PLASTIC AND MAXILLOFACIAL

SURGERY

Niecole Gayle S. Ledesma

BSN 4C
Plastic surgeries are any surgery that
changes the appearance or
restructures of any characteristic or
body part
Maxillofacial surgery refers to surgery
on the face and jaws
 TYPES OF SURGERIES
Rhinoplasty
blepharoplasty (eyelid surgery)
rhytidectomy (facelift)
browlift,
genioplasty (chin augmentation)
otoplasty (ear repositioning)
Cheiloplasty
microvascular reconstruction of the head and
neck
craniomaxillofacial trauma reconstruction
correction of defects in the face after skin cancer
resection.
 CHEILOPLASTY
technical term for surgery that changes the size or
shape of the lip.
Types
1. Upper and lower lip reduction surgery - a procedure for patients who
have naturally large and prominent lips
2. Upper lip lifting surgery (Upper lip shortening)- is for patients who
presented with excessively elongated upper lip.
3. Lip Augmentation -performed by injecting a natural or synthetic bio-
compatible material.
4. Corrective - patients who have suffered alterations in their lips as a
result of tumours, trauma, burns or lesions. It is also the cheiloplasty
surgery option for congenital alterations
 CHEILOPLASTY
You may Consider Cheiloplasty if :
1. You have thin lips and want to increase their
volume.
2. You have lips that are too thick and want to reduce
their volume.
3. You have a congenital disorder.
4. You have seen your lips affected by some disease.
5. You once underwent some previous treatment that
failed.
 CLEFT LIP
Cleft lip is a congenital malformation
in embryonic development leading
to discontinuity of the upper lip.

The cleft may be:

Complete or incomplete
Bilateral or unilateral

These may occur singly or together

and often occur with other congenital
anomalies such as spina bifida,
hydrocephalus, or cardiac defects
 ANATOMY AND PHYSIOLOGY OF THE LIPS

The lips surround the entrance to the oral cavity. They function to provide competence to the
oral cavity during mastication and at rest. The lips affect uttered sounds that facilitate spoken
language and provide changes of facial expression that facilitate unspoken language. They
provide sensory information about food prior to its placement in the oral cavity. To accomplish
the multitude of functions, lips require a complex system of muscles and supporting structures
 PATHOPHYSIOLOGY OF CLEFT LIP
During the first six to eight weeks of pregnancy, the shape of the embryo's
head is formed. Five primitive tissue lobes grow:

a) one from the top of the head down towards the future upper lip;
b-c) two from the cheeks, which meet the first lobe to form the upper lip;
d-e) and just below, two additional lobes grow from each side, which
form the chin and lower lip

If these tissues fail to meet, a gap appears where the tissues should have
joined (fused). This may happen in any single joining site, or
simultaneously in several or all of them. The resulting birth defect reflects
the locations and severity of individual fusion failures (e.g., from a small lip
or palate fissure up to a completely malformed face).
 RISK FACTORS
Several factors may increase the likelihood of a baby developing a cleft lip
and cleft palate, including:
Family history -Parents with a family history of cleft lip or cleft palate
face a higher risk of having a baby with a cleft.
Exposure to certain substances during pregnancy -Cleft lip and cleft
palate may be more likely to occur in pregnant women who smoke
cigarettes, drink alcohol or take certain medications.
Having diabetes - There is some evidence that women diagnosed with
diabetes before pregnancy may have an increased risk of having a baby
with a cleft lip with or without a cleft palate.
Being obese during pregnancy - There is some evidence that babies
born to obese women may have increased risk of cleft lip and palate.
 How is CLEFT LIP diagnosed?

Diagnosis of a cleft lip is made by prenatal ultrasonography,

by MRI, or by physical examination at birth. Detailed
assessment is made of the child’s breathing, feeding, growth,
and development.
 Problems related to cleft lip and palate
A cleft lip and cleft palate can cause a number of issues,
particularly in the first few months after birth, before surgery is
done.
Problems can include:

difficulty feeding
hearing problems
dental problems
speech problems
 Cleft Lip Surgery Procedure

Landmarks in place and Medial and lateral lip .Undermining skin of medial lip
incision lines marked. element of cleft incised. prior to moilizing orbicularis oris
muscle

Closure of orbicularis oris muscle, Closure of cleft lip

creating a philtral ridge. completed.
 Cleft Lip Repair Post-Operative Instructions

Diet:
Infants may resume breast milk, formula, and/or spoon-
fed purees as taking previously.

If the child is older and has been taking small finger

foods, it is okay to resume this diet, however all foods
should be very soft and cut into small pieces.

