Brusati Roberto
Smile House-CLP Center, San Paolo University Hospital, via di Rudinì 8, Milan, Italy.
J Craniomaxillofac Surg. 2016 Aug;44(8):901-11. doi: 10.1016/j.jcms.2016.05.003. Epub 2016 May 15.
At the end of 50-year-long clinical activity, the evolution of my approach to the treatment of unilateral cleft of the lip and palate is discussed. I had several teachers in this field (Rusconi, Reherman, Perko, Delaire, Talmant, Sommerlad and others) and I introduced in my approach what I considered to be improvements from all of them. My current protocol is related to the anatomy of the cleft: for wide clefts a two-stage protocol is applied (1° step: soft palate and lip and nose repair; 2° step: hard palate repair with gingivoalveoloplasty); for narrow cleft (less than 1 cm at the posterior border of hard palate) an "all in one" protocol is performed with or without gingivoalveoloplasty (in accordance to the presence or absence of contact between the stumps at alveolar level). The most important details regarding surgery of the lip and palate are discussed. Robust data collection on speech and skeletal growth is still needed to determine whether the "all in one" approach can be validated as the treatment of choice for unilateral complete lip and palate cleft in selected cases.
在长达50年的临床工作结束之际，我对唇腭裂单侧治疗方法的演变进行了探讨。在这个领域我有多位老师（鲁斯科尼、雷尔曼、佩尔科、德莱尔、塔尔芒、索默拉德等人），我将我认为他们各自方法中的改进之处都融入到了自己的治疗方法中。我目前的治疗方案与腭裂的解剖结构有关：对于宽腭裂采用两阶段方案（第一步：软腭、唇和鼻修复；第二步：硬腭修复及牙龈牙槽成形术）；对于窄腭裂（硬腭后缘小于1厘米），根据牙槽水平处残端之间是否接触，采用或不采用牙龈牙槽成形术执行“一体化”方案。文中讨论了唇腭裂手术的最重要细节。关于语音和骨骼生长仍需要强有力的数据收集，以确定“一体化”方法能否被确认为某些特定病例中单侧完全性唇腭裂的首选治疗方法。
