Cleft palate repair

We often see many babies with cleft lip and palate. This condition is unavoidable and difficult to detect during prenatal examinations. Cleft lip and palate does not affect the child's life or health, but it will affect their appearance. If left untreated, it will cause the child to have low self-esteem and affect his future life. Many parents choose to have their children undergo cleft lip repair surgery. So, what is the process like?

1. General surgical method

1. Anesthesia: General anesthesia is performed by oral intubation, and local infiltration anesthesia can be performed in the surgical area using lidocaine containing a certain ratio (1:100,000~200,000) of epinephrine.

2. Body position: Use padded shoulders and keep your head tilted back.

3. Rinse and clean the oral and nasal cavities.

4. Relaxing incision: Whether to use a relaxing incision depends on the width of the cleft. The relaxing incision is generally located on the palatal side of the alveolar process on both sides, from the anterior tooth area to the back, bypassing the maxillary tuberosity and reaching the side of the soft palate.

5. Fissure edge incision: from the top of the fissure edge directly to the tip of the uvula.

6. There are generally two ways to dissect and reconstruct muscles. One is to prepare two pairs of triangular flaps in opposite directions on the oral and nasal sides of the soft palate according to the procedure introduced by Furlow. The one with the tip facing forward contains the soft palate muscle (levator veli palatini), which are then sutured in the cross direction. Another method is to dissect out the levator veli palatini on both sides and suture them in place.

7. Soft palate extension or push back: One method is to use the procedure introduced by Furlow to extend the soft palate using two pairs of triangular flaps. The other method is to extend the soft palate by pushing back two large flaps or a single flap.

8. The use of the vomer flap can assist in closing the hard palate cleft, but at the same time it can elevate the starting point of the soft palate.

9. The palate wound should be closed without tension, and the loose incisions on both sides should be sutured or filled with iodine gauze depending on the situation.

2. Complications

Bleeding, local infection, palatal leakage, re-cleft, etc.

Precautions

1. Avoid damaging the greater palatine neurovascular bundle when peeling off the cleft palate mucoperiosteal flap.

2. The tension at the junction of the soft and hard palate should not be too great to prevent the wound from splitting.

3. The integrity of the soft palate muscles should be restored and the length of the soft palate extended as much as possible to restore good velopharyngeal closure.

3. Postoperative Care

1. Pay attention to the situation inside the oral cavity. If there is bleeding from the wound, stop the bleeding in time.

2. Clean your mouth every day after surgery and drink plenty of water.

3. Try to avoid the baby crying as it may increase the risk of the wound opening.

4. The iodoform gauze in the loose incisions on both sides can be removed about one week after the operation.

5. The stitches will be removed about one week after the operation. If absorbable sutures are used, they do not need to be removed.

6. Antibiotics are routinely used after surgery to prevent infection.

7. One month after the operation, the patient will be fed with liquid and semi-liquid diets, and then gradually changed to normal diet according to the condition of the patient.

8. Avoid bottle feeding for one month after surgery.

9. Determine the time for follow-up examination, speech evaluation and speech training after the operation.