What Is the Difference between a Cleft Lip and Cleft Palate?

Cleft lip is a common congenital malformation of the oral cavity, maxillofacial region, and is divided into unilateral and bilateral sides. The factors that cause cleft lip have not been identified so far, but there are two major factors: genetics and environment. Cleft lip repair is mainly divided into unilateral cleft lip for different types of cleft lip. Mainly for cleft lip for adjustment.

Cleft Lip Reshaping

Cleft lip is a common congenital malformation of the oral cavity, maxillofacial region, and is divided into unilateral and bilateral sides. The factors that cause cleft lip have not been identified so far, but there are two major factors: genetics and environment. Cleft lip repair is mainly divided into unilateral cleft lip for different types of cleft lip. Mainly for cleft lip for adjustment.

Chinese name

Cleft Lip Reshaping

Foreign name

Cleft lip surgery

Causes of cleft lip

Recessive hereditary cases of chromosomes

main performance

Split upper lip

Shaping

Fixed point

Both

The main manifestations of the cleft lip are:

The upper lip is split. It can be divided into three degrees according to the location of the crack and the degree of cracking.

1. The cleft lip was only cracked for the first time.

2. The second degree is that the fissure exceeds the red lips but does not reach the bottom of the nose.

3. The third degree is the fissure from the red lips to the bottom of the nose. The first two are also called incomplete cleft lip, and the last one is also called complete cleft lip.

(1) The cleft lip can be divided into:

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

2. Bilateral cleft incomplete type, complete type and mixed type, that is, one complete side and incomplete type.

(2) According to the degree of cracks:

First-degree cleft lip is limited to cracked red lips.

The second degree of cleft lip is part of the upper lip without cracking to the bottom of the nose. Shallow degree means that the fissure does not exceed 1/2 of the lip height; deep degree means that the fissure exceeds 1/2 of the lip height.

degree cleft lip is full crack of upper lip and nose

In addition, recessive cleft lip means that although the skin and mucous membranes are not cracked, they lack muscle layers.

First, fixed point

Fixed point refers to drawing the incision design of all the different surgical methods on the lips and nose, and then piercing the skin of several key points of the design line with an injection needle dipped in a melanin solution. Be careful not to penetrate too deeply and cause bleeding.

Second, cut

Before the incision, lip clips or sutures can be used at the corners of the upper lip near the mouth to compress the labial artery to reduce bleeding. Of course, you can also pinch the labial artery with your fingers to achieve the same purpose. During the incision, the surgeon uses his left middle finger to rest against the oral mucosa of the incision and tightens or tightens the lips with the index finger and thumb. In this case, the tissue is tight and easy to cut.

Fourth, suture

Suture from inside to outside. First, the nasal base is sutured to restore the nasal wing, then the lip mucosa and orbicularis oris are sutured, and the latter should achieve functional reduction. Muscle suture should not be too much, and a needle at the bottom of the nose is particularly important. The secondary needle can not only achieve the purpose of orbicular orbicular muscle reduction, but also achieve the purpose of correcting the deflection of the nasal column root.

The precautions before surgery are as follows: Because the child sucks, it will increase the upper lip tension and excessive movement, which will affect the wound healing. Therefore, children should change their eating habits before surgery, instead of breastfeeding, and use spoons to feed. In addition, because of a cold and runny nose, the wound is infected, which is an important factor affecting the effect of surgery. Therefore, if a child has a cold, surgery should not be performed.

Keep the surgical incision clean after the operation, and prevent the infection with an appropriate amount of antibiotics.

The second stage of cleft lip:

Overview of the second stage of cleft lip repair After cleft lip repair, there are often different degrees of cleft lip and nose deformities. Common manifestations are:

1) Whistle-like deformity caused by too short red lips in the middle of the lips or poor repair of orbicularis oris muscles and contraction of scars on the mucosa;

2) front lip (too short in humans);

3) front lip (too wide in humans);

4) Lip red asymmetry;

5) Orbicular orb muscle repair is not good;

6) Anterior lip sulcus is too shallow;

7) The upper lip is too tight;

8) The upper lip is too long

The two major repair procedures for cleft lip are:

The repair of the second stage of the cleft lip is more complicated, and the scars and directions left during the first stage of the operation must be fully considered, and the treatment plan must be fine-tuned. Only in this way can the best surgical plan be formulated.

1 correction of orbicularis deformities

To correct this muscle deformity, the orbicularis oris muscles that are vertically attached to the outer feet of the nose wings are separated, and the orbicularis oris muscles are widely separated until the nasolabial sulcus is bilateral, and then a tunnel is formed under the skin of the front lip. The lateral orbicularis oris muscle fibers are turned horizontally and sutured to each other to form a normal orbicularis oris muscle ring.

