Jiri Borsky, Jana Veleminska, Michal Jurovčík, Jiri Kozak, Dana Hechtova, Miroslav Tvrdek, Milos Cerny, Zdenek Kabelka, Jaroslav Fajstavr, Jan Janota, Jiri Zach, Renata Peterkova, Miroslav Peterka
Plastic Surgery Clinic, Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Int J Pediatr Otorhinolaryngol. 2012 Nov;76(11):1616-26. doi: 10.1016/j.ijporl.2012.07.031. Epub 2012 Aug 18.
In the children born with a cleft lip, surgery is the first step in correcting the inborn anomaly. In comparison with usually made 3-month surgery, benefits of the surgery in neonates have been reported: a very good wound healing, feeding facilitation, and good socialization of a child from neonatal age. The aims of the present study were to perform cheiloplasty in early newborns affected by the total cleft lip and palate (CLP) by the technique modified to search for optimum aesthetic result, and to assess the surgery outcome from qualitative and quantitative aspects.
The operations were performed by the same surgeon in 97 neonates 1-8 days old during 2005-2008. The original technique by Tennison was modified and used. Aesthetic outcome of the surgery was evaluated according to scar visibility, and the shape and symmetry of the lip and nose. The effect of cheiloplasty on the formation of the upper jaw segments was evaluated in a sample of unilateral CLP patients using the 3D-finite element scaling analysis (FESA). We compared 3D models of dental plaster casts made prior to lip surgery (in neonates under 8 days of age) and prior to palate surgery (at 12 months of age).
Only the children in excellent health state and without an associated inborn defect were allowed to pass the operation. There were no per-operative complications (except the correction of tracheal tube position in several cases). The parents appreciated bringing home a neonate with no visible cleft. This aspect not only facilitated baby feeding, but had important positive psycho-social impact on the whole family. The wound healing and aesthetic effect of the cheiloplasty were very good. The scar was barely visible and lip and nose were symmetric in majority of children. After lip closure, the growth and approximation of jaw segments was observed. This aspect was also associated with incisors development in the anterior portion of the segment including premaxilla.
Our results show, that early neonatal lip surgery of CLP is promising technique with very good aesthetic results and important positive psychological impact on the child and its family.
对于唇裂患儿，手术是矫正先天性畸形的第一步。与通常在3个月时进行的手术相比，新生儿期手术的益处已有报道：伤口愈合良好、便于喂养，且患儿从新生儿期起就能很好地融入社会。本研究的目的是采用改良技术对患有完全性唇腭裂（CLP）的早期新生儿进行唇成形术，以寻求最佳美学效果，并从定性和定量方面评估手术效果。
2005年至2008年期间，由同一位外科医生对97例1至8日龄的新生儿进行手术。采用改良的坦尼森原始技术。根据瘢痕可见度、唇和鼻的形状及对称性评估手术的美学效果。在单侧CLP患者样本中，使用三维有限元缩放分析（FESA）评估唇成形术对上颌节段形成的影响。我们比较了唇手术前（8日龄以下新生儿）和腭裂手术前（12个月龄）制作的牙石膏模型的三维模型。
只有健康状况良好且无相关先天性缺陷的儿童才能通过手术。术中无并发症（少数病例除外气管导管位置的调整）。家长们很高兴能把一个没有明显腭裂的新生儿带回家。这不仅便于婴儿喂养，而且对整个家庭产生了重要的积极心理社会影响。唇成形术的伤口愈合和美学效果非常好。大多数儿童的瘢痕几乎不可见，唇和鼻对称。唇闭合后，观察到颌节段的生长和接近。这也与包括前颌骨在内的节段前部的切牙发育有关。
我们的结果表明，早期新生儿CLP唇手术是一种很有前景的技术，具有非常好的美学效果，对患儿及其家庭有重要的积极心理影响。
