Cleft Palate Repair

Cleft palate is more common and can occur separately or with cleft lip. Cleft palate not only has soft tissue malformations, but most patients with cleft palate can also be associated with varying degrees of bone defect and deformity. They are far more severe than cleft lip in terms of physical dysfunction such as sucking, eating and language. Due to the growth and development of the jaw bone, it often leads to the collapse of the middle part of the face. In severe cases, it is a dish-shaped face, and the bite is disordered (often anti-jaw or open jaw). Treatment of diseases: cleft lip and palate Indication Cleft palate is divided into four degrees according to the degree of deformity: i degree: soft cleft palate. Limited to soft crotch. Ii degree: soft and hard cleft. There are fissures in both the soft and hard palate, but the alveolar incisors are intact. Degree of iii: complete splitting on one side. The fissure self-suspended, soft palate, hard palate midline forwards directly to the incisor, the needle to the outside, the nasal septum is connected to the contralateral palate, and the alveolar also has a fissure, which is often accompanied by a unilateral cleft lip. Iv degree: completely split on both sides. From the back to the incisors, the fissures are divided into left and right forks and turned to the outside to form a "y" shape. The lower edge of the vomer is free. This type of cleft palate often coincides with bilateral cleft lip. There are many surgical repair methods for cleft palate, especially iii to iv degree cleft palate is more complicated. Otolaryngology is often used to repair i-ii degree cleft palate due to clinical work needs. Contraindications 1, there is skull base bone destruction or paranasal infiltration, cranial nerve damage or distant metastasis. 2, there are liver and kidney dysfunction, poor overall condition. Preoperative preparation 1. If there is anemia in children with cleft palate, it should be treated and corrected before surgery, and blood should be prepared. 2. If there is nasal and pharyngeal infection, it should be controlled first. Surgical procedure There are many surgical methods and cleft methods for cleft palate. The basic operations are as follows: 1. The position is supine, the shoulder is high, the head is reclined, the sides of the head are fixed with sandbags, the mouthpiece is opened, and the open cavity is opened. 2. The bilateral incision of the ankle is first cut at about 5 mm from the gingival margin on both sides of the hard palate, and the molar is passed back from the cuspid to the maxillary nodule. The incision must be cut through the entire layer of the periosteum to reach the bone to form a periosteal flap. During surgery, care should be taken to avoid damage to the aorta. 3. Separation of the periosteal tissue is inserted from the incision with a periosteal separator, and the bone is pushed under the periosteum to promote the separation of the entire tissue flap from the bone surface to the edge of the split. Then separate backwards until the posterior margin of the hard palate, gently separate the blood vessels around the aorta, be careful not to damage or cut the artery and accompanying nerves, separate to the maxillary nodules, and determine the location of the uncinate process. 4. After cutting the uncinate process, after determining the position of the uncinate process, insert it with a small bone chisel and pierce the neck of the uncinate process. In this way, the tension of the squat muscle can be alleviated. Use a stripper to insert the wound edge and separate the soft palate tissue toward the center until the soft palate has been loosened. If there are still some tissue tensions, blunt separation can be performed. Soft tissue oozing, can be used to stop bleeding with sand strips impregnated with 1:1000 adrenaline. 5. Cut the edge of the split and use a small needle to hang the sling through a thread of the filament for traction. After cutting the edge of the split with a pointed knife, the cut is forced to be neat from the hard palate until the top of the uvula. 6. Cutting the anterior border of the soft palate of the aponeurosis by the aponeurosis attached to the posterior border of the tibia, and cutting the aponeurosis can further relax the soft palate. In addition to the case of a wide gap, the nasal mucosa must be cut at the same time to facilitate suturing, and it is generally not necessary to cut the nasal mucosa. 7. The suture tissue flaps on both sides of the suture have been cut open and separated, and the nasopharyngeal mucosa, muscle and oral mucosa were sutured separately. 8. Stuffing in the gap between the loose incision and the maxillary nodule on both sides, and stuffing with iodoform gauze to achieve the dual purpose of compression and hemostasis. complication Incision delayed healing and wound infection.

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