唇腭裂教学外科INTROD1

,CollegeofStomatology,TheCongenitalCleftLipandPalate,ShiBingM.D,PhD,Epidemiologyoforalcleftsaninternationalperspective,MostcommoncongenitaldevelopmentaldeformitiesoforalandmaxillofacialregionMostcommoncongenitaldiseaseinChina,ThedeformitywilldevelopwithdevelopmentThedeformitywilldevelopwithgrowthThedeformitycanaffectedtheallorgansexcepteyesinface,Incidence,CL/Pareasfellows:Oneofevery775to1000whitesOneofevery1370to5000blacksOneofevery479to850AsiansOneofevery230to1000nativeAmericansOrientalCaucasianBlacksCPisasfellows:Oneof1500to3000whitesOneofevery2000to5000blacksOneofevery1600to4200AsiansOneofevery1700nativeAmericans1:2000;noracialdifferenceCleftlipwithpalateis1.5to3.0timesasfrequentasisolatedcleftlipSideofcleft:L:R:Bil-6:3:1,IncidenceofcleftlipandpalateinChina(19952000),CL/Pare1.42per1000livesbirthsinfantsCPis0.225per1000birthsinfants,Cleftlipindog,Etiology,MultiplegenesEnvironmentalfactors,Geneticfactors,SignificantincreaseofCL/Pproposition,butisolatedCPoccursinafrequencyexpectedinthegeneralpopulationIncreasefrequencyofCPamongrelativeofpatientswithCPwithoutanincreaseincidenceofCL/PInaffectedfemaleswithCL/PthereisahigherfrequencyofaffectedoffspringthaninaffectedmaleswithCL/PPositivefamilyhistory:20to30%SyndromesassociatedwithCL/P:around250,Thresholdtheoryofcleftlipandpalate,Oneoftwinwithleftincompletecleftlip,Applicationofthresholdtheory,Applicationofthresholdtheory,AffectedRelativesPredictedRecurrence(%)CL/PCP,Environmentalfactors,NutritionaldeficienciesAvitaminosis,lackofCa,P,folicacidetc.InfectionsSuchascoughiscausedbyviruswithinfirsttrimesterofpregnancyTraumaAccidentandfightEndogenouscorticosteroidsRetinoicacid,Dexamethasone,Steroids,PharmaceuticalsDrugs,medicinalherbsPhysicalfactorsexposuretoradiation(X-ray),microwaveSmokingandalcohol,Racialinfluences,CL/Pisoneper1000populationinCaucasians2.1per1000inJapaneseCL/Pper1000birthswas1.34forwhiteand0.41forblackpatientRacialheterogeneityexistsinthefrequencyofCL/PinadescendingorderoffrequencyamongOrientals,CaucasiansandblacksNosuchheterogeneityintheincidenceofisolatedCPamongthethreeraces:itisapproximately0.5per1000births,Parentalage,BirthorderappearstoplaynoroleinthedevelopmentofeitherCL/PorCPSomeevidencethattheriskofproducinganaffectedchildisdecreasedinorderparents,Relationofparentsagewithcleft,Embryology,Primarypalate:FusionoffrontonasalprocesswithmaxillaryprocessClosedbetween4thto8thweeksSecondarypalate:FusionoftwolateralpalatalprocessafterdownwarddisplacementoftongueClosebetween7thto12thweeks.Incisiveforamen:Thejunctionofprimaryandsecondarypalate,Upperlip,Cleftpalate,Theprocessofembryodevelopment,Fusionofthefacialprominences,Comparingdevelopmentofthemedialnasal,lateralnasal,andmaxillaryprominencesbeforecontactandfusion,Formationoffacialfeatures,Formationofbilateralcleftlip,Simonartsband,Processofpalateformation,TheprocessofMEEdisappear,Processofcleftpalateformation,Cleftpalateformation,AntenatalDetection,OverallDetectionrate(WA)is22.2%DetectionofBilateralCleftLip&Palate47%DetectionofisolatedCleftPalateisdifficult.,Syndromeswithcleft,PierreRobinsyndrome,Craniao-facialdeformitywithmediancleftlip,Mediancleftoflowerlip,Fistulainlowerlip,Preventpathway,VitamenB12canreducetheincidenceofcleftpalateinducedbyDEXVitamenB6hasbeenusedtopreventCL/PinlocalareainAmericanBecarefultotakeanykindofdruginfirstthreemonthofpregnancyperiod,Classificationofcleftlipandpalate,Cleftlip,Unilateral:right,leftExtent:incomplete(onethird,twothirds),completeBilateral:right,leftExtend:incomplete(onethird,twothirds),complete,Rightunilateral(microform)incompletecleftlip(degree),LeftUnilateralincompletecleftlip(degree),RightUnilateralincompletecleftlip(degree),leftUnilateralcompletecleftlip(degree),Rightunilateralcompletecleftlip(degree),Bilateralwithcompletecleftandsubmucouscleft,Incompletebilateralcleftlip,Completebilateralcleftlip,Rightincompletecleftlipandleftcompletecleftlip,Submucousbilateralcleftlip,cleftofalveolarprocess,Unilateral:right,leftExtent:incomplete(onethird,twothirds),completeBilateral:right,leftExtend:incomplete(onethird,twothirds),complete,RightIncompletecleftalveolar,Bilateralcleftalveolar,Cleftpalate,UnilateralcleftpalateComplete:right,leftIncomplete:BilateralcleftpalateCompleteIncompleteIncompleteandcomplete,Incompletecleftpalate(degree),Bilateralcleftpalate(degree),Leftcompletecleftpalate(degree),Cleftsoftpalate(degree),Submucouscleftpalate,PracticeGuidelines,HealthcareneedsOrganizationofservicesfinances,Part1:healthcareneeds,NeonatalemotionalsupportandprofessionaladviceNeonatalnursingSurgeryOrthodontictreatmentSpeechandlanguagetherapyEar,noseandthroat(ENT),Clinicalgenetics/pediatricdevelopmentmedicineEmotionalsupportandprofessionaladviceforthegrowingchildanditsparentsDentalcareNationalregister,Part2:organizationofservices,CleftcareshouldbeprovidedbyamultidisciplinaryteamofspecialistMembersoftheteamshouldhavespecialtrainingincleftcareTheteamshouldagreeonthestagesoftreatmentincludingtheexamination,recordcollectionandgeneralprotocolsThereshouldbeonepersonresponsibleforqualityimprovementandcommunicationwithintheteam,Co-ordinationofthecareofindividualpatientsisimportantsincenumerousspecialistareinvolved.ThisshouldbetheresponsibilityofonememberoftheteamThenumberofpatientsreferredtotheteamshouldbesufficienttosustaintheexperienceandspecialistskillofallteammembersandtoallowevaluationoftheteamsperformancewithinareasonableperiodoftime.,Part3:finances,EmotionalsupportandprofessionaladviceduringtheneonatalperiodNeonatalnursingSurgeryOrthodontictreatmentSpeechandlanguageassessmentandtherapyEar,noseandthroattreatment,Clinicalgenetics/pediatricdevelopmentmedicineEmotionalsupportforthegrowingchildanditsparentsTravelexpensesGeneraldentalcareincludingcleftrelatedprosthodontics,Maintenanceofintactprimaryandpermanentdentitionsproducesthebestlongtermdentalandaestheticoutcomes.Theultimategoalforthetreatmentofcleftsistoattainnormalappearanceandfunction,especiallyspeechandchewing,withtheleastpossibleimpactongrowthanddevelopmentresultingfromsurgicalintervention.,AimsofCleftTreatment,NeedforTreatmentofClefts,FacialaestheticappealFeedingdifficultiesCausedbypoororalseal&nasalrefluxSpeechproblemsChronicmiddleearproblems,DentalManagementinCleftLip&Palate,InitialDentalAssessmentofNeonatesProtocolsforPreventiveDentalCareManagementofCaries&OtherPathologyInterceptiveOrthodonticsSecondaryAlveolarBoneGraftingOrthodonticTreatmentOrthognathicSurgery,华西医科大学口腔医学院唇腭裂序列治疗的时间安排与方法,Pre-surgicaltreatment,HotzplateLathamapproach,PSO-Extra-oralstrapping,Hoffman1686,Desault1790,Init