Doctor-patient questions and answers about cleft lip and palate treatment
(a) cleft lip surgery related:
Where is the tissue used to repair cleft lip surgery? Do you need to grow meat or skin to fill the gap?
Cleft lip surgery is to design a surgical incision around the cleft according to the principle of geometry, and use the tissue near the cleft to restore and reconstruct the ectopic anatomical structure without taking meat from other parts of the child or parents.
When can cleft lip surgery be done?
The operation time of cleft lip is 3 ~ 6 months, and the weight is above 6 kg.
It is also a cleft lip. Why is it better than me?
Each patient's tissue quantity, abnormal degree of anatomical structure and aesthetic standard are different, so the postoperative effect of different individuals is not comparable.
The design of the operation is to achieve the best surgical effect as far as possible according to the existing situation of the patient without affecting the future growth and development of the patient.
How is there a small gap in the lips after cleft lip surgery? What should I do?
Although cleft lip surgery emphasizes appearance, it is not cosmetic.
The key to cleft lip surgery is to establish the symmetrical structure of the upper lip, the attachment relationship between the orbicularis oris muscle and the surrounding structures, and accurate surgery to ensure that the child's upper lip grows according to the normal growth law.
The postoperative cavity may be caused by insufficient mucosal tissue of the red mouth or wound contraction.
But in any case, this seemingly obvious deformity is easy to correct, but we need to observe the final effect and the correction time through a certain period of time (at least 1 year).
How long does it take for the wound to return to normal after cleft lip operation, and can you see the operation effect?
Immediate surgical effect, such as symmetry, full red lips, human ridge fossa, scar distribution, etc. However, the general change law of surgical wound after operation is that the wound is red and swollen one month after operation, and the scar contraction is the most obvious. After half a year, the scar begins to absorb, and the scar generally softens one year after operation, and then it will continue to soften with the passage of time, with a lifetime.
Therefore, we suggest observing the wound after cleft lip surgery for at least one year before making a judgment. In addition, you can also observe whether the scar continues to change as the child grows. As long as there are changes, it is recommended to continue observation, unless the changes are not obvious, indicating that the surgical effect has been relatively stable.
How long can you do cleft palate surgery after cleft lip surgery?
Cleft palate surgery can be done 4-6 months after cleft lip surgery.
How long can you do the second cleft lip operation after cleft lip operation?
From the first operation to the present, the shortest is more than half a year.
After cleft lip surgery, the nose still collapses. At what age do you have surgery? How old do you want to do nose surgery early?
It is a common phenomenon that the nose still collapses after cleft lip surgery, and it is also an international problem. We made a sequence recovery plan.
Children who still have obvious collapse after the first cleft lip repair can be taken to the hospital for examination at the age of 5. If necessary, we will suggest anatomical reduction of the alar cartilage of the affected side. For patients over 15 years old, we would recommend costal cartilage transplantation for nasal deformity correction.
In a word, the nasal deformity of patients with cleft lip and palate needs a long and multi-step sequential treatment process. We should not be too anxious, otherwise haste makes waste.
(2) Cleft palate surgery related:
How old can a child with cleft palate have an operation?
Cleft palate operation time: 8 ~ 12 months, weighing more than 9 kg.
What method does cleft palate surgery use to repair cracks?
The purpose of cleft palate surgery is to restore the patient's voice on the premise of minimizing the interference of growth and development. Cleft palate surgery combined with muscle reconstruction and soft palate lengthening can restore the function of patients' soft palate to the maximum extent, achieve velopharyngeal closure required for pronunciation, and avoid or reduce slack incision.
After cleft palate surgery, the pronunciation is still unclear. How's it going?
Just after cleft palate surgery, the peripheral motor nerve function that dominates the muscles is still recovering, and the muscles that were broken before surgery can't move effectively, so the velopharyngeal closure can't be realized, and the pronunciation is unclear.
For patients with cleft palate after operation, we require regular follow-up visits from 65,438+0 months to 65,438+0 years old, with regular review every year, and voice assessment for 3.5 to 4 years old. Objective To evaluate the recovery of speech and velopharyngeal function.
After cleft palate surgery, there was a yellow white material around the wound. Is the wound infected? What should I do?
