The scope of treatment is: facial deformities mainly cleft lip and palate (including cleft lip and palate, cleft face, cleft nose and eyes, first and second gill arch hypoplasia syndrome, hemifacial atrophy, jaw deformity, oblique neck, webbed neck, etc.), eyelid defects, eye socket reconstruction, lip cosmetic surgery, oral and maxillofacial neck tumors, peripheral neuromuscular function reconstruction, cosmetic surgery, repair and reconstruction of various congenital and secondary limb deformities, body shape Liposuction, autologous fat transplantation, breast augmentation and facial filler.
What is cleft lip and palate?
Congenital cleft lip (commonly known as harelip) is formed because the development of the upper lip is hindered during the embryonic period, resulting in the formation of a unilateral, bilateral or median cleft in the upper lip. Congenital cleft palate (commonly known as lupus) results from an obstruction to the development of the fused protrusions to the palate during the embryonic period, causing the oral cavity to communicate with the nasal cavity, resulting in the formation of a cleft in the center of the palate. Because these two deformities are often combined, we refer to them collectively as cleft lip and palate deformities.
What other deformities may be associated with cleft lip and palate?
Some children with cleft lip and palate may have congenital heart disease or other craniofacial or extremity deformities. Sometimes cleft lip and palate is just a manifestation of a systemic syndrome of the lip and palate, so children with cleft lip and palate should also have a systemic examination. Most people with cleft lip and palate do not have a combination of mental retardation.
Why do you have cleft lip and palate?
The cause of most cases is not known. A few children have a genetic predisposition, and most children may have a polygenic predisposition related to environmental factors. Especially in the first trimester or first trimester of pregnancy, the mother may have viral infections, medications, lack of oxygen, nutritional deficiencies or imbalances, exposure to harmful chemicals, poisoning, radiation, and excessive mental and emotional stress that may adversely affect the development of the fetus and lead to the development of cleft lip and palate.
According to statistics, there is one cleft lip and palate in every 600-1000 newborns, with more males. The probability of inheritance is about one third. Families who have had children with cleft lip and palate in the past should consult with their doctor before having a child this time around in order to have a good birth.
What are the effects of cleft lip and palate?
Patients with cleft lip and palate may suffer from maxillary dystrophy, maxillary recession, midface depression, and antimandibular deformity. Patients with cleft alveolar ridge may suffer from malocclusion, occlusion abnormalities, and tooth eruption disorders due to disruption of the continuity of the dental arch. Children with cleft lip and palate have difficulty sucking, some are prone to upper whistle infections, and some are prone to ear diseases. These children often develop serious psychological problems as they grow older due to cosmetic defects and dysarthria.
What are the principles of cleft lip and palate treatment?
The treatment of cleft lip and palate is a systematic project, which we call sequential treatment and requires a comprehensive treatment in stages and steps.
1. When the child is about 3 months old and in good physical condition (the general criteria are 10 weeks after birth, weight greater than 10 pounds (about 10 pounds) and hematocrit greater than 10 grams), cleft lip repair can be performed. In the case of children with bilateral cleft lip, the surgery should be postponed until 6 months after birth.
2, 6 months-2 years to complete the cleft palate repair surgery, we generally advocate the cleft palate repair surgery before learning to speak (around one year old), because timely surgery before the child starts to learn to speak and postoperative with language training is crucial for the patient’s articulation and speech in the future. If cleft lip and palate are present at the same time, they should be operated separately, with cleft lip first and then cleft palate.
3.After the initial cleft lip repair, if the appearance is still unsatisfactory, you can undergo cosmetic lip and nose surgery before school age, before going to secondary school, or after becoming an adult.
4.If cleft lip and palate affects the alveolar bone, most patients need to receive bone graft repair for cleft alveolar ridge at the age of 9-11 years in order to fuse the cleft alveolar bone and close the oral-nasal leak between the mouth and nasal floor.
5.If patients with cleft palate still have incomplete palatopharyngeal closure after surgery: i.e. heavy nasal sound, nasal leakage, mispronunciation, not easy to be heard, etc., and the effect is not significantly improved by speech therapy, surgery should be performed again to correct the incomplete palatopharyngeal closure according to the results of speech assessment, nasopharyngoscopy, X-ray multidimensional dynamic photography, nasal phonometer, speech spectrum analyzer, etc., so that they can obtain good The results of X-ray dynamic photography, nasopharyngometer, voice spectrum analyzer, etc. will be used to correct the incomplete palatopharyngeal closure in order to obtain good vocal function.
