Cleft Lip Repair

Congenital cleft lip is generally divided into unilateral cleft lip and bilateral cleft lip. According to the degree of fissure, it is divided into lip red crack, incomplete cleft lip and complete cleft lip. The characteristics of complete lip include: the triangle is triangular, the nasal side of the affected side is flat, the nose is flat, the distance between the inner and outer feet of the nose is widened, the outer leg is low, the nasal column is obliquely split, and the bilateral cleft lip is short. Or have the orbicularis muscle split, dislocation. Cleft lip repair requirements are: 1 accurate anatomical alignment, repair of fissures. 2 Reconstruct the direction of the orbicularis oculi muscle. 3 reconstruct the nasal base, lip peak, and lip. 4 repair the nostrils and nose. Treating diseases: cleft lip Indication 1. 3 months after birth, good health, feasible repair. The cleft lip repair of 2.2 to 3 years old also corrected the secondary deformity of the cleft lip and the reduction of the orbicularis muscle. 3. Repair the cleft lip secondary deformity 2 times 2 years after surgery. 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 1. Fixed point: Determine the basic point of surface anatomy of the upper lip. There are 7 common basic points, point 1 is on the healthy side lip peak; point 2 is the lowest point in the person; point 3 is on the affected side lip peak, 1~2=2~3; points 4 and 6 are on the nasal cleft side of the lip cleft Upper, the sum of the point 4 to the small pillar edge and the point 6 to the inner edge of the nose is equal to the width of the healthy nostril; the point 5 is at the midpoint of the healthy nostril; and the point 7 is at the thickness of the affected side. In addition to the above basic points, according to different repair methods, it is necessary to add fixed points to perform different repairs. 2. Separation: If the nasal basement is wide and the tension is large during suturing, the alveolar groove should be separated first to achieve the purpose of reducing the tension. Before the lip red on each side, a suture is pulled, the lip is opened, and then the mucosa is cut in the side of the alveolar cleft, and the periosteum is separated upward by the shank; the separation range of the disease side is greater than that of the health On the side, it is sometimes necessary to extend and separate to the base of the alar, so that the soft tissue of the cheek is fully loosened, so that there is no tension after suturing. Then, it was blocked with a gauze of 1:200,000 adrenaline physiological saline solution, and hemostasis was suppressed. If the crack is narrow, it is not necessary to separate this plane. 3. Incision: First, use a lip clamp to pressurize the upper lip on both sides of the crack, and then use a sharp-edged knife to cut obliquely from the bottom to the top in the direction of the dotted line, leaving the mucosa slightly more than the skin. The skin, muscle, and mucous layers are separated. Keep the cut red lips to repair the lips. 4. Separation and suturing of the muscle layer: the muscle layer is separated under the subcutaneous and submucosal, respectively, and then separated and cut at the base of the nasal column and the base of the nose, and divided into two to three triangular muscle flaps. Then, the triangular muscle flaps are overlapped and sutured, and the upper upper triangular flap is sutured at the base of the nasal small column, and the lower triangular flap is sutured over the red lips to completely reset the orbicularis muscle. 5. Stitching: According to the design incision, the mucosa is sutured first, the suture is hit on the oral side, and the muscle layer is cross-stitched from top to bottom. The skin and skin were then sutured with a 3-0 to 5-0 nylon monofilament thread or a polypropylene thread. Finally, a z-shaped lip suture is used to avoid shallow lip red cracking caused by straight stitching. The transition portion of the thin side lip is cut, and the lip of the lip is formed into a triangular flap to increase the thickness of the thin side lip, so that the thickness of the upper lip is uniformly symmetrical, and finally the excess tissue is removed. complication Bleeding, airway obstruction, infection, wound rupture, and fistula formation are common symptoms after cleft lip and palate repair.

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