Contents

1. Contents Secondary Nasolabial deformities Cleft Palate

2. Nasolabial deformities after cheiloplasty Secondary Nasolabial Deformities

3. Why ? • Serious deformities • Unbalance of facial growth • Error in operation • Shortcoming of operation design • Infection and Split open

4. Timing of Operation • Facial growth have finished • avoid to disturb facial growth • maintain stability of healing effect

5. Clinical sign • Shorten or lengthen of upper lip height • Shorten or extension of upper lip width • Deformities of vermilion • Deformities of nose • Scar

6. Shorten or lengthen of upper lip height nose base lip peak

7. Clinical sign • Shorten or lengthen of upper lip height • Shorten or extension of upper lip width • Deformities of vermilion • Deformities of nose • Scar

8. Shorten or extension of upper lip width right cheilion left cheilion

9. Clinical sign • Shorten or lengthen of upper lip height • Shorten or extension of upper lip width • Deformities of vermilion • Deformities of nose • Scar

10. Broken white roll

11. Much or little tissue

12. Abnormal cupid’s bow

13. Clinical sign • Shorten or lengthen of upper lip height • Shorten or extension of upper lip width • Deformities of vermilion • Deformities of nose • Scar

14. Big nostril Inclined nose columella Collapsed nose ala

15. Small nostril Inclined nose columella Collapsed nose ala

16. Short nose columella

17. Clinical sign • Shorten or lengthen of upper lip height • Shorten or extension of upper lip width • Deformities of vermilion • Deformities of nose • Scar

18. Scar

19. Anesthesia • General ：hard cooperation complicated • Local ：good cooperation simple

20. Preparation of operation • Body：blood test、x-ray of chest • Local：no rash and inflammation

21. Operation method • Suspending of nose ala • “V－Y”plasty • “Z”plasty

22. Suspending of nose ala

23. “V－Y” plasty

24. “Z” plasty

25. “V－Y” plasty

26. “Z” plasty

27. How to avoid secondary nasolabial deformities • Good design of operation • Skillful operation • Good nursing

28. Cleft Palate

29. Embryogenesis Maxillary process Frontonasal process Maxillary process Medial nasal process Medial nasal process Secondary palatal process Secondary palatal process Primary palatal process Palate

30. Hereditary factors Etiology Environmental factors

31. Muscle • Palatopharyngeus muscle • Palatoglossus muscle • Levator veli palatini muscle • Tensor veli palatini muscle • Uvula muscle

32. Anatomy

33. Clinical Classification • Cleft of soft palate • Incomplete cleft palate • Unilateral complete cleft palate • Bilateral complete cleft palate • Other (Obsolete cleft palate, Congenital fistula…)

35. Cleft of soft palate

36. Cleft of soft palate

37. Incomplete cleft palate

38. Bilateral complete cleft palate

39. Bilateral complex cleft palate

40. Obsolete cleft palate

41. Congenital fistula

42. Clinical features • Abnormal morphology • Dysfunction of suck • Hypernasality and nose emission • Bad oral hygiene • Malocclusion • Hearing loss • Dysfunction of maxillary growth

43. 治疗原则 综合序列治疗： 外科手术，正畸治疗， 缺牙修复，语音训练，心理治疗等

44. 目 的 • 整复腭部的解剖形态；恢复腭部的生理功能，重建良好的“腭咽闭合”，为正常吸吮、吞咽、语音、听力等生理功能创造条件。

45. 手术治疗

47. 手术要求 • 封闭裂隙 • 将移位的组织结构复位 • 将分裂的肌纤维复位后准确对位缝合 • 减少手术创伤 • 妥善保留与腭部的营养和运动有关的血管、神经和肌的附着点 • 术后的软腭要有适当长度、相当高度以及灵活的动度 • 手术方法简便 • 确保患儿安全

48. 手术年龄－－有争议 • 1～2岁为最佳年龄 • 语音发育尚未形成 • 但因手术创伤影响上颌骨发育

49. 术前准备 • 体格检查：生长发育、体重、营养状况、心、肺、有无其它先天性畸形及上呼吸道感染等全身器质性疾患。 • 实验室检查：胸片、血常规、出凝血时间、EKG、听力 • 胸腺肥大——术前三天口服激素 • 口腔颌面部炎症——预先治疗 • 扁桃体过大——摘除 • 保持口鼻腔清洁，清除病灶

50. 麻醉选择 全身麻醉，气管内插管