Some cleft lip and palate patients often have different degrees of facial deformity or mid-facial skeletal insufficiency, which has been manifested as maxillary recession, mid-facial depression, mandibular protrusion and antimandibular deformity, etc. They need to undergo surgical correction of jaw deformity, oral orthodontics, oral prosthesis or oral implant to further improve facial deformity and restore occlusal function.
What kind of anesthesia is chosen for the surgery?
Except for adults who can choose local anesthesia for lip and nose deformity correction surgery, general anesthesia is required for both cleft lip and palate repair surgery for young children, bone grafting surgery for alveolar ridge cleft in school age, and facial bone deformity correction surgery in adulthood.
What should I pay attention to after surgery?
1. After cleft lip repair surgery, the upper lip should be protected by the lip arch, and the child’s hands should be braked to avoid scratching the surgical area. The sutures are usually removed 5-7 days after surgery.
2, cleft palate repair after surgery children should pay attention to avoid feeding hot food.
3, cleft lip and palate repair should be fed a liquid diet for a week after surgery, and a soft diet for 2-3 weeks after surgery.
4. Functional training of the palate muscles and language training can be started 1 month after cleft palate repair and correction of incomplete palatopharyngeal closure. After 2-3 months of surgery, a follow-up visit will be made to evaluate the function of palatopharyngeal closure in order to determine the next treatment plan and to guide the child’s speech therapy.
How can parents cooperate with the treatment?
(1) Physical condition: If a three-month-old baby needs to receive vaccination, the time is 2 weeks before the surgery. You should avoid colds before surgery. If you have fever, cough, runny nose, sore throat, oral infection, rash, toothache, diarrhea, etc., you should treat them and wait until they are cured before surgery.
(2) Bring items: You can bring familiar pillows, quilts and dolls from home to increase the child’s sense of security.
(3) Fasting: The duration of fasting needs to be coordinated with the surgery, and feeding and watering are prohibited during the fasting period. The child should be trained to eat with a spoon or tube.
(4) Post-surgery: After returning to the ward, hot towels can be used to wipe the face to get rid of the disinfectant and blood on the face. To reduce the accumulation of sputum after anesthesia, tap the back every two hours to facilitate sputum discharge.
(5) Oral hygiene: Drink boiled water after each feeding to maintain oral hygiene. For larger children, mouthwash can be used to gargle to reduce blood and blood odor in the mouth.
The significance of sequential cleft lip and palate treatment Cleft lip and palate treatment is a systematic and sequential work, which also requires the close cooperation of patients, parents and the society.
In addition to a timely and reasonable surgical plan, a child with cleft lip and palate needs careful care and more love and attention.
In today’s fairly advanced medical technology, most of these children can have a healthy and harmonious life if they receive timely and effective treatment and if proper psychological intervention and psychological guidance is ensured for the child and parents.
Surgical correction of secondary deformities of cleft lip More than half of the patients will also have deformities of the skin, soft tissues and jaws of the lip and nose after cleft lip repair surgery, which is the secondary deformity of cleft lip. The main manifestations are lip scarring, bilateral lip asymmetry, upper lip overtightening, nasal base collapse, nasal tip deviation, nasal wing collapse, and antimandibular deformity. Only through patient and careful or even multiple surgeries can these complex deformities be corrected.
Even if the cleft palate repair surgery is successful, incomplete palatopharyngeal closure may occur due to congenital underdevelopment of the palatopharynx, motor dysfunction of the palatopharyngeal muscles or scar contracture. Except for a very small number of patients who can correct their pronunciation through speech training, the vast majority of patients must be surgically corrected to establish good palatopharyngeal closure and provide a healthy anatomical platform for clear and normal pronunciation.
Surgery for correction of maxillary and mandibular deformities facial skeletal deformities mainly include some facial contour deformities and dysfunctions due to trauma, diseases or congenital deformities such as mid-facial depression deformities, antimandibular deformities, small jaw deformities, opening deformities, deviated jaw deformities, hemifacial dysplasia and other diseases.
1.Orthognathic surgical technique: It is to truncate, move forward and fix the receding maxilla to restore the front protrusion of the middle of the face and the occlusal relationship between the upper and lower teeth, and to correct the mid-facial depression and antitussive malocclusion. If the gap between the broken ends of the maxilla is more than 5 mm, bone grafting is needed. In patients who did not have bone graft repair in the early stage, the maxilla is mostly two segments (unilateral cleft palate) or three segments (bilateral cleft palate), and after block osteotomy and anterior displacement, bone grafting is also needed to repair the cleft at the same time. For serious cases, sometimes it is necessary to simultaneously osteotomize and retract the protruding mandible to achieve the best surgical effect.
