Cleft lip

Cleft lip is a common oral and maxillofacial congenital malformations, the incidence is about 1: 1000. Normal fetus, after starting from the fifth week of some embryonic projections gradually fused to form face each other, such as failure of normal development can occur malformations, including cleft lip.
(A) by fracture cleft lip can be divided into parts:

1. incomplete unilateral cleft lip is divided into type and complete type.

2. bilateral cleft lip incomplete form, complete and hybrid side that is not exactly a complete type.

(B) the degree of fracture is divided into:

Ⅰ degree cleft lips cracked limited.

Ⅱ degree cleft lip was split upper lip, nasal floor not to crack. Ⅱ degree superficial cracks not exceeding high lip 1/2; Ⅱ degree deep fissures over the high lip 1/2.

Ⅲ degree of cleft upper lip, nasal floor completely split

Cracked finger skin, mucous membranes, while not split, but the lack of muscle.

Clinical manifestations

Mainly as cleft upper lip split. According to the site and extent of the fracture split can be divided into three degrees.

1. only once cleft lips cracked.

2. The second time fissure over lips but less than the nasal floor.

3. All three degrees fissure cracked lips from the bottom to the nose, also known as the former two incomplete cleft lip, also known as the last of complete cleft lip.
(A) the timing of surgery

Is generally believed that unilateral cleft lip surgery is appropriate in about six months, bilateral cleft lip is slightly delayed. The basic conditions for children to adapt to the surgery are: general health is good, no anemia, and no respiratory tract infection, local and surrounding tissue without infection.

(B) The basic requirements for surgery

Cleft lip repair surgery is to try to restore the basic requirements of the lips, nose normal form and function. Normal lips, the nose has the following characteristics: both sides of the nose and other large and round, tip of the nose and columella center, not collapse nose, upper lip two equal height, symmetry, plump lips, slightly protruding lip beads, vermilion border was arched shape (Fig. 1). Above anatomical features can be used as basis for cleft lip repair surgery design.

Cleft lip

Chun Feng point margin of 1.3 points shown vermilion

2:00 shows people

People on both sides of the ridge 1-4,3-5 shown in humans

Figure 1 Normal lip nose shape

(C) surgical method to repair cleft lip

The basic steps to repair cleft lip surgery for fixed-point design, cut and sew. Many fixed-point design. Now only introduce triangular flap. The steps are as follows.

1. Fixed-point design

1) first find out the vermilion border point

In the contralateral vermilion border to find Chun Feng point D and among the lowest point C, and then press the CB = CD, fix a B point. In ipsilateral vermilion border thickest set B '(Fig. 2①). Finally, surgery B, B 'two points on the joints, which form the affected side of the Chun Feng (Fig. 4).

Cleft lip repair 2 fixed-point design

2) two basic measurement data

From nose to root columella roots were measured in normal ipsilateral nostril nostril bottom width at the bottom of a difference to get the number for X. Since the midpoint of the contralateral nasal floor to point D measured h, normal lip height, that should be restored after surgery to repair the upper lip height (Fig 2②③).

3) fix the other points, crossed

In the bottom sides of the ipsilateral nasal fracture respectively designated A, A '. So that AA 'is equal to the width of the difference between the two nostrils at the bottom of the number of X, so that AA' after the two-phase suture, both sides of the nose and other large. Connection AB. Normal height h minus the lip derived AB y, this is the need to increase the lip ipsilateral high. At point B, for about BE = y and with the lower lip vermilion border nearly parallel. In A 'as the center for the radius AB, B' for the center y (need to increase the lip height) as the radius to make the arc and intersect at B "(best B'B" near-vertical with the vermilion border). Again B'B "points respectively for the center, to BE as radius for the arc cross in E '. Connection A'B", B "E' and E'B 'respective lines (be careful not to draw B'B" line here does not make the cut). After adjustment points to a hypodermic needle dipped in methylene blue piercing the skin, draw lines to iodine fixation (Figure 2④⑤).

2. Incision, suture

Surgery requires careful, light, reducing the trauma, accurate cutting, stitching and tidy.

First incision with your fingers clenched outside the upper lip when cut, to reduce bleeding. Followed by the design lines cut AB, BE, A'B ", B" E 'and E'B ". After the cut, you can drop the contralateral upper lip, forming a triangle in the BE at the open cracks would be formed in the ipsilateral B "E'B 'triangular flap crevices into this (Figure 3). A margin of the line AB and A'B "relative. Successively layered suture (Figure 4). Trimming lips, under the circumstances the use of embedded or Z-shaped dual triangular flap to increase the fullness vermilion. Nose shaped by Kawasaki , the general proposition be deferred to a later 13-year-old radical nasal deformity correction surgery.

Cleft lip

Figure 3 cleft lip repair of incision 4 cleft lip repair suture

Complete cleft of the wider cracks, tension greater need vestibular sulcus incision for sneak separation, to facilitate the organization in place suture.

(Iv) treatment after surgery

1. Upper lip to lip bow tape reduce tension wire fixed two weeks to prevent and mitigate scar healing wound dehiscence.

2. Pediatric basic anesthesia awake, double elbow with a splint bandage, avoid scratching the wound and reduce tension bow lips.

3. lip wound with 3% hydrogen peroxide and 4% boric alcohol to gently wipe the blood to prevent scab covering affect wound healing.

4. wounds five days stitches.