唇裂腭裂CLEFTLIPANDPALATE.ppt.ppt
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1、 Cleft Lip and Cleft Palate NormalLipWithAnatomicalTermsvVermilion:Thelowermarginoftheupperlipiscalledthevermilionandischaracterizedbyitsrosycolor.vCupidsbow:ThetermCupidsbowisusedtodescribetheconcaveordippedportionofthevermilionborderinthecenteroftheupperlipvTubercle:vPeakoftheCupidsbow:vPhiltrum/p
2、hiltraldimple:Theportionoftheupperlipbetweenthetwophiltralcolumnsisknownasthephiltrumvphiltralcolumnsorlines:Abovethecenteroftheupperlipisadimplecalledthephiltraldimple,andtheraisedridgesoneithersideofthisdimplearethephiltralcolumnsorlinesNormalLipWithAnatomicalTermsTypesoffacialclefts Cleft lip Med
3、ian cleftLateral Facial CleftOblique Facial CleftMedianFacialCleftLateralFacialCleft(HemifacialMacrosomia)BilateralObliqueFacialCleftCleft Lip 1.DefinitionofcleftpalatevCleftlip,sometimescalledharelip,isacongenitalmalformationofembryonicoriginthataffectsthelip.Itoccursbyitselfortogetherwithanalveola
4、rorpalatalcleft.2.IncidencevTheincidenceoforalcleftsvariesfrom1to2.21/1000.vTheincidenceofcleftlipvariesacrossraces(approximately1to1000forwhitesand0.41forblacksinUnitedStates).vMalepreponderanceismarkedinthemoresevereorcompletecleftlip,themale:femaleratiobeingapproximately3:2.vInmostseriescleftlipw
5、ithcleftpalateisreportedas1.5to3timesasfrequentlyasisolatedcleftlip.2.IncidencevInChina,theincidenceisabout1.8/1000,andtheconditionoccursmorefrequentlyinmalesthanfemales.3.EtiologyThecauseofcleftsisnotunderstoodverywell.Whilstweknowwhathappens,wedonotknowwhy.vParentalagevDrugusevInfectionsduringpreg
6、nancyvSmokingor/anddrinkingduringpregnancyvHeredity,FamilyHistoryvX-ray,microwavevdeficiencyofvitaminC,D,BvEnvironmentalFactors5.TypesofcleftlipAlthoughmanyclassificationshavebeenproposed,weprefertousedefinitiveanddescriptivetermsinordertoavoidconfusion:v1.Accordingtotheposition:Acleftlipmaybeunilat
7、eralorbilateral.upperlipcleftandLeft-sidedoccurrencearemorefrequentthanthelowerandtherightside.Amediancleftandcleftsofthelowerlipareextremelyrare.5.Typesofcleftlipv2.Accordingtotheextent:Thecleftmayvaryinextent,beingeitherincompleteorcomplete.1)Acompletecleftlip:isoneinwhichthecleftextendsthroughthe
8、floorofthenostril.Thistypeisalmostinvariablyaccompaniedbyanalveolarorpalatalcleft.2)Anincompletelipcleft:oftenvariesmerelyanothingofthevermilionborder,toonethatextendspartwayuptowardthethresholdofthenostril.Occasionallyshowsascarcelyperceptiblenotchingofthevermilionborderandaslightgroovingoftheskins
9、urface,indicatinganimperfectmuscularunionbeneath.UnilateralcleftlipUnilateralcompletecleftlipUnilateralincompletecleftlipUnilateralincompletecleftlipUnilateralincompletecleftlipUnilateralCompleteCleftLiplbBilateralcleftlipbilateralincompletecleftlipbilateralcompletecleftlipbilateralmixedcleftlipBila
10、teralCompleteCleftLip17-year-oldgirlwithbilateralcleftlipandcleftpalateBilateralcleftlip/palateBilateralcleftlip/palatebilateralmixedcleftlip5.PresentingFeaturesDeformityanddysfunctionarisingfromprimaryabnormalitywillleadto:vSeparationofthelipvabnormalfacialdevelopmentvspeechanomalies:usuallynotsero
11、usvairwayabnormalitiesvFeedingproblemsvpsycho-socialdifficulties:associatedwithaestheticandfunctionaldeficienciesvInalmosteverylipcleftthereisanassociatednasaldisfigurement.Thisusually,butnotalways,variesinseverityindirectproportiontothewidthofthecleft.Thusanincompletecleftmayexhibitonlyaslightsprea
