外科来自PC的备份文件UNILAT2014

,CollegeofStomatology,Unilateralcleftlip,Anatomy,NormallipanatomyCleftlipanatomy,Normallipanatomy,AlarbaseNostrilsillPhiltrumcolumnPhiltrumdimpleVermiliontubercleArchofcupidsbowWhiteskinrollofmucocutaneousjunction,Anatomyofnormallip,Arteryofnormalupperlip,Naturalpositionofthelip,LooseupperlipEversionofitslowerportionOverandslightlyinfrontofthelowerlip,Normalpositionofupperlip,Cleftlip-noseanatomy,PeakofcupidsbowrotatedtoupperpositionOrbicularismusclefibersparallelthemarginofthecleftColumellaisshortandobliquedtonormalsideAlarbasealwaysshowedwideandflat,Anatomyofunilateralincompletecleftlip,Anatomyofunilateralcompletecleftlip,Arteryofunilateralcompletecleftlip,Skeletondefectofunilateralincompletecleftlip,Skeletondefectofunilateralincompletecleftlip,Skeletondefectofcompletecleftlip,Pre-surgicaltreatment,HotzplateLathamapproach,PSO-Extra-oralstrapping,Hoffman1686,Desault1790,InitialDentalAssessmentofNeonates,Pressuretheprotrudepre-maxilla,Pre-SurgicalOrthopaedics-Impression,ResuscitationEquipment,SurgerySetup,EquipmentSetup,Trayselection,SpecialTray,InitialDentalAssessmentofNeonates,Pre-SurgicalOrthopaedics-Impression,Alginatemixedwithaprecisewater-powderratiotocontrolset,SeatingImpression,RemovingImpressionbabyonside,Removingalginatefragments,InitialDentalAssessmentofNeonates,Hotzpalate(negativemovement),PlastercastchangebyHotzfoesixmonths,Lathamapproach(Positivemovement),Pre-SurgicalOrthopaedicsArchChanges-Model,Birth,3months,InitialDentalAssessmentofNeonates,Pre-SurgicalOrthopaedicsArchChanges-ModelOutlined,Birth,3months,InitialDentalAssessmentofNeonates,术前矫形技术选择,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,a,a,b,b,a,b,A,A,B,B,Tennisonsmethod,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),Markingsforanadhesioninacompletecleftlip,Lipadhesion,唇粘连术+唇裂修复术,1,2,3,4,5,6,7,8,Pointmarksforunilateralcleftliprepair,Definitivecleftliprepair,Definitivecleftliprepair,2-5=3-5-x=8-92-4=8-102-6=8-7,2003年发表,Postoperativelyoriginfromformer-Millardsmethod,长庚式旋转推进法,创新点：裂隙侧鼻底横切口的摒弃,旋转推进法的诞生及发展,1956,1968，1977,理论基础：裂隙两侧切口长度相等的条件常见情况：常见完全性唇裂患侧唇峰下降不足或过度,（）,（）,（）,（？）,Computeraidoperativedesign,对UCLP畸形的简化与归纳,口鼻区形态可以简化一个W形状。由于唇裂的存在，这个W被破坏扭曲，要修复唇裂，就是要恢复这个W的正常形态；一旦恢复了这个W，唇裂畸形也就被顺利修复。,唇裂修复中应遵循的几何学理论一,角平分线上每一点到两侧唇峰的距离都相等。只要把旋转下降的切口末端点定在这个角平分线上，当裂隙缘患侧唇峰点经过旋转，下降到与健侧唇峰同一水平时，角平分线连同口鼻区的三角形也就顺利地恢复到正常对称的位置。切口末端点可以在角平分线上移动：定点越向上，切口线越长，定点越向下，切口线越短,唇裂修复应遵循的几何学理论二,梯度旋转下降的原理健侧上唇切口的设计，在皮肤、肌肉和粘膜各不相同，但是都遵循角平分线的原则，其切口末端都位于角平分线上，保证皮肤、肌肉和粘膜能获得同样的下降幅度。,华西式旋转推进法,1,2,3,5,创新点：角平分线原则的应用：2-5=3-5,3m,2y,4y,6y,Completeunilateralcleftliprepair,唇裂修复术后一年,唇裂修复术后一年,Incompleteunilateralcleftlip,UnilateralCompleteCleftLip,Incompleteunilateralcleftliprepair,Microformunilateralcleftliprepair,北美单侧唇裂主要术式,改良旋转推进法（38%）,旋转推进法（46%）,Delaire（2%）,直线法（1%）,下三角瓣法（9%）,其他（4%）,主要旋转推进法改良,其他（34%）,Mulliken改良（4%）,Postoperativecareafterthecleftlipclosure,AntibioticointmentisappliedgenerouslytoallskinsuturelinesimmediatelyaftersurgeryThesutureareremovedonthef