2.Osteotomy and traction osteogenesis technique: The specific part of the maxilla is cut off, traction device is placed, and after a 5-day incubation period, traction of the cut-off maxilla block is started forward, 1mm per day, until it reaches the predetermined position. The advantages of this method over traditional orthognathic surgery are: less bleeding, less trauma, and reduced risk; soft tissue expansion while the jaw bone is pulled forward, avoiding postoperative recurrence of maxillary recession; no intraoperative bone grafting; and no incomplete palatopharyngeal closure due to pulling the soft palate forward while the maxilla is moved forward. Osteotomy traction osteogenesis technique indications: congenital facial skeletal dysplasia, trauma, disease and other acquired factors causing facial skeletal dysplasia, etc.
3.Suture traction osteogenesis technique: a special traction device is fixed on the maxilla and skull, multiple facial bones are linked together through the suture, and the suture will continuously generate new bone when the bones in the middle of the face are moved forward by the pulling force, and after a period of traction, the deformity of facial skeletal dysplasia can be corrected. This method is simple, safe, minimally invasive, and does not require the amputation of bones to correct a collapsed midface bone deformity. If treated at this age, patients receive more benefits than other procedures, and it is a very beneficial procedure for the patients involved. However, if the bones are significantly ossified beyond this age, I am afraid that this method cannot be performed. This method is suitable for children under 14 years of age, and patients with craniofacial skeletal hypoplasia should receive this treatment at an early age.
The first and second gill arch hypoplasia syndrome is the second most common congenital malformation of the face, after cleft lip and palate, with clinical manifestations ranging from mild malformation of the auricle or low placement of the ear to residual dermatome, traces of earlobe or even complete absence, atresia of the external auditory canal, hypoplasia of the middle ear, hearing impairment or deafness. In severe cases, the entire ascending branch of the mandible and the condyle are short, the articular fossa is flat and shallow, and the body of the mandible on the affected side is also hypoplastic, resulting in shortening of the affected side and a sloping occlusal surface with an open bite. Due to the masticatory muscle dysplasia, the muscle force on both sides is unbalanced, and the mandible is skewed to the affected side when opening and closing the mouth and reaching forward, and the line from the corner of the mouth to the ear screen is split to form a giant mouth, i.e. transverse facial cleft.
Treatment principle: At three months of age, the patient undergoes transverse facial cleft repair surgery and ear removal, and at around 2 years of age, the patient undergoes mandibular traction osteogenesis to lengthen the mandible downward and outward in order to restore the facial shape and bite function. If you have microtia or outer ear, outer ear reconstruction is usually performed around the age of 5.
Hemifacial atrophy is an atrophy of the skin and soft tissues or bone and cartilage tissues that is limited to one side of the face, and it gradually worsens with age. The disease progresses slowly, with subcutaneous tissue atrophy and thinning, and muscle atrophy and thinning as the disease progresses. If the disease develops in early childhood, the growth and development of the facial bones are severely affected, resulting in small bone size and severe deformities. The typical hemifacial atrophy develops before the age of 20 and progresses slowly. The cause of the disease is not known. This condition is more common in women.
There is no specific treatment for this condition, but tissue transplantation is often used to augment the facial appearance through surgery.
Lip reconstruction and aesthetic thin lips, heavy lips, thick lips, bilateral lip asymmetry, lip and cheek trauma or scar, lip and cheek defect, facial hemangioma or deformity caused by hemangioma treatment, lip and cheek tumor, lip and cheek aesthetic can be corrected through surgical or non-surgical methods.
Oculoplastic reconstruction of the orbital sockets due to trauma, tumor and other causes of eye loss, orbital sockets deformity, especially because of retinoblastoma resection after radiation therapy caused by periorbital bone underdevelopment, facial atrophy of the affected side, bilateral asymmetry, despite the installation of a prosthetic eye, but there are still orbital sockets deformity, upper eyelid depression, or prosthetic eye piece fitting difficulties and other difficult orbital diseases, through surgery can be obtained satisfactory results.
Reconstruction of the eyebrows and reconstruction of peripheral nerve and muscle functions can be treated by repair and reconstruction surgery due to trauma, tumor resection, congenital defects and other factors that cause muscle movement dysfunction and affect the function of the affected area such as peripheral nerve breakage, defect, and muscle deficiency.
Head, neck, oral and maxillofacial tumors Head, neck, oral and maxillofacial tumors are common major diseases that seriously endanger human beings. Early detection and early diagnosis and treatment are important elements of tumor prevention and treatment.
The treatment of most head and neck tumors is still a comprehensive treatment based on surgery. As long as the indications for surgery are met, surgery must be performed without losing time. Without the technique of repair and reconstruction, large tumor resection will not be possible.