Ferdous Kazi Md Noor-ul, Salek A J M, Islam M Kabirul, Das Bijiy Krishna, Khan A R, Karim Md Shahid
Department of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.
Pediatr Surg Int. 2010 Oct;26(10):995-1000. doi: 10.1007/s00383-010-2643-0.
Repair of anterior palate after repairing the cleft lip in complete cleft lip and palate patient is sometimes very difficult. It needs wide, extensive and difficult dissection, and has later chances of wound infection, wound dehiscence, complete wound disruption, recurrent oronasal fistula formation and also maxillary hypoplasia. In this study, we compare the outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP).
A prospective study was carried out in 43 patients with UCLP. In Group A, 23 patients underwent cleft lip and cleft hard palate repair with vomer flaps simultaneously, and only cleft lip repair was done in another 20 patients in Group B at the first sitting. After 3 months in both groups, repair of the cleft soft palate and cleft entire palate was done. The gaps of the cleft alveolus and posterior border of the cleft hard palate were measured during the first and second operation, and duration of operations, postoperative complications and requirement of blood transfusion during the operation were also recorded.
The procedure of simultaneous repair of cleft lip and closure of cleft hard palate with a vomer flap is easy to perform. Cleft alveolar and gap of the posterior border of the cleft hard palate were reduced remarkably. No fistula formation occurred and no blood transfusion was needed, but the procedure took some extra operating time. These were compared with simple cleft lip repair.
Repairs of cleft lip and simultaneous closure of cleft hard palate with vomer flaps are safe in patients with UCLP, and it makes easy the closure of the soft palate later on and decreases the chance of oronasal fistula.
在完全性唇腭裂患者中,修复唇裂后再修复前腭裂有时非常困难。这需要广泛、深入且困难的解剖操作,术后有伤口感染、伤口裂开、伤口完全裂开、复发性口鼻瘘形成以及上颌发育不全的风险。在本研究中,我们比较了单侧完全性唇腭裂(UCLP)患者同时采用犁骨瓣修复唇裂和硬腭裂与单纯修复唇裂的效果。
对43例UCLP患者进行了一项前瞻性研究。A组23例患者同时采用犁骨瓣修复唇裂和硬腭裂,B组另外20例患者在首次手术时仅进行唇裂修复。3个月后,两组均进行软腭裂和全腭裂修复。在首次和第二次手术时测量腭裂牙槽间隙和硬腭裂后缘间隙,并记录手术时间、术后并发症及术中输血需求。
同时采用犁骨瓣修复唇裂和关闭硬腭裂的操作易于实施。腭裂牙槽和硬腭裂后缘间隙明显减小。未发生瘘管形成,无需输血,但该手术需要额外的手术时间。这些结果与单纯唇裂修复进行了比较。
对于UCLP患者,唇裂修复并同时采用犁骨瓣关闭硬腭裂是安全的,这使得后期软腭裂的关闭更容易,并降低了口鼻瘘的发生几率。