was complicated by a severe infection in the glabella region mapped with local wound care in addition to mild hypertrophic scarring.