Abnormal correction in 2 people

Surgical method: Design an isosceles triangle to cut the "bottom" and "height" of the orbicularis oris muscle in the middle part of the human, and then use the "waist" as the axis to make two external rotations in opposite directions to form the human midge. , And there is no deformity in the center of the muscle that forms a concave depression; you can also cut the "high" and "waist" of the triangle and use the "bottom" of the two halves as the axis to make two 90-degree external rotations in opposite directions. The bulge of the lip arch is strengthened, and the central muscle-free part forms the dissociation of the entire concave muscle layer. The incision, rotation, and fixed suture are performed in a transverse incision at the root of the nasal column, so the operation is difficult.

3 correction of lip red deformity

The early repair methods almost did not take into account the shape of the lip arch and the poor conditions of the deformed upper lip. Therefore, the shape of the lip arch after surgery is often curved trapezoidal or even triangular. Therefore, it can be designed on the lip red mucosa. An arch-shaped incision can be used to remove the skin strips and sut up the lip-red mucosa.

4 Repair of cheek and sulcus deformities

A "U" shaped mucosal incision is made in front of the premaxillary bone and the free advancement of the mucosal flap is made until the height of the new cleft canal is fixed and the wound in front of the premaxillary bone is fixed to allow itself to heal.

5 Correction of nasal deformities

It is manifested by short nasal column, bilateral carotid separation of the nasal wing, displacement of the nasal wings outward and upward, and wide nasal floor. If it is a bilateral mixed cleft lip, bilateral asymmetry deformities will occur. The restoration of nasal deformities is one of the important goals of postoperative repair of bilateral cleft lip. By reducing the base of the nose and placing the wings in the normal position, the main means such as raising the nose and extending the nasal column are used to achieve or approximate the normal nose shape.

Postoperative management

1. The upper lip is fixed with wire lip arch tape for 2 weeks to prevent wound dehiscence and reduce scar healing.

2. Pediatric basic anesthesia is used to fix both elbow joints with splint bandages to avoid scratching wounds and reducing lip arch.

3. Gently wipe the lip wound with 3% hydrogen peroxide and 4% boric acid alcohol to prevent blood clots from affecting the wound healing.

4 Prevention of lip wound infections, oral antibiotics

Cleft lip repair surgery is targeted at infants. Although there is not much bleeding during the operation, it should still be given high attention. The baby must be in the process of gaining weight before surgery, weighing more than 5kg; both the red blood cell count and hemoglobin must be within the normal range. For example, when the white blood cell count is greater than 10 / L, the cause must be identified and given to the patient after treatment. Surgery; the baby's time to coagulate should be normal. In addition, attention should be paid to whether the infant's thymus has been degraded. If it has not, the surgery should be taken seriously.

In the morning, the face, lips and nostrils should be washed with soap and water. During the operation, 1: 1000 benzalkonium bromide or 75% ethanol was used to disinfect the operation area. Blood transfusion is generally not required during the procedure, but intravenous infusion of 5% glucose is required. Take the supine position during the operation, and raise your shoulders to raise the head later. This not only facilitates the operation, but also can accumulate blood flow in the nasopharyngeal cavity during bleeding during operation, so as not to be sucked into the lungs. However, any secretions and blood clots in the throat must be removed at any time during the operation. Maintaining the respiratory tract usually during the operation is the key to ensuring the safety of the operation.

Cleft lip reshaping methods are mainly as follows: 1. Cleft lip, which is characterized by a ditch or scar that exceeds the vertical length of the upper lip, red lips have all traces, white lips are defective, and the upper lip is shortened to varying degrees. Nasal deformities can occur, and sometimes nose deformities are even more serious than lip problems. Surgical treatment is usually required, but it must be handled carefully during surgery to prevent postoperative deformities that are more serious than congenital deformities. 2, unilateral incomplete cleft lip, unilateral incomplete cleft lip has different degrees of upper lip fissure, but the common feature is that the nasal floor, or Simonart band are intact. It can be repaired by rotary propulsion. Although the degree of nasal deformity is different and the degree of movement reduction is also different, both can be performed at the same time as cleft lip repair. 3. Unilateral complete cleft lip. Unilateral complete cleft lip is characterized by fissures in the upper lip, nasal floor, and alveolar (derived from the first ridge). Although secondary cleft palate does not necessarily appear, complete cleft palate is often accompanied by full cleft palate. The key to assessing unilateral complete fissure is the position of the alveolar and the vertical height of the affected lip. Alveolar bone generally has four positions (1) narrow and not collapsed. (2) Narrowness with collapse. (3) The gap is wide and does not collapse. (4) The gap is wide and accompanied by collapse. "Width" is determined by the length of the base of the nasal wing with an appropriate alveolar bone distance. (That is, when the cleft lip is closed, the base of the nasal wing is located at the crack.) "Collapse" refers to the distance between the lingual side of the affected maxilla and the ideal dental arch calculated from the healthy arch.

