唇腭裂教学外科UNILAT1

,CollegeofStomatology,Unilateralcleftlip,Anatomy,NormallipanatomyCleftlipanatomy,Normallipanatomy,AlarbaseNostrilsillPhiltrumcolumnPhiltrumdimpleVermiliontubercleArchofcupidsbowWhiteskinrollofmucocutaneousjunction,Anatomyofnormallip,Arteryofnormalupperlip,Naturalpositionofthelip,LooseupperlipEversionofitslowerportionOverandslightlyinfrontofthelowerlip,Normalpositionofupperlip,Cleftlip-noseanatomy,PeakofcupidsbowrotatedtoupperpositionOrbicularismusclefibersparallelthemarginofthecleftColumellaisshortandobliquedtonormalsideAlarbasealwaysshowedwideandflat,Anatomyofunilateralincompletecleftlip,Anatomyofunilateralcompletecleftlip,Arteryofunilateralcompletecleftlip,Skeletondefectofunilateralincompletecleftlip,Skeletondefectofunilateralincompletecleftlip,Skeletondefectofcompletecleftlip,Preparebeforeoperation,GeneralbodyexamineBloodexamineLiverfunctiontestrenalfunctiontestX-rayoflungUrinetest,Timingofoperation,Someclinicalpreferoperatingontheseinfantsimmediatelyfollowingbirthwithin48hoursManysurgeonsfeelthatsurgeryshouldbedelayedforaminimumof8-10weeksPreferoperationin3monthto6monthsisbetterinchinaCleftlipcanberepairedatanytime,buttheinfantsshouldhavereached10weeksofage,10Ibinweight,and10gofhemoglobin,Anesthesiaforcleftliprepair,EndotrachealanesthsiaisadministeredthroughanoraltubecomingoutSedationandlocalinfiltrationwithlidocainewillallowsurgery,however,thisapproach,isnotconductivetoaccuratedanddetailedsurgery,Treatmentplanofcleftlip,Pre-surgicalorthopedicsOperativerepairCorrecttheseconddeformity,Anatomyofrepair,Themarkingsbeginwithacarefulandaccurateidentificationofthenormalandabnormallandmarksinthecleftlip.Point1:thepeakcupidsbowonthenon-cleftsidePoint2:themidlinepointofthearchcupidsbowPoint3:theproposedpeakofcupidsbowonthecleftside(distancefrom1to2),Point4;thepointatwhichthewhiterollandvermilionbegintothinoutordisappearonthelaterallipelement.ThispointshouldbeatthesamelevelasthepeakofCupidsbowonthenormalside(1)andshouldbewheretherollisstillwelldevelopPoint5andpoint6:thebaseofcolumellaonthecleftandnon-cleftsidesPoint7andpoint8:thepointatwhichthealarbasesinsertintothenostrilsillPoint9:themidlineofthecolumella,Thecriteriaforasatisfactorycleftliprepair,Accurateskin,muscleandmucousmembraneunionsymmetricalnostrilfloorsandsymmetricalnostrilSymmetricalvermilionborder,Reproducingthenormallowerborderofthephiltrum,CupidsbowcontourSlightlyeversionofthelipAminimalscarwhichbyitscontractionwillnotinterferewiththeaccomplishmentoftheotherstatedrequirements,Adhesion,Achievesaquick,easy,andeffectivemethodofapplyingaconstrictingbandacrossthecleftReducethewidthofthecleftMoldsthemaxillaeintobetteralignmentwhilestallingforcatch-upgrowthandpacifyingtheparents,Theadhesioniscarriedoutatabout3to5weeksandlefttoworkforabout6monthAtthisoperationasmuchoftheposteriorsoftpalateaspossibleisunitedtoachieveposteriormoldingEarlycoordinationwiththeposteriorpharyngealmusculature,Operativedesignofunilateralcleftliprepair,DesignoflinesegmentDesignofflapsharpRectangleflapTriangleflapUppertriangleflapLowertriangleflap,a,a,b,b,a,b,A,A,B,B,Markingsforanadhesioninacompletecleftlip,Lipadhesion,唇粘连术+唇裂修复术,1,2,3,4,5,6,7,8,Pointmarksforunilateralcleftliprepair,Definitivecleftliprepair,Definitivecleftliprepair,Definitivecleftliprepair,Postoperativelyoriginfromformer-Millardsmethod,a,a,b,b,a,b,A,A,B,B,Computeraidoperativedesign,I型术式切口设计与缝合,II型术式切口设计与缝合,III型术式切口设计与缝合,IV型术式切口设计与缝合,华西法(个体化)单侧唇裂的手术设计,Completeunilateralcleftliprepair,唇裂修复术后一年,唇裂修复术后一年,唇裂修复术后一年,Incompleteunilateralcleftlip,UnilateralCompleteCleftLip,UnilateralCompleteCleftLip,a,a,b,b,a,b,A,A,B,B,a,a,b,b,a,b,A,A,B,B,Tennisonsmethod,a,a,b,b,a,b,A,A,B,B,1,2,2,2,1,1,3,3,3,4,4,4,5,5,1,1,1,2,2,2,3,3,3,4,4,4,a,a,b,b,c,Randallsmethod,(a-b)=(15)+(45)(b-c)=(c-4),Incompleteunilateralcleftliprepair,Incompleteunilateralcleftliprepair,Microformunilateralcleftliprepair,Postoperativecareafterthecleftlipclosure,AntibioticointmentisappliedgenerouslytoallskinsuturelinesimmediatelyaftersurgeryThesutureareremovedonthefourthpostoperativedayALoganbow,wit