About 3 days after operation, sometimes food residue or exfoliated cells will form around the suture, which generally does not need special treatment, and can strengthen gargling after meals.
After cleft palate surgery, it was found that the wound was sutured. What should I do with it?
The appearance of cleft palate surgery is imported absorbable suture, which will be absorbed by itself without taking it out. In addition, the suture will also eliminate itself with the friction of eating.
Two weeks after cleft palate surgery, blood flowed out of the mouth. What should I do?
It may be caused by mild infection and erosion of the wound near the gum. If the bleeding is obvious, you can use cleaning materials such as paper towels and gauze rolls to press the bleeding place for 30 minutes to avoid re-injury when you rinse your mouth and brush your teeth. If there is still bleeding, you can press it again or go to the hospital for examination and treatment in time.
In short, bleeding can be controlled by pressing to stop bleeding first, and then going to the hospital can reduce the amount of bleeding. This kind of bleeding seems fierce, but it is not vascular bleeding. As long as the local hospital gives anti-infection treatment, it can be effective. Of course, as a reminder, you can go to the hematology department for examination when necessary to rule out systemic hemorrhagic diseases.
One month after cleft palate surgery, I found a crack in the wound. Did the operation fail? What should I do?
Can't say the operation failed.
Cleft palate surgery is not only to close the fissure, but also to restore the position and good connection of the muscles (levator veli palatini) needed for pronunciation.
Cleft palate surgery is to avoid the growth inhibition of patients' facial development (maxilla) by routine cleft palate surgery in the future, and to avoid making surgical incisions (loose incisions) on both sides of gums as much as possible. In this way, the tissue at the suture crack will be relatively less and tense, and the wound healing may be slower, but according to our observation, most patients' wounds will heal after 2-3 months.
For the case that fistula still exists 6 months after operation, we suggest that children can check the phonetic effect at the age of 4 before deciding the treatment plan.
Fistula after cleft palate operation. When can I have another operation?
Not all palatal fistulas require surgery. Generally, only fistula holes that obviously affect normal function need to be repaired.
Generally, we don't do fistula closure surgery before the child is 5 years old, unless the fistula is very large, which has obviously affected the child's vocal function.
Otherwise, wait until the age of 5, and decide whether to operate and when to operate according to the examination and suggestions of the phonetician.
What is the cause of bad breath after cleft palate surgery? How to solve it?
In the short term, it is the smell of cells, tissue necrosis and protein degeneration falling off the wound. In addition, children eat less and poor oral hygiene can also lead to odor.
However, with the recovery of patients' eating, the odor will be gradually eliminated, so you can rinse your mouth more and eat as soon as possible.
When eating after cleft palate surgery, it will still leak out of the nose. What is the reason? What should I do?
If there is no obvious fistula in the palate, it is mostly caused by the alveolar cleft of the child. Although the alveolar processes on both sides are close together, liquid can still overflow. Don't worry, as long as you strengthen oral hygiene and come to the hospital for a follow-up visit at the time agreed by the doctor, you can find out the reason.
1 can cleft palate be operated once?
Not all primary operations for cleft palate can achieve perfect velopharyngeal closure. About 10% of cleft palate patients still need secondary pharyngoplasty to achieve complete velopharyngeal closure required by speech.
1 Cleft palate surgery has been performed. Why do you need another operation? Is it the same as last operation?
Some patients with cleft palate still have postoperative velopharyngeal insufficiency or palatal fistula after one operation, and may need a second operation.
Before the second-stage operation, comprehensive operation, imaging and voice evaluation should be carried out, and the surgical plan should be designed according to the actual state and requirements of the patient.
1 Is the pronunciation normal after velopharyngeal closure?
Most patients with cleft palate have compensatory abnormal pronunciation habits caused by structural abnormalities. Surgery can only solve structural problems, and the bad pronunciation habits that have been formed must be treated with speech, otherwise it will still affect pronunciation.
1 velopharyngeal closure was performed. How to hold your breath while sleeping? What should I do?
If it is in a short time after pharyngoplasty, it may be that local tissue edema and scar lead to poor muscle movement; If symptoms appear for a long time after operation, sleep breathing monitoring should be carried out to understand the ventilation status of patients in sleep state.
