What are the types of cleft lip repair?

(A) the causes of cleft lip

hereditary factor

1, that is, with the increase of population prevalence, the prevalence of relatives increases. The closer the kinship, the higher the prevalence rate. The prevalence rate of men is higher than that of women. Usually, the children of male patients only have cleft lip, but the children of female patients are more likely to have cleft lip and cleft palate at the same time. The more serious the patient's condition, the higher the prevalence rate of his relatives. With the increasing number of children, the prevalence of cleft lip and palate in children will increase in the future.

2, consanguineous marriage

It is 50% ~ 100% higher than normal people.

3. National characteristics

Black 0. 4? , white 1? Is the Japanese higher than 3? .

environmental factor

1, nutritional factors

When the mother mice in animal experiments lack vitamins B, A and E, their young mice often have cleft lip and palate.

2. Endocrine effects

Mice were injected with a certain dose of dexamethasone on 13 ~ 15 days of pregnancy, and 82% of their young mice developed cleft palate.

3, the influence of drug factors

Pregnant women take tetracycline, salicylic acid, antiepileptic drugs, anti-leprosy drugs, sleeping pills, thalidomide, etc. People who have been exposed to pesticides for a long time are prone to cleft lip and palate.

4. Biological factors

Infection with virus (such as rubella) within 3 months before pregnancy can induce cleft lip and palate in infants.

5. Injury and mental injury

Incomplete abortion will damage the embryo and directly affect the fetal development.

Mental stimulation can increase the secretion of adrenocortical hormone in vivo, and injection of adrenocortical hormone can induce cleft palate in young rats in animal experiments.

6. Physical factors

Radiation and microwave can cause cleft lip and palate and other deformities in infants.

7, the influence of alcohol and tobacco

Pregnant women who smoke and drink alcohol have a higher incidence of cleft lip and palate.

(B) the classification of cleft lip

It can be divided into unilateral and bilateral cleft lip, and can be divided into three types from the perspective of treatment: recessive cleft lip, incomplete cleft lip and complete cleft lip. The corresponding nasal deformities are also divided into mild, moderate and severe. Mild nasal deformity is that the base of the nose is wide, but the shape of the alar is normal and the nostril protrudes normally. Moderate nasal deformity is characterized by wide nasal floor, nostril collapse or deepening alar groove, and cartilage hypoplasia rarely occurs. Severe nasal deformities are characterized by wide nasal floor, deep alar groove, severe nostril collapse, and often accompanied by alar cartilage hypoplasia.

1, cracked

Cleavage is characterized by grooves or scars exceeding the vertical length of the upper lip, all traces of the red lip, defects of the white lip, and vertical shortening of the upper lip to varying degrees. Nasal deformities can occur, and sometimes they are even more serious than lip problems. Surgery is usually needed, but careful operation must be performed during the operation to prevent postoperative deformity from being more serious than congenital malformation.

2. Unilateral incomplete cleft lip

Unilateral incomplete cleft lip has different degrees of upper cleft lip, but the same feature is that the nasal floor or Simonart area is intact. It can be repaired by rotating propulsion. Although the degree of alar deformity is different and the degree of motion reduction is different, it can be done at the same time as cleft lip repair.

3. Unilateral complete cleft lip

Unilateral complete cleft lip is characterized by cracks in the upper lip, nasal floor and alveolar space (from the initial maxilla). Although secondary cleft palate does not necessarily occur, complete cleft lip is often accompanied by complete cleft palate. The key to evaluate unilateral complete cleft lip is the position of alveolar bone and the vertical height of the affected lip. Generally, there are four positions (1) where the alveolar bone is narrow and does not collapse. (2) Stenosis with collapse. (3) The gap is wide and does not collapse. (4) The gap is large and there is collapse. ? Wide? It is determined by the length of alveolar bone from the base of the corresponding alar. (that is, when the cleft lip is closed, the base of the alar is located at the cleft lip)? Collapse? Refers to the distance between the lingual side of the affected maxilla and the ideal dental arch calculated by the healthy dental arch.

It can also be divided into:

1, unilateral and bilateral

2. Complete cleft lip and incomplete cleft lip

3, Ⅰ, Ⅱ, Ⅲ degree cleft lip

Grade I: Cleft lip (with or without recessive cleft lip)

Second degree: including the red lip, extending to the upper lip but not to the bottom of nose.

ⅲ degree: complete cleft lip to the bottom of nose (this type is often accompanied by alveolar cleft or cleft palate)

(3) Treatment of cleft lip

Timing of treatment:

Cleft lip repair can be performed after birth 1 month, for healthy people. Weight (weight should be greater than 6 kg), nutritional development, hemoglobin, respiratory and digestive tract health should meet the basic requirements of surgery.

