Dorrance surgery

The two-valve modified Dorrance procedure is used for the repair of cleft palate. This method has a long history and is a mature operation for stereotypes. It has been using its basic operation method at present, but there are many improvements. The shortcoming of this method is that the repair of the fissure can not be achieved, and the purpose of prolonging the soft palate is not achieved, so the postoperative pronunciation is not ideal. Treatment of diseases: cleft lip and palate Indication Dow's surgery is suitable for soft cleft palate and hard and soft cleft palate. It is not suitable for patients with hard soft palate and soft palate. Contraindications Cases with anemia, upper respiratory tract infection, inflammation of the ear and nasal passages, and grade III enlargement of the tonsils, especially those with congenital heart malformations, should be examined and treated by the relevant department before surgery. Preoperative preparation You should make a sputum guard before surgery and try it for 1~2d to make it accustomed to eating. Those whose trailing edge is too long should be worn away to prevent nausea and vomiting. The nose was started with 0.25% chloramphenicol 2 days before surgery. Prepare blood 150 ~ 200ml. Adult patients need to be treated with oral cavity 1 to 2 days before surgery, and often contain Du Bell liquid. One hour before surgery, a proper amount of atropine was injected subcutaneously. In the morning, the patient is fasted, and the surgery is delayed. The sick child can take about 200ml of sugar water 4 hours before surgery. Anesthesia was performed with an endotracheal intubation ether or enflurane, preferably a nasal cannula, or a cannula for oxygen and intravenous anesthesia. Anesthesia should not be too deep, so that cough reflex can be maintained throughout the anesthesia. A small amount of 0.25% to 0.5% procaine can be injected into the soft and soft palate to enhance the anesthetic effect and reduce local bleeding. The shoulder pad, keeping the head back, the anesthesia tube connected to the cannula is biased to one side, and the anesthesiologist is on the side, which is beneficial to the operator. Surgical procedure The operation was performed in two phases with an interval of 2 to 3 months. First stage surgery 1 Incision design and incision: from the lateral side of the maxillary nodules, about 1 ~ 2mm along the temporal gingival margin for an arc-shaped incision, and bypass the nasal orifice to the contralateral maxillary nodule. The periosteum was cut through a No. 15 blade and then inserted into the periosteal stripper to separate the mucoperiosteum from the hard palate, reaching the junction of the hard and soft palate. 2 Fully expose the aorta on both sides of the aorta, cut off the ligation, and insert the stump into the large hole to stop bleeding. A medium-thickness skin flap was cut inside the thigh and implanted on the nasal side of the mucoperiosteal flap. The mucoperiosteal flap was then sutured back to the original site for a delayed procedure. Wear the sputum guard plate to pressurize the skin grafting area, and remove the sputum guard plate after 8~10d skin graft growth. 2. The second operation was performed 4 to 8 weeks after surgery. 1 Incision along the original incision, free and pick up the mucoperiosteal flap, both sides and extended until the wing jaw folds exposed the wing hook and then cut. At the same time, the nasal mucosa and the aponeurosis are all cut off from the posterior edge of the humerus with curved scissors. At this time, the soft palate can be moved backward without tension, and the purpose of prolonging the soft palate is obtained. 2 Using a No. 11 sharp blade, pierce the edge of the soft palate, completely cut the uvula, and then suture the nasal mucosa, muscle and sacral mucosa. Stitching method: suture the nasal mucosa of the aponeurosis at the junction of the soft and soft palate with a No. 0 silk thread, suture with a reverse needle, and thread the head toward the nasal mucosa. After suturing the first needle, the line is used as a traction, and the nasal mucosa is sutured until suturing to the apex of the uvula. The muscle layer of the soft palate can be sutured by the same method. It can be sutured by silk thread or gut. The alignment of the muscle layer should be exact, and it should not be twisted before and after dislocation. It is not suitable for suturing too much. The uvula should be accurately aligned to avoid shortening due to misalignment. The suture head should be buried deep in the muscle. Finally, the oral mucosa of the soft palate was sutured with a No. 1 silk thread, and the muscle layer of the soft palate was deepened to strengthen the adhesion of the bilateral tissues. Intermittent suture of the periosteum of the hard palate, which can be supplemented with 2 to 3 needles. The necessary fashion can be at the junction of hard and soft sputum, supplemented by a 1-needle squat reduction suture (line 4), but care should be taken not to pull the aorta and lead to partial necrosis of the mucoperiosteal. Same as "two-valve surgery". Finally, the soft palate is pushed back, and the anterior edge of the mucoperiosteal flap is sutured with the membranous tissue of the residual aponeurosis at the posterior border of the tibia. The wound surface left by the bone surface is covered with several layers of iodoform gauze; the slacks on the sides of the maxillary nodules on both sides are filled with iodoform gauze and then worn into the bracts. complication Bleeding Bleeding can occur due to injury to the aorta, sinus arteries, and surrounding small blood vessels, and blood oozes from the edge of the loosened wound. The adrenaline gauze should be filled and pressurized to stop bleeding, and an antibiotic solution containing epinephrine can be dripped from the nasal cavity. Add a hemostatic agent, open the wound if necessary, and ligature to stop bleeding. 2. Difficult breathing Often caused by intubation injury caused by laryngeal edema, can be treated with hormones and aerosol inhalation. In a few cases, severe edema of the endotracheal mucosa caused by increased dyspnea, should be used for tracheostomy. 3. The wound partially splits and perforates Because there is still some tension after suturing the mucoperiosteal, it is easy to split the perforation at the junction of hard and soft palate. It can be self-healed and repaired after half a year. 4. Partial necrosis of the mucoperiosteal flap Due to the cutting of the aorta on one side, or in the sacral reduction suture, the blood supply to the aorta is blocked, and the tip of the mucoperiosteal is partially necrotic. The dressings were exchanged day by day, the necrotic tissue was cut off, and the repair was performed half a year after healing.

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