Morioka Daichi, Yoshimoto Shinya, Udagawa Akikazu, Ohkubo Fumio, Yoshikawa Astushige
Yokohama, Tokyo, Chiba, and Kumamoto, Japan From the Departments of Plastic and Reconstructive Surgery of Showa University Fujigaoka Hospital, Showa University, and Chiba University, and the Department of Plastic Surgery, Kumamoto Rehabilitation Hospital.
Plast Reconstr Surg. 2007 Dec;120(7):1981-1988. doi: 10.1097/01.prs.0000287322.79619.de.
The authors have volunteered their services as plastic surgeons in several countries, such as Nepal and Cambodia. In these programs, the authors saw many adults with cleft lips or palates who could not have primary repair at the proper time. The purpose of this report is to discuss the primary repair of untreated cleft lips or palates in adult patients.
Subjects were older than 17 years. In Nepal, primary repairs were performed in 129 adults with untreated clefts over the past 11 years. Unilateral cleft lips were repaired by rotation advancement with the small triangular flap method or the straight method with a small triangular flap. Bilateral clefts were repaired using a one-stage repair method. Cleft palates were repaired by a mucoperiosteal push-back or Furlow technique.
Differences between primary cleft repair for infants and for adults were as follows: (1) in adults, aggressive correction was possible, as maxillary growth was not a consideration; (2) correction of the anterior part of the nasal deformity was more difficult than in infants, as adults showed less elasticity and a more severe deformity of the nasal cartilages; (3) simultaneous palatoplasty should be chosen judiciously, as it is more invasive and results in higher morbidity; and (4) cheiloplasty under local anesthesia can reduce cost, time, and manpower.
These observations should be useful for the local and foreign surgeons who treat clefts in developing regions.
作者们曾在尼泊尔和柬埔寨等多个国家志愿担任整形外科医生。在这些项目中，作者们见到许多唇腭裂成年患者未能在合适时机接受一期修复。本报告旨在探讨成年患者未治疗的唇腭裂的一期修复。
研究对象年龄超过17岁。在尼泊尔，过去11年里对129例未治疗的成年腭裂患者进行了一期修复。单侧唇裂采用带小三角瓣的旋转推进法或带小三角瓣的直线法修复。双侧唇裂采用一期修复法。腭裂采用黏骨膜后推法或弗洛（Furlow）技术修复。
婴儿期和成年期唇腭裂一期修复的差异如下：（1）对于成年人，由于无需考虑上颌骨生长，可进行积极矫正；（2）成年人鼻软骨弹性较小且鼻畸形更严重，因此矫正鼻畸形前部比婴儿期更困难；（3）应谨慎选择同期腭裂修复术，因为该手术创伤更大且发病率更高；（4）局部麻醉下的唇裂修复术可降低成本、缩短时间并节省人力。
这些观察结果对在发展中地区治疗唇腭裂的国内外外科医生应有所帮助。