According to the severity of breath holding, positive pressure ventilation or three-stage operation is needed to help improve the upper airway ventilation during sleep.
(3) The operation of alveolar cleft is related.
Does the child's alveolus have gaps and long teeth? Do all alveolar cleft need surgery?
Children with alveolar cleft will grow teeth around the gap. Some patients have congenital tooth loss at the fracture site, except.
From the point of view of continuous treatment, alveolar cleft needs surgery. Surgery can close the alveolar cleft, restore the continuity of dental arch and fill the missing bone mass at the cleft.
Follow-up orthodontics and orthodontic treatment were carried out. But not every patient with alveolar cleft needs surgery. It needs to be clear that alveolar bone transplantation can not improve the shape and surface of dental arch.
When is it appropriate to perform surgery for alveolar cleft? What special examinations do you need to do before entering school?
Bone grafting of alveolar cleft is usually performed at the age of 8 ~ 12. The patients were examined before operation, and the special examinations included curved tomography, CBCT and occlusal examination.
(4) Perioperative examination and evaluation
Will surgical anesthesia affect children's intelligence?
General anesthesia used in modern anesthesia is drugs with little influence on human body and short metabolic time. Anesthetic drugs can be excreted by human metabolism after operation.
Tens of millions of people around the world use general anesthesia for surgery every year. Practice has proved that with the correct use of professionals, general anesthesia will not have any impact on intelligence.
Why can't the child be operated when he is ill? What should I do if children from other provinces can't operate during hospitalization?
The anesthesia risk of cleft lip and palate surgery is obviously higher than that of surgery, so in order to ensure anesthesia safety, children must not have respiratory tract infection and diarrhea before surgery, otherwise their lives will be in danger.
If you catch a cold but have no tracheal infection after hospitalization, you can stay in hospital for observation and decide whether to operate according to your recovery, which usually takes a week.
Patients with diarrhea should stop diarrhea about 3 days after treatment and arrange surgery as much as possible. It is indeed a patient with tracheobronchial infection, pneumonia and so on. We ask the patient to leave the hospital for treatment and rest.
At the same time, give the patient a green channel card to ensure that the operation will be arranged within 3 weeks after the respiratory infection is completely cured and within 2-3 days after hospitalization.
The child is in hospital, and the examination is over. Why don't you have an operation? How long will the operation take? Why?
Besides the child's physical condition, the factors affecting the operation arrangement should also consider the appropriate operation plan and the preparation of special materials, and the operation time cannot be determined simply according to the admission time.
Why can't you eat or drink before operation? How long is the specific fasting time?
Because the operation is performed under general anesthesia, diet should be forbidden before the operation. The specific time is to stop eating and drinking for 4 hours 6-8 hours before the operation. In the meantime, children should not be given any food.
The specific reason is that the side effects of narcotic drugs may cause vomiting and make stomach contents enter the trachea. In awake state, vomit can be eliminated by cough reflex, but for children who are not fully awake, cough reflex has not recovered, which will cause serious consequences such as respiratory tract obstruction and even life-threatening.
What do you need to do after the operation is arranged?
The day before the operation is very important:
(1) Ward nurses will prepare skin, antibiotic skin test, blood preparation and intestinal preparation for the operation site. According to the need, explain the preparation work before operation;
(2) The nurses in the operating room will visit you, conduct corresponding preoperative education, and explain some precautions for entering the operating room on the day of operation;
(3) The anesthesiologist will also visit you in the ward to understand your situation, so as to determine the appropriate anesthesia methods and anesthesia strategies during the operation. Introduce anesthesia risks to you and assist in signing anesthesia consent;
(4) The surgeon or bed manager will introduce you to the operation mode, possible complications and accidents, and assist in signing the operation consent.
What is the procedure on the day of operation?
Send someone to the operating room-check the patient before entering the operating room-the operating room is checked by nurses, anesthesiologists and surgeons-start anesthesia induction-surgery-send it to the resuscitation room after the operation-wake up after the anesthesia-someone is sent back to the ward.
(5) preoperative and postoperative treatment
What preparations and treatments should be made before cleft lip surgery?
