Experience of repairing cleft lip and palate deformity in Tibet
10.3760/cma.j.cn11453-20220622-00187
- VernacularTitle:西藏高原地区唇腭裂畸形修复经验总结
- Author:
Chenglong WANG
1
;
Luo BA
;
Nianza DANZENG
;
Zhipeng LIAO
;
Deji CI
;
Jizong NIMA
;
Wangmu SUOLANG
;
Keming WANG
Author Information
1. 中国医学科学院北京协和医学院整形外科医院外耳整形再造二科，北京 100144
- Keywords:
Cleft lip;
Cleft palate;
Tibet plateau;
Reconstructive surgical procedures
- From:
Chinese Journal of Plastic Surgery
2023;39(1):54-59
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the repair experience and clinical characteristics of cleft lip and palate in Tibet.Methods:From August 2020 to August 2021, patients with cleft lip and palate treated during the period of corresponding author aid to Tibet were included. The American Association of Anesthesiologists (ASA) was used to assess the anesthesia risk before operation. For the cleft lip repair, Millard rotation advancement technique and reconstruction of nasal-labial muscle tension lines group were used. Modified Von Langenbeck technique was adopted for cleft palate repair. The amount of blood loss and short-term postoperative complications such as hematoma, infection, wound dehiscence, flap circulation disorder and palatal fistula were counted. The Likert five-point scale was used to evaluate the surgical satisfaction of patients with cleft lip and the audiometric evaluation method was used to assess the improvement of cleft palate speech. The data were statistically analyzed by SPSS 20.0 software. The measurement data were expressed by Mean±SD. P<0.05 was considered statistically significant. Results:A total of 46 patients were included, including 26 males and 20 females, aged from 2 to 57 years, with a median of 32 years. There were 36 patients with cleft lip or secondary deformities after cleft lip surgery and 10 patients with cleft palate. Among the 46 cases, ASA Ⅰ was 39, and ASA Ⅱ, ASA Ⅲ were 5 and 2, respectively. There were 5 patients with congenital heart disease, including 2 cases of patent ductus arteriosus and 3 cases of patent foramen ovale. Pulmonary hypertension was found in 8 cases. The average blood loss during the repair of cleft lip and cleft palate was 30 ml and 50 ml, respectively. No postoperative complications such as hematoma, infection, wound dehiscence and palatal fistula occurred. The patients were followed up for 6 to 24 weeks, with an average of 8 weeks. The crista philtra point on the affected side of the patients with cleft lip was fully lowered and was basically symmetrical with the healthy side. The bilateral nostril symmetry was significantly improved compared with that before surgery, and the nasal columella was in the middle. The cleft palate was all closed and the mobility of soft palate was improved. All patients were satisfied with the surgical results, with an average satisfaction score of 4.5. The mean preoperative speech score of patients undergoing cleft palate repair was 1.4 ± 0.5 and the postoperative was 4.3 ± 0.5 ( t=16.16, P<0.001). Conclusion:Compared with the plain area, patients with cleft lip and palate in Tibet have the characteristics such as delayed treatment, the complex of deformity and often combined with other congenital organ malformation. In order to get good result and higher satisfaction rate, it is recommended to use classical surgical technique for the above deformity repair. It is also important to carefully evaluate the risk of general anesthesia.