The nasal deformity can be corrected at the same time when unilateral cleft lip is repaired.

For bilateral cleft lip, it can be repaired once on both sides, and it can be completed twice with an interval of more than 3 months when the crack is large.

Generally speaking, the repair of alveolar cleft is suitable at the age of 7 ~ 8, which is divided into two layers: inner and outer, with cancellous bone implanted in the middle. 12 years old is more suitable for nasal deformity correction and further scar plastic surgery.

The treatment of cleft lip and palate is a systematic treatment. Often, one operation cannot correct all deformities, and a second operation is often needed.

Preoperative preparation:

Before the operation (at least one week), you should change your baby's eating habits and try spoon feeding to prepare for the operation.

If the child has upper respiratory tract or digestive tract diseases, or the hemoglobin level is too low, or has a persistent low fever, or is obviously underweight, or the child is mentally ill and unresponsive, the operation should be postponed and actively treated, and the operation should not be rushed with luck. Choose general anesthesia intubation.

Postoperative care:

After operation, spoon feeding should be used instead of breast feeding to reduce suture leakage and trauma of alveolar ridge dressing. Restore a high-energy diet on the day of operation to avoid crying. Restrict the movement of upper limbs and prevent fingers from grasping the wound. Clean the suture with diluted hydrogen peroxide and then apply antibiotic ointment. The stitches were removed 5 ~ 7 days after operation.

On 10 day after operation, parents of children should know that the lip scar is the strongest 4-6 weeks after operation, and it is best to adhere to external fixation before 4-6 weeks. Generally, the scar softens 3 ~ 6 months after operation.

Surgical methods:

The basic requirement of cleft lip repair surgery is to restore the normal shape and function of lip and nose as much as possible. A normal lip and nose has the following characteristics: the nostrils on both sides are equally round, the tip of the nose and the columella are centered, the alar does not collapse, the upper lip is symmetrical in height, the red lip is plump, the lip bead is slightly protruding, and the red edge of the lip is arched. The above anatomical features can be used as the basis for the design of cleft lip repair surgery.

The basic steps of cleft lip repair surgery are fixed-point design, incision and suture. There are many fixed-point design methods. Now only the lower triangular flap method is introduced. The steps are as follows:

1, fixed-point design

First find the point on the red edge of the lips.

Find the peak point D and the lowest point C in the red edge of healthy lips, and then press CB=CD to determine point B, and set B at the thickest part of the red edge of affected lips? Point. b，b？ The two points are stitched together to form the peak point of the affected lip.

Measure two basic data

From the base of alar to the base of columella, the width of normal nostril and the base of affected nostril were measured respectively, and the difference between them was X. H measured from the midpoint of contralateral nasal floor to point D was the normal lip height, that is, the upper lip height that should be restored after the repair operation.

Set other points and underline them.

Fixed points a and a on both sides of the affected nasal floor fissure. . Do AA? Is equal to the difference between the width of the bottom of the two nostrils x, do AA? After two-point suture, the nostrils on both sides are the same size. Connect AB. Subtract AB from normal lip height H to get Y, which is the lip height to be increased on the affected side. At point b, BE is about =y, almost parallel to the red edge of the lower lip. With a? With AB as the center and b as the radius? Take the center of the circle y (the lip height to be increased) as the radius, make an arc and satisfy b? (best b? b？ Almost perpendicular to the red edge of the lips). B again? b？ With two points as the center and BE as the radius, make an arc that intersects at e? . Connect a? b？ 、B？ e？ What about e? b？ Each line (be careful not to draw b? b？ Ok, no incision). After correcting each point, puncture the skin with a hypodermic needle dipped in methylene blue, draw a line and fix it with iodine.

Step 2 cut and sew

The operation requires meticulous, light, small trauma, accurate incision and neat suture.

When cutting, first pinch the upper lip outside the incision with your fingers to reduce bleeding. Cut AB, BE and A in turn according to the design line. b？ 、B？ e？ What about e? b？ . After incision, the upper lip of the healthy side can descend, forming a triangular crack at BE. B will form on the affected side? e？ b？ A triangular tissue flap is inserted into this fissure. Is the edge of AB line related to a? b？ Relative. Suture in layers in turn. Trim the red lip, according to the situation, adopt embedded or Z-shaped double triangular flap method to increase the fullness of the red lip. Generally speaking, patients with nasal deformity advocate postponing the radical operation of nasal deformity after 13 years old.

The fissure of complete cleft lip is wide and the tension is high, so it needs to be cut in the vestibular sulcus for invisible separation, which is convenient for tissue suture in place.

Another method is the upper triangular flap method (Mi Leide method): this method is flexible and less harmful to people, but the repair of labial arch is a little poor, so I won't go into details here.