Children with cleft lip and palate can receive preoperative orthodontic treatment in infancy from birth. By wearing movable orthodontic appliances, we can achieve the purpose of assisting eating, improving nasal deformity, narrowing cracks and guiding the normal development of jaws.
Why did the doctor ask me to do orthodontics before bone grafting? Why does the doctor want me to pick my tonsils before I can do pharyngeal surgery?
Before all operations, the doctor will comprehensively evaluate each patient and judge according to the patient's own situation.
(1) Whether surgery is needed;
(2) Whether to operate now, or the best operation opportunity;
(3) What kind of operation is the best?
If the patient's surgical conditions are not good, or there are some conditions that affect the surgical operation and surgical approach, in order to ensure the surgical effect, the doctor may ask to solve these "obstacles" before the operation.
What should children with cleft lip and palate do if they have "land to cover the sky"? What should adult cleft lip and palate patients do?
Because of the congenital deformities of jaws, teeth and lips in children with cleft lip and palate, and the influence of surgical trauma and scar, most children will have a "natural world", that is, varus.
After malocclusion in children with cleft lip and palate, the treatment opportunity and corrective measures should be decided according to different ages and degrees of malocclusion, which requires careful examination and diagnosis by orthodontists.
Adult patients with cleft lip and palate have a "natural world", but after examination and diagnosis, if the jaw deformity is mild, orthodontic masking treatment can be considered to alleviate the malocclusion; If the jaw deformity is serious, orthognathic surgery and orthodontics should be combined to solve the problem of face and occlusion.
What should I do if the patient with cleft lip and palate has a bad face?
Because of growth and operation, patients with cleft lip and palate have serious jaw deformity and ugly face. Most patients need orthognathic surgery combined with orthodontic treatment in adulthood, so that their faces can be better solved.
What should patients with cleft lip and palate do if their teeth are uneven? What about incomplete teeth?
The existence of alveolar cleft in patients with cleft lip and palate can lead to the disorder of tooth germ development, the disorder of tooth arrangement after eruption, and the malocclusion such as torsion, gap, inclination, impaction, deletion and variation.
Patients should mainly observe the deciduous period and arrange their teeth properly in mixed dentition period to prepare for alveolar bone transplantation. In the permanent tooth stage, if the jaw deformity is mild, comprehensive orthodontic treatment can be carried out; If the jaw deformity is serious, it is necessary to wait until adulthood, and through orthognathic surgery and orthodontic treatment, the problems of facial morphology and occlusion can be better solved.
Why do doctors in other hospitals say that the age of operation is different? When is the best age for children to have surgery? Why?
The optimal age for surgery is relative. Cleft lip is usually 3-6 months after birth, and cleft palate is 8- 12 months.
What is the effect of the best age for children with cleft lip and palate to miss surgery? What now?
The so-called optimal operation age is also relative, and the operation method and the quality of the surgeon can make up for the influence of missing the optimal operation age to some extent. Just get ready for treatment.
Is cleft lip and palate surgery only done once?
All patients with cleft lip and palate need at least three operations, namely, cleft lip repair 3 months after birth, cleft palate repair 10 months, and alveolar cleft bone grafting at the age of 9.
If it is only cleft lip or cleft palate, it is necessary to decide whether a second operation is needed in the follow-up visit after the first operation, usually when the child is 5 years old.
Should all patients with cleft lip and palate have a second operation?
Absolutely not. Surgery is a double-edged sword, which can not only correct the deformity of patients, but also create new deformities. So be sure to choose carefully. The choice of the second operation is more difficult than the first operation, which involves many influencing factors and requires high experience and technology of doctors.
What circumstances require a second operation? When should it be done?
The operation for patients with cleft lip and palate is not as much as possible, so we should choose the right time and method. Generally it varies from person to person. Routine is to wait until the child is about 5 years old after the first operation, and then decide the next treatment method after comprehensive review. Some cases can be corrected without surgery, for example, some children have poor pronunciation and scars on their upper lips.
/kloc-Patients over 0/5 years old generally have no age limit. In principle, they can have surgery as long as they want to improve, unless the doctor's methods or skills are not up to standard.