treat cordially

(1) principle

The treatment of cleft palate is a complicated process, which requires the cooperation of experts such as oral and maxillofacial surgery, plastic surgery, orthodontics, voice training, psychiatry and psychology to achieve satisfactory results.

1. Best age

In terms of cleft palate operation time, we should try to complete cleft palate repair before the age of 2. For patients with fissure stenosis, it is best to complete cleft palate repair within one year after operation, without exposing or less exposing the hard palate bone surface. However, when the fracture is serious and a large area of exposed bone surface may be left after operation, the operation time can be delayed appropriately. For patients with cleft palate aged 5 ~ 10, the posterior pharyngeal wall enlargement of Huaxi is helpful to improve the velopharyngeal closure rate, while for patients with cleft palate aged over 10, the velopharyngoplasty with Huaxi palatopharyngeal muscle flap can significantly improve the velopharyngeal closure rate of elderly patients. Children with cleft palate can be closely monitored, and cleft palate should be considered only when there are feeding, hearing or voice problems.

2. Surgical methods

In principle, the surgical method of cleft palate is to choose a surgical method that can effectively restore the voice of cleft palate patients and has little effect on maxillary growth. The research shows that the repair of hard palate cleft palate with plow bone flap can effectively reduce the cleft width of cleft palate, so that most patients can avoid or reduce the distance of making relaxation incision near the gingival margin on both sides and moving the periosteal flap of palate mucosa to the midline when repairing cleft lip, and it has no obvious effect on the early growth of maxilla. In cleft palate repair, Sommerlad levator palatini muscle reconstruction is mainly used, as well as Lang's method, two-flap method and anti-double Z method, and the following principles are followed for design and operation: strive to reconstruct the morphological structure of levator palatini muscle ring; Extend the length of soft palate as much as possible; Try to avoid or reduce surgical treatment.

(2) repair

Surgical repair. Suitable before 5 ~ 6 years old. The operation not only closed the cleft palate, but also provided the correct conditions for the child's pronunciation. Children should be trained in pronunciation after operation. The basic principle of cleft palate repair surgery is to prolong the soft palate, close the palate and pharynx, and restore normal swallowing and pronunciation functions. At present, the commonly used operations are:

1. modified Langerhans operation;

2. Pear bone mucosal flap surgery;

3. Arterial island palatal flap surgery;

4. Retropharyngeal mucosal muscle flap transplantation.

Cleft palate repair is a key step in the treatment of cleft palate. However, the medical community still has different views on the choice of operation age. In the past, from the perspective of children's tolerance to surgery, doctors often advocated that 3 ~ 6 years old was the best age for surgery. There are also many doctors who believe that the safety of operation has been obviously improved due to the improvement of anesthesia technology, and suggest that the earlier the operation, the better, and no more than 2 years old at the latest. Early operation is very effective in improving postoperative pronunciation.

After the operation, in order to improve the pronunciation, the child should be trained in pronunciation under the guidance of a doctor in order to form a correct pronunciation. Children need to go to the orthodontics department for orthodontic treatment when they are teenagers.

In addition to surgical treatment, we should also pay attention to the following aspects:

1. In order to avoid choking on milk, you can let your child sit still while feeding, or you can feed it with a dropper. Semi-liquid or solid food is easier to feed than liquid food;

2. Cleft palate is often complicated with tonsillitis and hyperplasia, otitis media and chronic nasopharyngitis. Antibiotics should be used in time.

The basic principle of cleft palate repair surgery is to use tissue flap near the crack to close the crack, prolong the soft palate, reset the dislocated tissue structure and restore the physiological function of the soft palate. In order to improve velopharyngeal closure, retropharyngeal tissue flap was used to increase the length of soft palate and lateral pharyngeal tissue flap to reduce the width of pharyngeal cavity.

(3) Nursing

After cleft palate surgery, it is advisable to let the sick child bend his knees, lie on his side, lie on his side or hold his head in a low position, so that blood or saliva can flow out of his mouth. The child's muscle strength is weak, and the tongue may fall backwards when sleeping, affecting breathing, and an oral airway can be placed; Give oxygen if necessary. After the child is awake, the endotracheal tube can be removed. After the child is fully awake for 4 hours, a small amount of sugar water can be fed and observed for half an hour. If you don't vomit, you can eat liquid food.

Precautions after operation:

1. Don't feed too hot food.

2. Eat a small amount of warm water to clean your mouth after feeding.

3. Avoid the stimulation of residues and hard objects.

4. Keep the wound local clean and dry.

5. Avoid excessive crying, scratching and bumping into wounds.