Effect of the Periosteal Flap Technique on Cleft Width and the Formation of Alveolar Ridge in Relation to the Bite Level in Surgery for Cleft Lip and Palate

The effect of the periosteal flap technique on the width of the alveolar cleft and on the formation of the alveolar ridge in relation to the bite level was examined in 36 cases of complete unilateral cleft. Attention was paid to the time interval between periosteoplasty and palatal repair, and some of the cases were re-examined approx. a year after palatal repair. Patients with a well formed bridge between the alveolar segments displayed at least the same degree of narrowing of the cleft as those in which no formation of bone bridge was established roentgenologically. The occurrence of upward rotation at the end of the alveolar segments facing the cleft was similar in both groups. The original width of the cleft did not influence the upward rotation of the alveolar ridge, but it did influence the narrowing of the cleft.     

The Maxillary Periosteal Flap in Primary Palate Surgery1

Clefts of the primary palate have been closed in infants by the utilization of a large anterolateral maxillary periosteal flap to form a periosteum-lined cavity with the inferior aspect of the nasal floor. The results in 12 cases with Wide unilateral and bilateral clefts revealed deposition of bone in the primary cleft within six months, and this increased with time. Good alignment of the alveolar arch was achieved in all cases. Further bone deposition followed subperiosteal implantation of “Surgicel” at the age of one year in four cases, with lessening also of the ala base asymmetry. No interference with maxillary growth has been observed. The full assessment of this type of primary palate closure requires some years of observation, but the present results are promising.     

Experience of participating in the 14th Nepal Cleft Lip and Palate Surgery Project

Adventist Development and Relief Agency (ADRA) Japan, a non governmental organization (NGO), following an official request of Federal Democratic Republic of Nepal Government has organized Nepal Cleft Lip and Palate Surgery Project since 1995. We participated in the 14th Project as one of the anesthesiologists from 7th to 22nd November 2009 and performed general anesthesia with a Nepalese anesthetist without a medical license in Sheer Memorial Hospital. Use of unfamiliar anesthetic medications and limited medical devices made us understand the difficulty of anesthetic management. This valuable anesthetic experience will be useful for us in general anesthetic management in the future.     

低龄唇腭裂整复术患儿的护理

对501例≤3周岁的低龄唇腭裂患儿采用唇腭裂整复术治疗,术前对患儿及其家长给予心理护理和早期喂养技能训练,术后取消常规配戴唇弓,出院前给予语音训练指导等.结果术后外形基本满意,伤口如期愈合,术后1年随访语音功能显著改善.     

A Model of the Unmet Need for Cleft Lip and Palate Surgery in Low- and Middle-Income Countries

Background

There is a significant unmet need for the cleft lip and/or palate (CL/P) care in low- and middle-income countries (LMICs); however, country-level estimates that can be used to inform local and international cleft care program strategies are lacking.

Methods

Using data from Operation Smile surgical programs in twelve LMICs and country-level indicators from the World Health Organization and World Bank, we developed a model to estimate the proportion of individuals with CL/Ps older than respective surgery age targets for cleft lip and cleft palate surgery (1 and 2 years, respectively). After extrapolating this model to other LMICs with available indicator data, we combined these findings with estimates of CL/P prevalence among live births to estimate the total number of unrepaired CL/P cases in LMICs worldwide.

Results

The models were constructed from a total of 887 cases of cleft palate and 576 cases of cleft lip across the twelve countries. From these, we estimated that there are 616,655 cases of unrepaired CL/P (95 % CI 564,893–678,503) in the 113 countries with available data for extrapolation. The rate of unrepaired CL/Ps ranged from 2.5 per 100,000 population in Romania to 28.5 per 100,000 in Cambodia, respectively (median rate 10.7 per 100,000 population).

Conclusions

Our model provides marked insight into the global surgical backlog due to cleft lip and palate. While the most populated LMICs have the largest number of unrepaired CL/Ps, low-income countries with relatively less healthcare infrastructure have exceptionally high rates (e.g., Cambodia, Afghanistan, and Nepal). These estimates can be used by local and international cleft care organizations to set program priorities, estimate resource requirements, and inform strategies to support cleft care.

     

正颌联合术后正畸矫治唇腭裂术后的牙颌面畸形

目的探讨应用正颌手术联合术后正畸矫治唇腭裂术后牙颌面畸形的方法。方法2002年1月至2010年8月,共收治25例唇腭裂术后颌骨畸形患者。男11例,女14例;年龄16～33岁;单侧唇腭裂19例,双侧6例。所有患者术前均未接受过正畸治疗。本组患者均联合应用正颌手术和术后正畸建牙合矫治唇腭裂术后颌骨畸形。结果25例患者经过3~12个月的术后正畸治疗,均建立了良好的咬牙合关系,恢复正常咬合功能。随访6个月至3年,术后疗效稳定。结论唇腭裂术后颌骨畸形采用正颌手术联合术后正畸能够有效矫治牙颌面畸形。     

Early Management of Bilateral Total Cleft Lip and Palate

Coordination of maxillary orthopedics with surgical interventions for cleft lip and palate repair is described. The objective is to obtain optimal form and function during the whole course of development, performing every step at the most propitious moment and refraining from measures that could make later management more difficult. For this purpose the ?ele?nik approach to bilateral lip repair and a two-step closure of the palate have been used in Zurich for the past six years, yielding to-date positive results: regular intermaxillary relationship, no need for expansion in deciduous dentition, cephalometric values within the range of normal variations, very satisfactory speech results.     

计算机辅助外科在腭裂手术中的应用

选取2021年1月-2022年12月于徐州市第一人民医院行腭裂手术的54例患者作为研究对象,分析 在腭裂手术中计算机辅助外科的应用价值。所有患者均实施计算机辅助外科,对手术治疗效果、平均手术 时间、术中平均出血量、术后感染发生情况、两侧上颌结节连线至悬雍垂的垂直距离术后的延长长度等进 行评估。结果显示,54例患者在计算机辅助外科实施下,均得到治愈,有效率为100.00%;平均手术时间为 （69.35±15.05）min;术中平均出血量（44.20±6.70）ml;术后1例患者出现轻度感染（1.85%）;术后患 者两侧上颌结节连线至悬雍垂的垂直距离术后的延长长度为（5.76±1.12）mm。可见,计算机辅助外科的 应用价值、可行性较高,可以使手术趋于更加精确、微创,能够为腭裂患者提供更佳的治疗效果。