Unilateral cleft lip flap repair

The cleft lip is commonly called "rabbit lip", which means that the upper lip is cracked, which is a kind of congenital malformation. Cleft lip is the most common congenital malformation in the oral and maxillofacial region, often associated with cleft palate. Normal fetuses begin to fuse with some embryonic processes to form a face after the fifth week. If they fail to develop normally, they can deform, including cleft lip. According to previous surveys, the prevalence of cleft lip and palate in newborns is approximately 1:1000, but the information is not exactly the same everywhere. According to the results obtained by China Birth Defects Testing Center from 1996 to 2000, 2265 cases of cleft lip and palate were detected in the 22,618,600 perinatal children in 31 provinces and cities nationwide, and the prevalence rate was 1.625:1000. The above data indicate that the prevalence of cleft lip and palate in China is on the rise, similar to recent foreign reports. According to statistics, the ratio of male to female in cleft lip and palate is 1.5:1, more men than women. Treating diseases: cleft lip Indication 1. Because the central lip has no muscle, the orbicularis muscles on both sides must be sutured in the center of the upper lip. Make the orbicularis muscles completely reset. 2. The red edges of the lips are neat and tidy, and the upper alveolar groove is deep. 3. There is no central notch (the central red lips are thin), and the good ones form the lips at the same time. 4. Both sides of the lips are red symmetrical. Contraindications 1. The weight of children who choose cleft lip repair surgery is less than 5kg. 2. Hemoglobin is less than 10g/100ml. 3. The white blood cell count is higher than 104/mm3 or the coagulation function is abnormal. 4. Children who are preparing for cleft lip repair surgery are younger than 10 weeks old. 5, the child has an acute infection of the upper respiratory tract infection. 6, children with cleft lip repair surgery have digestive tract diseases. 7. There are inflammatory diseases in the face and mouth and in the ear, nose and throat. 8, excessive tonsil may affect the breathing after surgery. 9, children with cleft lip repair surgery can not tolerate general anesthesia. Preoperative preparation 1. The patient should have a good nutritional status, hemoglobin is above 10g, and surgery should be performed without acute and chronic inflammation. Regular general physical examination and general improvement are required before surgery. 2. Clean the mouth and nostrils 1 to 2 days before surgery. Surgical procedure (1) Rotating propulsion flap repair: 1. Dotted line: First determine the basic points 1, 2, 3, 4, 5, 6, and 7, and measure the lip height (distance of 1 to 5 points). Determine the point 8 on the medial side of the base of the nasal column and the medial side of the healthy side, and draw a curved line from point 8 to point 3. The length is slightly larger than the lip height, and the curved connection is 6-7, so that 6~7=3~ 8; from point 6 outward curved line to point 9, the length of the line depends on the width of the base of the healthy nostril, the large nostril incision is longer, otherwise, the size of the nostrils on both sides is basically appropriate. As a result, three triangular petals (a, b, c-valves) are formed. 2. Incision, separation, suture: according to the cutting and separating suture points. The a, b, and c incisions are formed by scribing to stop bleeding, and the orbicularis oculi muscle is separated and restored. The mucosal layer was first sutured, with points 4 and 6, points 8 and 6 points, points 3 and 7, and points 3 and 9 relatively sutured. The muscle layer is then sutured. Finally, the skin is relatively sutured as described above. (b) Improved rotary propulsion flap repair: 1. Fixed point and scribe line: First, the basic points 1, 2, 3, 4, 5, 6, 7, 8, and 9 are determined, and the point 10 is located on the inner side of the middle side of the healthy side and the outer side of the point 8 . Let 8 to 10 = 8 to 11, 3 to 10 = 6 to 7 = lip height. 2. Incision, separation and suture: cut the whole layer of the lip according to the fixed-dot line to form three upper lip a, b, c, first suture the mucosal layer, then separate the muscle layer and reset the suture (see the basic steps of the operation) ). The c-lobes are rotated inward to stitch the points 10 and 11. The a lobe rotates downward, the b-lobes rotate inward, points 6 and 10, points 3 and 7, and are stitched with 4 and 6. This method can prolong the nasal column and lip height, avoiding the shortcomings of the i method. (three) triangular valve repair: 1. Fixed point and scribe line: Determine the basic points 1, 2, 3, 4, 5, 6, and 7 according to the fixed point method, and measure the normal lip height (the height of points 1 to 5). 3 to 4 lines, making it equal to 2/3 lip height. 3 to 8 is the vertical line of the red edge of the lips, equal to 1/3 of the lip height. Point 8 should not exceed the jealousy of the healthy side. Lined by point 6, 6 ~ 9 = 3 ~ 4 = 2 / 3 lip height, with points 7 and 9 as the center of the circle, with a radius of 3 ~ 8 long arc, at point 10, forming 4, 3, 8 and 6, 9, 10, 7 two lines and triangular lips. 2. Incision, separation, and suture: Cut the entire layer of the lip by scribing to stop bleeding. Separate the muscle layer and reset the orbicularis muscle, suture the mucosa, and suture the points 4 and 6, 3 and 9, 8:10, 3 and 7, if the point 3 and the affected side of the lip fail to overlap, ie 3 to 4 The length is greater than 2/3 lip height, and the selection point 11 (that is, 4 to 11-2/3 lip height) is divided into points 8 by points 3 and 11, respectively, and the 3, 8, and 11 triangular petals are cut and sutured. (4) Rectangular valve repair: 1. Fixed point and drawing method: The same points as above are used to determine the basic points 1, 2, 3, 4, 5, 6, 7 and 8, 9, and 10. 3~4=6~9=2/3 lip height, 3~8 lines perpendicular to 3~4 lines, 7~10=6~10=9~10=3~8=1/3 lip height, 7~10 The line is perpendicular to the 6-10 line, which forms a rectangular lip. 2. Incision, separation, suture; cut the whole layer of the lip according to the line, stop bleeding, separate the muscle layer and suspend the mucosal layer after the reduction of the orbicularis muscle, point 4 and 6, 3 and 9, 8 and 10, 3 and 7 Stitching. Pay attention to the reconstruction of the lip shape when sewing the lip red. complication Bleeding, airway obstruction, infection, wound rupture, and fistula formation are common symptoms after cleft lip and palate repair.