During the third week to the eighth cycle of the embryo, the fetal facial development has been completed, focusing from both sides of the face to the center. If the development is blocked for some reason during this period, one or both tissues can not be well integrated, and one or both sides will have cleft lip.
From the genetic factors, cleft lip is an autosomal dominant recessive genetic case, and there are many influencing factors. If the mother suffers from rubella during pregnancy 1 to 2 months, or because of nutritional defects, such as lack of vitamin b6 and folic acid, or taking some drugs, such as methotrexate, or the mother is 40 years old, these can all lead to cleft lip.
Cleft lip plastic surgery can be divided into one stage and two stages. The first stage is difficult and cannot be completely repaired at one time. Complete repair of cleft lip requires multiple repair operations.
The main manifestations of the first stage of cleft lip are:
The upper lip is cracked. It can be divided into three degrees according to the location and degree of cracks.
1. First-degree cleft lip is just red lip.
2. The second degree is that the fissure exceeds the red lip but does not reach the bottom of the nose.
3. The third degree is that the tear is completely split from the red lip to the bottom of the nose. The first two kinds are also called incomplete cleft lip, and the last one is called complete cleft lip.
(a) cleft lip can be divided into:
1. Unilateral cleft lip can be divided into incomplete type and complete type.
2. Bilateral cleft lip has incomplete type, complete type and mixed type, that is, one side is complete type and the other side is incomplete type.
(2) According to the crack degree, it is divided into:
First degree cleft lip is limited to red cleft lip.
Second-degree cleft lip is the upper lip split, not the bottom of the nose. Shallow second degree means that the crack does not exceed1/2 of the lip height; The second depth is 65438+ the crack exceeds 0/2 of the lip height.
Third degree cleft lip is a complete cleft of the upper lip and the bottom of the nose.
In addition, recessive cleft lip means that although the skin and mucosa are not cracked, there is no muscle layer. First, fixed point
Fixed point refers to drawing the incision design of all different surgical methods on the lip and nose, and then stabbing the skin at several key points of the design line with an injection needle dipped in Meilan liquid. Be careful not to pierce too deep and cause bleeding.
Second, cut
Before incision, lip forceps or suture can be used to compress the labial artery near the upper lip angle on both sides to reduce bleeding. Of course, you can also pinch the labial artery with your fingers to achieve the same goal. During incision, the operator puts the middle finger of his left hand against the oral mucosa of the incision, and tightens or tightens his lips with his index finger and thumb to make the tissue tense and facilitate incision.
Fourth, suture
Sew from the inside out. Suturing the base of the nose to restore the alar, and then suturing the labial mucosa and orbicularis oris muscle should be able to achieve functional recovery. Muscle suture should not be too much, and a needle at the bottom of the nose is especially important. The second needle can not only restore the orbicularis oris muscle, but also correct the deviation of the root of nasal columella.
Precautions before operation are as follows: Because the child's sucking action will increase the tension and excessive activity of the upper lip and affect the wound healing. Therefore, children should change their eating habits before surgery, not breast-feeding by their mothers, but feeding with spoons. In addition, because cold, runny nose and wound infection are important factors that affect the effect of surgery, so if the child catches a cold, don't have surgery.
Keep the incision clean after operation and use appropriate antibiotics to prevent infection.
Secondary manifestations of cleft lip:
Summary of secondary repair of cleft lip After the repair of cleft lip, there are often different degrees of lip and nose deformities. Common manifestations are:
1) whistling deformity caused by short lip redness of middle lip or poor repair of orbicularis oris muscle and scar contraction on mucosa;
2) the front lip (the person is too short);
3) the front lip (the person is too wide);
4) Lip redness is asymmetrical;
5) Poor repair of orbicularis oris muscle;
6) The gingival sulcus of the anterior lip is too shallow;
7) The upper lip is too tight;
8) The upper lip is too long
Secondary repair of cleft lip mainly includes:
The second-stage repair of cleft lip is complicated, and the scar and direction left by the first-stage operation must be fully considered during the operation, and the treatment scheme should be fine-tuned Only in this way can we work out the best surgical plan.
1 correction of orbicularis oris muscle deformity
To correct this muscle deformity, we should first separate the orbicularis oris muscle vertically attached to the external foot of the nose, continue to widely separate the orbicularis oris muscle to the bilateral nasolabial sulcus, and then make a tunnel under the skin of the front lip, and the orbicularis oris muscle fibers on both sides of the tunnel will be horizontally turned over and stitched together to form a normal orbicularis oris muscle ring.
2 people's abnormal correction
Surgical method: design an isosceles triangle on the orbicularis oris muscle in the middle of human body, cut the bottom and height of the triangle, and then rotate outward in two opposite directions with the waist as the axis to form the ridge of human body, while there is no deformity in the middle of the muscle body, that is, form a concave middle ridge; You can also cut the "height" and "waist" of the triangle, and then make two 90-degree external rotations in opposite directions with the "bottom" of the two halves as the axis to strengthen the bulge of the lip arch edge, while the muscle layer of the whole diaphragm is formed by the part without muscle in the middle, and it is difficult to cut, rotate and fix the suture at the transverse incision at the root of the nasal columella.
3. Correct the lip red deformity
The shape of the labial arch was hardly considered in early repair, and the deformity of the upper lip was poor, so the shape of the labial arch after operation was often arc trapezoid or even triangle. Therefore, an arc incision can be designed on the labial mucosa, the pimp can be taken out, and the labial mucosa can be turned up for suture.
Repair of labial and buccal groove deformity
Make a U-shaped mucosal incision in front of the maxilla, push the mucosal flap forward freely until it reaches a new height of the labial groove, then fix the wound in front of the maxilla and let it heal itself.
Correction of nasal deformity
It is characterized by short nasal columella, separation of bilateral alar cartilage, outward and upward displacement of both alars, and wide nasal floor. If it is bilateral mixed cleft lip, there will be bilateral asymmetry deformity. The repair of nasal deformity is one of the important goals of secondary repair after bilateral cleft lip surgery. By narrowing the root of the nose, putting the alar in the normal position, raising the tip of the nose and lengthening the columella, we can reach or approach the normal nose shape as much as possible.
Polizel's therapy
1. Fix the upper lip with steel wire lip arch tape for 2 weeks to prevent the wound from cracking and reduce scar healing.
2. After the child is awake from basic anesthesia, both elbow joints are fixed with splint bandage to avoid scratching the wound and reduce the labial arch.
3. Gently wipe the lip wound with 3% hydrogen peroxide and 4% boric acid alcohol to prevent the blood scab from covering and affecting the wound healing.
4. Prevent lip wound infection and take antibiotics orally.