Chung Kyung Hoon, Sato Nobuhiro, Chou Pang-Yun, Lo Lun-Jou
Plastic & Reconstructive Surgery, and Craniofacial Research Center, 22386Chang Gung Memorial Hospital, Chang Gung University, Taoyuan.
Cleft Palate Craniofac J. 2021 Feb;58(2):251-256. doi: 10.1177/1055665620938480. Epub 2020 Jul 10.
Primary reconstruction of complete bilateral cleft lip and palate (BCLP) with protruding premaxilla in one-stage surgery is challenging because of the tension on muscle repair. Such patients are also common in the developing countries. For this condition, we have applied intraoperative "rapid premaxillary molding (RPM)" technique and obtained satisfactory results.
We reviewed the data of patients with complete BCLP with protruding premaxilla applying intraoperative RPM including both our institution and cleft missions to developing countries in the past 20 years. Selection criteria were patients receiving either no or insufficient preoperative molding presenting with significant protruding premaxilla, had consecutive follow-ups after surgery. To perform this technique, the surgeon holds the patient's face with both hands and compresses the protruding premaxilla with both thumbs. An intermittent but stable backward pressure is applied to the premaxilla until the segment is gradually flexible. Repeated compression is performed prior to tying the muscle sutures, at which time the premaxilla is retro-positioned and aligned with the lateral maxillary segments. Pre- and postoperative data were evaluated.
We have treated a total of 60 patients with complete BCLP with protruding premaxilla applying intraoperative RPM. All patients tolerated the operations and there were no major intra- and postoperative complications including lip dehiscence and vomer fracture. All of them had satisfactory results such as adequate muscle repair and symmetry of the lip and nostrils.
The RPM is a reliable and valuable intraoperative adjunct procedure for patients with complete BCLP presenting the protrusive premaxilla.
一期手术对伴有前颌骨突出的双侧完全性唇腭裂（BCLP）进行初次重建具有挑战性，因为肌肉修复存在张力。此类患者在发展中国家也很常见。针对这种情况，我们应用了术中“快速前颌骨塑形（RPM）”技术并取得了满意的效果。
我们回顾了过去20年中在我们机构以及参与发展中国家腭裂治疗任务的应用术中RPM技术治疗伴有前颌骨突出的双侧完全性唇腭裂患者的数据。入选标准为术前未进行塑形或塑形不足且前颌骨明显突出、术后接受连续随访的患者。为实施该技术，外科医生双手托住患者面部，用双拇指挤压突出的前颌骨。向前颌骨施加间歇性但稳定的向后压力，直到该节段逐渐变得柔韧。在缝合肌肉之前反复进行挤压，此时前颌骨向后复位并与上颌骨外侧段对齐。对术前和术后数据进行评估。
我们共治疗了60例应用术中RPM技术的伴有前颌骨突出的双侧完全性唇腭裂患者。所有患者均耐受手术，未出现包括唇裂和犁骨骨折在内的重大术中及术后并发症。所有患者均取得了满意的效果，如肌肉修复充分以及唇部和鼻孔对称。
对于伴有前颌骨突出的双侧完全性唇腭裂患者，RPM是一种可靠且有价值的术中辅助手术。
