Two-valve cleft palate repair is used for the repair of cleft palate. This method has a long history and is a mature operation for stereotypes. It has been using its basic operation method at present, but there are many improvements. The shortcoming of this method is that the repair of the fissure can not be achieved, and the purpose of prolonging the soft palate is not achieved, so the postoperative pronunciation is not ideal. Anatomy of the ankle.

Treatment of diseases: cleft lip and palate

Indication

Two-valve cleft palate repair is suitable for cases of soft cleft palate and hard and soft cleft palate or hard and soft palate.

Contraindications

Cases with anemia, upper respiratory tract infection, inflammation of the ear and nasal passages, and grade III enlargement of the tonsils, especially those with congenital heart malformations, should be examined and treated by the relevant department before surgery.

Preoperative preparation

1, should make a good protective plate before surgery, and try to wear 1 ~ 2d, so that it is used to eating. Those whose trailing edge is too long should be worn away to prevent nausea and vomiting.

2, 2d before the start of the nose with 0.25% chloramphenicol, 4 times a day.

3, preparation of blood 150 ~ 200ml.

4, adult patients need to do oral cleansing 1 to 2 days before surgery, and often contain Du Bell liquid.

5, 1 h before surgery, subcutaneous injection of the right amount of atropine.

6, fasting in the morning, the surgery delayed the late child, can take about 200ml of sugar water 4h before surgery.

Surgical procedure

1. Incision design and incision

On the sides of the sides, about 1 to 2 mm from the gingival ridge, the anterior canine ulnar side, posterior and maxillary nodules, and bent to the outside to reach the outside of the lingual arch, using a 15 blade first Side longitudinal incision, deep to the bone surface. Instead, the curved splitting stripper was inserted into the bone surface of the loose incision and peeled from the front to the back to the edge of the crack, so that the mucosa was completely lifted from the bone surface. When bleeding, a small gauze containing adrenaline can be used to compress and stop bleeding.

2. Chiseled wing hook

Continue to remove the soft tissue around the posterior iliac crest, and be careful not to damage the anterior aorta. The wing hooks are smashed and protruded near the inner panel of the wing, and the wing hooks can be broken by using a bone chisel or applying pressure, and the purpose is to make the swaying muscles sliding on the wing hooks lose the ability to be soft and soft. Thereby, the tension of the soft palate on both sides relative to the suture can be reduced, and the perforation can be prevented from being cracked here.

3. Cut the edge of the crack and cut the diaphragm

Use a No. 11 sharp blade to cut along the edge of the hard palate and cut the soft palate back to the top of the uvula. The blade should be sharp, and it is better to puncture the soft palate 2 to 3 mm to cut the muscle. Be careful not to tear the uvula, otherwise it may cause the uvula to be short or defective and affect the postoperative speech effect.

At the junction of the soft and soft palate, the mucoperiosteal flap was pulled to the outside with a small hook, and the posterior border of the humerus was peeled off with a curved stripper to expose the aponeurosis on the posterior border of the tibia. Use the elbow scissors to cut the aponeurosis and nasal mucosa together, and be careful not to damage the aorta. At this point, the soft palate tissue is sagging and sagging at all without tension, and the sides are easily moved closer to the middle seam.

4. Stitching

The nasal mucosa of the aponeurosis at the junction of the soft and soft palate was sutured with a No. 0 silk thread, and sutured with a reverse needle, and the thread was directed toward the nasal mucosa. After suturing the first needle, the line is used as a traction, and the nasal mucosa is sutured until suturing to the apex of the uvula. The muscle layer of the soft palate can be sutured by the same method. It can be sutured by silk thread or gut. The alignment of the muscle layer should be exact, and it should not be twisted before and after dislocation. It is not suitable for suturing too much. The uvula should be accurately aligned to avoid shortening due to misalignment. The suture head should be buried deep in the muscle. Finally, the oral mucosa of the soft palate was sutured with a No. 1 silk thread, and the muscle layer of the soft palate was deepened to strengthen the adhesion of the bilateral tissues. Intermittent suture of the periosteum of the hard palate, which can be supplemented with 2 to 3 needles. The necessary fashion can be at the junction of hard and soft sputum, supplemented by a 1-needle squat reduction suture (line 4), but care should be taken not to pull the aorta and lead to partial necrosis of the mucoperiosteal.

complication

Bleeding

Bleeding can occur due to injury to the aorta, sinus arteries, and surrounding small blood vessels, and blood oozes from the edge of the loosened wound. The adrenaline gauze should be filled and pressurized to stop bleeding, and an antibiotic solution containing epinephrine can be dripped from the nasal cavity. Add a hemostatic agent, open the wound if necessary, and ligature to stop bleeding.

2. Difficult breathing

Often caused by intubation injury caused by laryngeal edema, can be treated with hormones and aerosol inhalation. In a few cases, severe edema of the endotracheal mucosa caused by increased dyspnea, should be used for tracheostomy.

3. The wound partially splits and perforates

Because there is still some tension after suturing the mucoperiosteal, it is easy to split the perforation at the junction of hard and soft palate. It can be self-healed and repaired after half a year.

4. Partial necrosis of the mucoperiosteal flap

Due to the cutting of the aorta on one side, or in the sacral reduction suture, the blood supply to the aorta is blocked, and the tip of the mucoperiosteal is partially necrotic. The dressings were exchanged day by day, the necrotic tissue was cut off, and the repair was performed half a year after healing.