Reverse Bidirectional Z Cleft Palate Repair

The normal pharynx is a circular anatomical structure called the velophage closed loop. The ring is mainly composed of 6 pairs of muscles (salvage, levator levator, genioglossus, pharyngeal muscle, uvula, pharyngeal muscle), aponeurosis and posterior pharyngeal mucosa (Passa- Vul). This ring is complete and can open and close the nasopharyngeal cavity normally. Due to the coordinated action of the above six pairs of muscles, and the mutual cooperation of the tongue, the teeth and the lips, different voices can be emitted when the airflow passes through the oral cavity. The cleft palate closed ring ruptured in the cleft palate, the pharynx could not be closed, and the pronunciation was unclear. At the same time, due to the long-term abnormal voice and swallowing function, the developmental abnormalities of the soft palate muscle appear, forming compensatory or disuse anatomical features. In order to achieve good development and pronunciation, the cleft palate must be repaired early to restore the normal pharyngeal closed loop anatomy. Therefore, the purpose of cleft palate repair is to close the fissure, repair the anatomical structure of the velophary, and achieve normal development and pronunciation. Anti-bilateral Z-cleft repair for the repair of cleft palate. Treating diseases: cleft palate Indication 1. Applicable to unilateral complete or incomplete cleft palate repair in infants from 3 to 14 months. 2. Suitable for the repair of submucosal (hidden crack). 3. Also applies to 2 cleft palate surgery. Contraindications 1. In addition to the general contraindications for cleft palate surgery, the cleft palate is completely cleft and the cleft is wide. 2. The soft palate is thinner and shorter than the full cleft palate. Preoperative preparation 1. Infants and young children are best observed for 7 days after hospitalization. No abnormalities are performed. 2. 3 days before surgery, nasal drops with antibiotic eye drops, 3 times / d. 3. Infants, young children with blood before surgery 150ml, adult 300ml spare. 4. Antibiotics can be applied 1 day before surgery. 5. Fast morning in the morning. Oral cleaning. Appropriate amount of atropine and sleeping pills were given 1 h before surgery. Surgical procedure Cut design The slit edge incision hangs from the uvula to the anterior alveolar ridge. The soft palate has double inverted Z-shaped incision on both sides of the oral cavity and nasal cavity surface, and the oral side is I and II valves. The nasal cavity side is III and IV valves. 2. Cut the flap The mucosa was cut from the anterior alveolar ridge to the bilateral side of the uvula at the edge of the crevice. The mucosa and muscle layer of the I valve on the side of the open cavity were cut, and the muscle layer of the I valve was turned up. The mucosa of the II valve was cut from the uvula to the wing hook and the flap was turned up. From the anterior uvula to the wing hook, the nasal mucosa was cut to form a III valve, and the IV mucosal muscle flap was formed from the posterior margin of the hard palate to the incision of the flap and the nasal mucosa. 3.Z-shaped cross-sitting 1 Close the nasal side wound surface: the nasal mucosa wound edge on both sides of the hard palate fissure was sutured with 1-0 silk suture, to the posterior margin of the hard palate, the III and IV flaps were sutured, and the IV muscle tip fiber muscle suture was sutured to the I lobe root muscle. Close the oral side of the wound: suspending the suture. I and II flaps were placed in position. The tip muscle of the I valve was sutured and fixed on the root muscle of the IV valve. Then, the oral mucosa of the cross flap was sutured, and the oral mucosal flap on both sides of the hard palate was sutured. complication 1. Z-shaped mucosal flap peeling is inadvertently perforated, the wound is left behind after suturing the wound, infection, partial re-cracking or perforation occurs. 2. The Z-shaped flap has a tension after cross-displacement and suture, which causes the wound to partially rupture. 3. There is tension after the hard palate crack, and the wound partially splits, causing mouth and nose. 4. Other complications are the same as general cleft palate surgery.