Nutrition and hydration are important aspects to

healing.Frequent, smaller feedings may also be
necessary.
 Cleft Lip Repair Post-Operative Instructions
Pain Control:
Mild pain is expected with this procedure. By the time the
child is ready to leave the hospital, his/her pain should be
fairly well controlled.
You should use liquid Tylenol or ibuprofen (Motrin) for
pain relief as needed. Each medication may be given
every 6 hours as needed,
The times may be staggered. For example, Tylenol may
be given at 12:00 and 6:00, and ibuprofen at 3:00 in
between
 Cleft Lip Repair Post-Operative Instructions
Activity & Restrictions:

For infants, you should use the velcro

elbow restraints called "No-Nos" AT ALL
TIMES to protect the lip of the child from
rubbing or pulling. this is required to be
use for 1-3 weeks after surgery, as
specifically directed by the surgeon.
If the child uses a pacifier, he/she
should avoid it for the next 3 weeks.
 Cleft Lip Repair Post-Operative Instructions
Wound Care:
The child's lip repair will feature an outside layer of sutures that are
not dissolvable.
Advise the mother to try to keep the site clean, and free of crusting.
It is okay to clean around the nostrils gently with a washcloth to
remove crusts or dried blood,
Nothing should be applied to the lip until scar care is discussed at
the first post-operative visit.
If silicone nasal stents were used for the child's lip repair, please do
not tug or pull on these since they are temporarily stitched in
place.
The nasal stent will be removed at the 3 week post-operative
visit.You may clean around the base of the stents with a wash
cloth, Q-tip or use saline spray if they seem to get clogged.
 Cleft Lip Repair Post-Operative Instructions
Scar Care:

After surgery, full scar maturation can take up to 12+ months. Over
time, you will notice changes in the color and texture of the scar to
be more like the surrounding tissue.
Once healed, your surgeon will talk to the parents about scar
optimization. This may feature techniques like scar massage,
deliberate sun protection, and even topical products like
moisturizer or silicone scar gel
 NURSING DIAGNOSIS
Risk for Aspiration related to anatomic defect
Imbalanced Nutrition: Less than Body
Requirements related to sucking difficulties (infant
) secondary to cleft lip

Ineffective family coping related to situational

crisis of birth of a child with a defect
Risk for Infection related to location of surgical
procedure
Impaired verbal communication related to
impaired motor function of muscles of speech
secondary to oral deformity
 Most Common Medications
Pain Medications
Tylenol
Indication : Relief mild - moderate pain , fever

Nursing Responsibilities
Do not exceed the recommended dosage.
Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever,
severe or recurrent pain occurs (possible serious illness).
Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products.
Give drug with food if GI upset occurs.
Discontinue drug if hypersensitivity reactions occur.
Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a
specific antidote; basic life support measures may be necessary

Patient Teaching
Do not exceed recommended dose; do not take for longer than 10 days.
Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
Avoid the use of other over-the-counter preparations. They may contain acetaminophen, and serious
overdosage can occur. If you need an over-the-counter preparation, consult your health care provider.
Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns.
 Most Common Medications
Pain Medications
Ibuprofen
Indication : Relief of mild - moderate pain, fever

Nursing Responsibilities
Be aware that patient may be at increased risk of CV event, GI bleeding, monitor accordingly.
Administer drug with food or after meals if GI upset occurs.
Arrange for periodic ophthalmologic examination during long-term therapy.
Discontinue drug if eye changes, symptoms of hepatic impairment, or renal impairment occur.
WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, and
supportive therapy.

Patient Teaching points

Use drug only as suggested; avoid overdose. Take the drug with food or after meals if GI upset occurs. Do
not exceed the prescribed dosage.
Avoid over-the-counter drugs. Many of these drugs contain similar medications, and serious overdosage
can occur.
You may experience these side effects: Nausea, GI upset, dyspepsia (take drug with food); diarrhea or
constipation; drowsiness, dizziness, vertigo, insomnia (use caution when driving or operating dangerous
machinery).
Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision, black
or tarry stools.
 References
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https://www.anavara.com/treatment/cheiloplasty/
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Mayo Clinic. (2021). Cleft lip and cleft palate. https://www.mayoclinic.org/diseases-
conditions/cleft-palate/symptoms-causes/syc-20370985
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cheiloplasty/
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palate/cleft-lip-and-palate-treatment/cleft-lip-surgery
R. (2019a, February 6). acetaminophen (N-acetyl-p-aminophenol) Nursing Considerations &
Management. RNpedia. https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-
notes/acetaminophen-n-acetyl-p-aminophenol/
R. (2019b, February 13). Ibuprofen nursing considerations & management. RNpedia.
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/ibuprofen/
Redett, R., Steinberg, J., & Seifert, K. (2019). Cleft lip repair Post-Operative instructions. Johns
Hopkins Pediatric Plastic Surgery.
https://www.hopkinsmedicine.org/plastic_reconstructive_surgery/patient_information/_docs/clef
t-lip-discharge.pdf