12、dingandflatnessoftheaffectednostril,whileinawidebilateralcleftthenostrilsareextremelyflattenedanddistortedthenasaltipretracted,andthenasalcolumellashortenedvThemusclesofthemouthincleftlipfailtomeetinthemidlineandthusseekotherattachments.Thesesubstituteattachmentspreventthemusclesfrombecomingfullyfun
13、ctional,andtheirdevelopmentisincomplete.6.Treament1.TeamapproachThemanagementofcleftsrequirestheparticipationofthefollowingexperiencedspecialists:asurgeon:suchasaplasticsurgeon,anoral/maxillofacialsurgeon,acraniofacialsurgeon,oraneurosurgeonanaudiologist:whoassesseshearingapediatricdentistorotherden
14、talspecialist:suchasaprosthodontist,whomakesprostheticdevicesforthemouth);vanorthodontist:whostraightenstheteethandalignstheteethandjaws.vageneticist:whoscreenspatientsforcraniofacialsyndromesandhelpsparentsandadultpatientsunderstandthechancesofhavingmorechildrenwiththeseconditionsTeamapproachvanurs
15、e:whohelpswithfeedingproblemsandprovidesongoingsupervisionofthechildshealthvanotolaryngologist:anearnoseandthroatdoctor,orENTvapediatrician:tomonitoroverallhealthanddevelopmentTeamapproachTeamapproachvapsychologistorothermentalhealthspecialist:tosupportthefamilyandassessanyadjustmentproblemsvaspeech
16、languagepathologist:whoassessesnotonlyspeechbutalsofeedingproblemsvandothernecessaryspecialists:whotreatspecificaspectsofcomplexcraniofacialanomalies.TeamMembers2.surgicalrepairofcleftlipTimingofOperation:selectingasuitabletimetooperateonthecleftlipvariesfromsurgeontosurgeon.Someclinicspreferoperat
17、ingontheinfantsimmediatelyfollowingbirth,preferablywithin48hours,even24hours.Othersconsistthatthesurgeryshouldbedelayedforaminimumof8to10weeksfollowingthebirth.ruleoftensvAlthoughtherearestillmanydifferentopinions,themostacceptedstandpointisthatliprepairshouldbecarriedoutwhenthechildsgeneralhealthan
18、dweightpermitthesafeinductionofgeneralanesthesia.anesthesia.vThetime-honored“ruleoftens”isausefulguidetothetimingofsurgery:Accordingtothisrule,liprepairshouldbecarriedoutwhenthechildhasattainedaweightof10pounds,is10weeksold,andhasahemoglobinconcentrationhigherthan10milligram/dl.TimingofOperationinch
19、inav1.Unilateralcleftlip:36monthsoldv2.Bilateralcleftlip:612monthsoldvThePurposeofRepair:a.Restorationofnormal/nearnormalanatomyb.Restorationofnormal/nearnormalfunctionc.Promotionofnormal/nearnormaldevelopmentresultinginsatisfactory2.surgicalrepairofcleftlipvThepurposeis,ofcourse,torestoretheanatomi
20、cpartstotheirproperpositionstopromotenormalgrowthanddevelopment.vAneffectiverepairmustrealignthevermillionandCupidsbowofthelip,reconstructtheupperlipandphiltrum,andreapproximatetheorbicularisorismusclewithintherepair.2.surgicalrepairofcleftlipCriteriaforliprepairvAccurateskin,muscle,andmucousmembran
21、eunionvSymmetricalnostrils,SymmetricalnostrilfloorsvSymmetricalvermillionbordervPreservationofthecupidsbowvAminimalscar2.surgicalrepairofcleftlipvAnesthesia:Generalanesthesiaisused.2.surgicalrepairofcleftlip(takingunilateralliprepairasanexample)vmethodsofunilateralliprepair:Tennision-RandallMethod(T
22、riangularflapmethod)Millardmethod:(Rotation-advancementmethod)ItisthemostpopulartechniqueforunilateralcleftlipdescribedbyMillard.Millardmethodthefirststep:MarkingsvMidlinenadir2vPeaksofCupidsbow1,3vNewCupidsbowpeakoncleftside4vTheextentofrotationcurve5vCommissures6,7vAlarbaseoncleftside8vTheincision
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