1. Determine the position of the incision. Draw the incision design of all the different surgical methods on the lips and nose, and then pierce the skin of several key points of the design line with an injection needle dipped in a melanin solution.

2. Cut the crack. During the incision, the surgeon uses his left middle finger to rest against the oral mucosa of the incision and tightens or tightens the lips with the index finger and thumb. In this case, the tissue is tense and easy to cut. Before the incision, lip clips or sutures can be used at the corners of the upper lip near the mouth to compress the labial artery to reduce bleeding. Of course, you can also pinch the labial artery with your fingers to achieve the same purpose.

3. After the wound is cut, in order to reduce the tension of the wound suture, it is necessary to make a loose incision in the alveolar ridge on both sides and make a blunt peel on the periosteum. The affected area is wider than the healthy side, including the soft cheeks and the cleft wing. For complete cleft lip, the outer corner of the nose wing should be cut off from the attachment point of the lower inferior turbinate, so that the external feet of the nose wing can be fully freed, and it can be easily reset, and finally the nose wing can be bilaterally symmetrical.

1. One week after the operation is a critical period for wound healing. Special attention should be paid to eating, keeping warm, and cleaning the wound; avoid crying, avoid colds, fever, diarrhea, and any other adverse effects on the wound.

2. After cleft lip surgery, feeding with a spoon or dropper should not be allowed to suck the nipple or bottle, and liquid food should not be sucked with a straw.

3. Postoperatively, children should be prevented from scratching the wound with their hands, pulling off the lip arch, or extending their hands into the cavity. If necessary, use small splints to brake both upper limbs.

4. After the cleft lip repair, the nurse nurse cleans the wound daily with a sterile cotton swab.

5, 6-7 days after cleft lip repair suture removal, children need to be under anesthesia.

6. In order to prevent scar hyperplasia, after the repair of the cleft lip, you can follow the doctor's advice for external use of anti-scarring drugs, such as Fukang cream and scar enemies.

7. In case of special circumstances, please contact the doctor in this hospital, it is recommended not to go to other hospitals for treatment by yourself; ^[1]

Complications after repair of cleft lip and cleft lip include bleeding, respiratory tract obstruction infection, wound dehiscence and fistula formation. Although obvious bleeding is rare, it is often necessary to re-enter the operating room for exploration and hemostasis. Respiratory obstruction is rare when there is no major bleeding, but it can be fatal if it occurs. The respiratory tract should be closely monitored in the resuscitation room. Only when the condition is stable, the patient can be transferred to the ward. If the respiratory tract is narrow, the oxygen saturation should be monitored in the ward or monitored in the ICU ward.

Bilateral cleft lip is a serious congenital malformation of the oral and maxillofacial region. According to the fissure site, it can be divided into three types: partial cleft, complete cleft, and mixed cleft.

Repair standard

1. Because the central lip has no muscles, both orbicularis oris muscles must be sutured in the center of the upper lip. Make the orbicularis orthodontics completely reset.

2. The red lips are neatly aligned and the upper alveolar groove is deep.

3. There is no central notch (thin red lips are thin), and those who are good form lip beads at the same time.

4, bilateral lip red symmetry.

Intraoperative precautions

1. Pinpoint and scribe should be accurate.

2. Cut the skin neatly and vertically. The direction of the incision is from bottom to top to avoid cutting the red lips vertically.

3. All operations are required to be precise to minimize the damage. 3-0 to 5-0 nylon monofilament sutures are commonly used to reduce the scar response to a minimum.

4. The points are accurately aligned when stitching, especially the red lips must be aligned, otherwise a trapezoidal red lips will be formed. Muscle suture is key to being reliable and gapless.

Postoperative management

1. The wound was treated with bandaging within 24 to 48 hours after bilateral cleft lip repair. If the dressing is contaminated by postoperative exposure, exposure therapy can be applied after 24 or 48 hours.

2. The lip arch is fixed for 6 to 8 days after bilateral cleft lip repair, in order to reduce the tension of the suture, ensure incision healing, and reduce scarring.

3. Clean exposed wounds with 405 alcohol or red mercury 4 to 6 times a day.

4. After 5 to 7 days of bilateral cleft lip repair, the suture was intermittently removed, and all sutures were removed from 6 to 8 days.

5. If there is a deformity of the upper lip and nostril, the parents can be instructed to repair the deformity after 1 to 2 years. ^[2]