唇腭裂教学外科CLEFTP1

,CollegeofStomatology,Cleftpalate,ShiBingMD,PhD,Associateddeformities,Childwithcleftpalatemayhaveotheranomaliesinasmanyas29%ofcasesHighamongtheassociatedanomaliesarethoseaffectingthecardiacandskeletalsystems,Frontskeletalpalatalviewsofaleftcompletecleftpalate,Frontskeletalpalatalviewsofaleftcompletecleftpalate,Incompletemidlinecleftofthebonepalate,Anatomyofthepalate,Differentofanatomybetweennormalandcleft,Anatomyofthepalate,Thehardpalateconsistsofthepremaxilla,themaxillaandpalatineboneThegreaterpalatineforamenliesposteriorlyonthemedialaspectofthealveolarprocessbetweenthepalatineboneThemucousmembraneoftheanteriorhardpalateisstronglyadherenttotheperiosteumandcanbeseparatedonlywithdifficulty,Softpalate,TensorvelipalatimusclearisefromthebaseoftheskullandthelateralaspectofthecartilaginousportionoftheeustachiantubeLevatorpalatimuscleformaroundedbellyandinsertedintothenasalaspectofthepalatineaponeurosisPalatopharyngeusmusclePalatoglossusmuscleUvulamuscle,Passavantsridge,Diagnosisofcleftpalate,RangingfromthemostminimalbifiduvulatoatotalcleftofthevelumandhardpalateasfarastheincisiveforamenDiagnosisofsubmucouscleftmaybemadebyspeech,bypalpationbonypalateandtransluminationofthesoftpalate,Treatmentofcleftpalate,FeedingMaintenanceofanairwayMiddleeardiseaseThepossibilityofotherabnormalities,Feeding,SpecializedtypesofnippleshavebeenrecommendedforthechildwithcleftpalateNipplewithanenlargeholetobesuccessfulinalmostallcases,Airway,Theinfantwithcleftpalateisseeninassociationwithamicrognathiaorretrognathicmandiblemanybeparticularlypronetoupperairwayobstruction,PierreRobinsyndrome,MiddleEarEffusion(MEE)inCleftPalate,Incidence:Around95%ofCL/PorCPatCPattheageof1Y/OPathogenesis:Refluxtheory,Eustachiantubedysfunction,abnormalcraniofacialrelationshipPossibleresultsafterprolongedMEE:Eardrumperforation,Tympanosclerosis,Ossiculardamage,Cholesteatoma,etc.Diagnosis:Otoscopicexamination,audiogram,typanogramAbnormalhearing,abnormalspeech！,Goalsofpalatalsurgery,NormalspeechNormalfacialgrowth,Factorsaffectingtheresultofpalatesurgery,TypesofsurgeryTimingofsurgerySurgeonsskill,Timeofprimaryoperation,Earlyoperationmaybedefinedasclosureperformedpriortotheonsetofspeechinformedsentences(about18months)DelayedmaybedefinedaspalatoplastyperformedaftertheonsetofspeechOperationsoonerthanoneyearofagegenerallyisnotdesirable,Typesofpalatalrepair,LangenbeckpalatoplastyPushbackpalatoplasty(Dorrance,Wardill-Kilner,Widmaier-Pekopalatoplasty)Twoflappalatoplasty(Bardach_salyer),Twoflapofpalatoplasty,Twoflapofpalatoplasty,A,B,C,D,Sommerladscleftpalaterepair,Twoflapofcleftpalatoplasty,FurlowsdoubleZplast,Twostageprocedureforcleftpalaterepair,犁骨瓣在唇裂整复术中的应用,Twostageprocedureforpalatoplasty,Postoperativecare,Clearliquidsaregivenbymouthforabout24to48hours.Anyliquidsandmechanicallysemiliquidfoodsmaybegiven.Avoidanceofsuckingandblowingactionarecontinuedforabout3weeksafterdischarge.,UrgedtotalkaboutwithotherchildBeginspeechstimulationwithpicturebooksandmagazinesManyexercisecanberecommendincludesuckandblow,usingwhistles,mouthorgans,soapbubblepipes,anddrinkingstraws.,Complications,ImpairedairwayHemorrhageWounddisruptionFistulaNasalspeech,Impairedairway,CompromisedbysecretionsandbleedingatthetimeofsurgeryPostoperativelybyedemaPlacingaspecialtubeafterremovedtheendotrachealtube.Useofsystemicsteroids,hemorrhage,Bleedingatthetimeofpalatoplastymaybebrisk,requiringbloodreplacement.Usingepinephrineasavasoconstrictiveagentatthetimeofsurgery.Bloodlosscanbelimitedwithin50mlinourhospital.,Wounddisruptionandfistula,SutureofmucoperiostealflapsandvelumclosedundertensionconditioninviteswounddisruptionRelaxingincisionsandneutralizationofthetensorvelipalatinimusclesbydissectionindetailedFistulamustbedelaytorepairatleasthalfofoneyear,Fistulainhardpalate,Partofsoftdisruption,Nasalspeech,Palatoplastyisdeferreduntilafterspeechhasbegun.Palatehasashortanterior-posteriordimensioneventhoughclosedsurgically.Shortanterior-posteriordevelopmentresultsmostcommonlyfrominept,traumaticsurgeryOccasionallyfromamesodermaldeficiencyofthevelum,Treatmentofearproblems,AudiometrictestingiscarriedoutregularlyExaminationwithapneumaticotoscopeisessentialtocheckthemobilityofthedrum.Myringotomiesandplaceplastictubesaredoneifmiddleeardiseaseisprogressingorthereisasignificanthearingloss(orboth).,Speechproblem,UsingFoggingmirrortestObservation“Nasalgrimacing”Pronouncetheletter“a”,“i”,“p”etcLateralstaticX-rays,Dentalarchchangedtonarrow,Speechproblemstreatmentplan,Velopharyngealinsufficiency-SurgeryArticulationerrors-SpeechtherapyNeuromotorapraxiaSpeechtherapy,IncidenceofVPI,TheincidenceofVPIafterpalatalrepairisaround10to30%inspiteoftimingortypesofpalatalrepair,Velopharyngealinsufficiency,HypernasalityNasalemissionCompensatorychanges(Glottalstops,pharyngealfricatives),HypernasalityandVPfunction(relatedfactors),LengthandmobilityofsoftpalateMedialmovementoflateralpharyngealwallAnteriormovementofposteriorpharyngealwallPassavantsridgeAdenoidtissueHypertrophiedinferiorturbinateDeviatednasalseptum,咽后壁运动不足,软腭运动不足,咽后壁无代偿的情况,咽后壁有代偿的情况,DiagnosisofVPI,SpeechassessmentNasopharyngoscopy(NPS)Videofluoroscopy(VFS)Aerodynamicstudy,Speechassessment,Nasality,resonance,nasalemission,facialgrimacing,lipmovement,dentalocclusion,oronasalfistula,softpalatemotion,softpalatelengthandscarring.-AssesstheVPfunction,Nasopharyngoscopy,Usuallycanonlybeusedinchildrenolderthan4-5Y/O,VideofluoroscopyCanbedoneinyoungerchild(3-4Y/O),AerodynamicstudyUsedforscreening,TreatmentofVPI,SpeechtrainingSpeechprosthesisSurgery,Speechtraining,ArticulationtherapySuckingandblowingexerciseElectricalandtactilestimulationNPSBiofeedbackCancorrectmilddegreeVPIorimproveVPfunctionthuschangethetypeofsurgery,Speechprosthesis,RequiresgooddentitionandoralhygieneRequiresinterestedprosthodontistCurrentusedasadjuncttospeechtherapybeforedefinitivesurgery,Surgery,PharyngealflapLateralpharyngoplastyPosteriorpharyngealwallaugmentationLevatorrepositioning-FurloworSammerladPalatoplasty,腭再成形术矫治VPI,术前发音位,术后发音位,咽后壁瓣矫治VPI,术后6个月,术后3年,VPI,Normal,Biofeedb