Millad method for bilateral cleft lip surgery

Milader's bilateral cleft lip repair is used for the repair of bilateral cleft lip. Treating diseases: cleft lip Indication Millard's bilateral cleft lip repair method has two types of surgery, the first method and the second method. The first method is actually a surgical method in which Millard's unilateral cleft lip repair method (rotary advancement method) is applied to bilateral cleft lip repair. It is suitable for the repair of bilateral II degree cleft lip (second type of bilateral cleft lip), but not for the repair of bilateral III degree cleft lip (first type of bilateral cleft lip). The second method is suitable for the repair of bilateral III degree cleft lip. This section focuses on the first method. The operation was completed in two phases. Preoperative preparation Cleft lip disease children need to be fully and carefully prepared before surgery. 1. Understand and correct bad diet and sleep habits before admission. Within 3 days after admission, you should know if you have a respiratory infection or other infectious disease, and perform local and systemic examinations, including heart, lung condition, nutritional status and weight. Local presence or absence of eczema, erosion, swelling and so on. Thoracic examination should be performed to focus on the presence of congenital heart disease and thymic hypertrophy. Blood tests should also be performed. Hemoglobin, white blood cells, and clotting time should be in the normal range. Otherwise, the cause should be identified and treated, and surgery should be performed after recovery. 2. Before the operation, take a picture of the front, side and front back position to record the nose and lip deformity. 3. 3d before surgery should start and insist on using a spoon to feed liquid food or breast milk, so that the postoperative system can fully adapt to this feeding method, avoiding the crying of sick children caused by hunger after surgery, resulting in increased tension in the operating area. 4. 1d before surgery should be prepared for skin, antibiotic skin test, if necessary, with blood for blood transfusion preparation. 5. Fasting 6h before surgery. If the sick child is crying due to hunger, oral 10% glucose 100ml can be taken 3 to 4 hours before surgery. Atropine antispasmodic and sedatives were injected 30 min before surgery. 6. Prepare a metal lip bow or wire lead pellet for reduction before surgery. Surgical procedure 1. Milard's method of double cleft lip repair (1) The surgical methods and procedures of the first operation are as follows: 1 Design: First, set a point on the front lip of the operation side, generally a point is set at the base of the nasal column; then point b in the human incision, and find the lip point, ie c point. Secondly, the d point is set on the lateral lip, and the d point is generally located at the base of the surgical side of the nose; then the c' point of the lateral lip of the surgical side is found. The b' point is the end of the red lip. The e point is the apex of the lateral lip triangular tissue flap. Finally, the a-c-b segment, the e-b'-c' line, and the d-e-a line are respectively connected. 2 Incision: According to the design of the incision, the whole layer is incision (b-c line is cut to the submucosal layer), so that the anterior lip of the surgical side is separated from the nasal column and rotated downward until it descends to the normal position, forming a triangular-like creation. Cavity. After the b-c line is cut, the red lips of the front lip and the oral mucosa are turned down to be used as the oral lining. Then, a triangular-like tissue flap, the dec' flap, is formed on the lateral lip, which is then advanced into a triangular-like wound cavity left after the front lip is transferred downward; at the same time, a red lip tissue is formed. The flap (the end of the flap is b' point) to repair the red lips of the front lip, making the red lips full. 3 Nasal bottom treatment: Because the nostrils are often too wide (especially with bilateral second-degree cleft lip), it is necessary to remove a small triangular tissue flap at the bottom of the nostril. 4 suture: according to the surgical design, all the incisions are layered and sutured. 5 lip red treatment: the red lips of the front lip and the oral mucosa are turned down to make the oral lining, then the red lip tissue flap is transferred over it, and the incision is interrupted. (2) The surgical methods and procedures of the second operation are as follows: Two months after the first operation, the repair of bilateral cleft lip was completed according to the surgical methods and procedures of the first operation. 2. Milard's method of double cleft lip repair The second method of Millard is suitable for the repair of bilateral III degree (or II degree) cleft lip with larger front lip. The operation is completed in two phases. (1) The surgical methods and procedures of the first operation are as follows: 1 Design: As shown in Fig. 1, the a-lobe and the b-valve are fork-shaped flaps; the c-valve is a middle flap; the d-valve is a red-lip flap, which is turned down to lining. The a' flap and the b' flap are the base flap of the alar; the X and Y flaps are the lateral lip, and the upper end of the lateral lip is the red lip e and the e'. 2 Incision and suture: Cut the lip tissue according to the design, flip the C-valve, rotate the X-valve and Y-valve inward, and then make the two flaps of the mucous membrane and muscle layer across the anterior jaw wound (in the anterior lip) The back is relatively sutured; then the C-lobes are repositioned, and the incisions are sutured separately; the a-fork-shaped flaps ab and b-lobes rotate upward. Transfer to the bottom of the nose, sutured with the a' lobes and b' lobes on both sides, at this time the nose bulge is braided. In the second stage of operation, the two-forked flap is used for prolonging the nasal column. (2) The second operation is a small column extension, usually performed before the school age. The surgical methods and steps are as follows: 1 Design: First, make a "W"-shaped incision line on the base of both sides of the nostrils and the nasal column; then make a line of mouth on the bottom of the nasal vestibule on both sides, and make it parallel to the above-mentioned incision line; finally, on both sides The base of the nostril is designed as a longitudinal wedge-shaped tissue incision. 2 Incision: Incision was made according to design, and the nasal bottom tissue flap was peeled off. 3 suture: advance the nasal bottom tissue flap to the nasal column, and then suture each incision. In addition to the above two methods, Millard's bilateral cleft lip repair method has a one-stage rotary propulsion method and a double-forked flap repair method, which is another bilateral side for the repair of bilateral cleft lip primary malformation. Cleft lip repair method, no further details. complication The main complications of Milard's bilateral cleft lip repair are in addition to the common complications of unilateral cleft lip and bilateral cleft lip, and more serious, can cause severe lip and nose in younger cases. Secondary malformation, postoperative wound splitting or perforation is not uncommon; when used in adult cases, although it does not cause serious secondary deformities, complications such as wound splitting or perforation may occur. There may be deformities such as anterior labial tissue necrosis and thin red lip tissue in the lower lip of the anterior lip.

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