Repair of bilateral cleft lip

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. Treatment of diseases: cleft lip and palate 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 (a) z-shaped flap bilateral cleft lip repair (tennison) 1. Fixed point, scribe line: Determine points 1 and 2 on the nasal base line on both sides of the nasal column, determine points 7 and 8 on the nasal base line on the inner side of the nose, and determine the point 3 outside the central lip. 4. Determine points 5, 6 at the inner and upper points of points 3, 4 so that 135 = 246 = 60°. Then, according to the outer fixed point technique of the triangular flap method (tennison method), the points 9, 11, 13 and points 10, 12, and 14 on the outer side of the double crack are determined, so that 7 to 11 = 1 to 3 = 2 to 4 = 8 to 12 and 11 ~13=9~13=3~5=4~6=10~14=12~14, the distance between points 5 and 6 is greater than 1/3 of the width of the central lip, otherwise it will endanger the blood flow of the central lip that goes down. 2. Incision, separation, suturing: After cutting and stopping the bleeding according to the fixed-dot line, the split-side lateral orbital aponeurosis is separated, and the suture is pulled toward the center. First suture the mucosa before suturing the muscles and deepen the upper gingival sulcus. Then sutured by skin, point 1 and 7, 2 and 8, 3 and 11, 4 and 12, 5 and 13, 6 and 14, 3 and 9, 4 and 10 were sutured. Use the red lips on both sides to thicken the central lip and the formed lip to bring the upper lip close to the normal structure. This method features less resection of the tissue and a shorter central lip. (B) rectangular flap bilateral cleft lip repair (barsky) 1. Fixed point, scribe line: First, determine points 1, 2, 3, 4, 5 according to Figure 2, point 5 position between 3 and 4 points, so that 1 ~ 3 = 3 ~ 4 = 2 ~ 4 distance. Points 6, 10, 8, 12 and 7, 11, 9, and 13 are determined outside the crack so that 6 to 8 = 7 to 9 = 1 to 3, and 10 to 12 = 11 to 13 = 1/2 (6 to 8) = 1/2 (3 to 4). Therefore, the points 10 and 11 are located at the midpoints of the respective 6 to 8 and 7 to 9, and the 6 to 8 and 10 to 12 and 7 to 9 and 11 to 13 are perpendicular. The height of the upper lip is equal to the distance of (1 ~ 3) + (10 ~ 12). 2. Cut, separate, and suture: Cut the short flaps on both sides of the crack according to the design. The central lip incision reverses the mucosal layer inwardly to form a 1342 rectangular flap. After suturing the mucosa on both sides, the sacral muscles of both sides are resuscitated and sutured under the central lip rectangular flap, and then the skin is sutured, ie 1 Separate with 6, 3 and 8, 2 and 7, 4 and 9, 12 and 13, 10, 5, 11. Finally, the lip membranes on both sides are interlaced to thicken the upper lip and form the lip. The method features more resected tissue, no upper back lip, flat shape, and the upper lip is short and high. complication Bleeding, airway obstruction, infection, wound rupture, and fistula formation are common symptoms after cleft lip and palate repair.