Case review(cleft lip)

ry

Unilateral cleft lip

University Of Ulsan

College Of Medicine, student

Tae O, Kim

Ref) http://upload.wikimedia.org/wikipedia/commons/8/8d/Cleft_lip_adult_dog.JPG

CONTENTS

• Incidence of CL/P & CP

• Environmental risk factor

• Characteristics of Unilat. CL

• Embryogenesis of Unilat. CL

• Millard method as treatment of unilat.CL

Ref) j Lorean Med Sci 17: 49, 2002.

The cleft lip and palate incidience among the live births in the republic Korea

Continent Prevalence

Caucasian 1.16

Oriental2.1

(korean 1.81)

African 0.43~1.34

전세계적으로 신생아 700 명 중 1명

CL/P & CP 은 두경부의 선천성 기형 중에서 most common

(In one study by Poul Fogh-Anderson)

Prevalence is increasing recent

1: 770 (1941) → 1: 500 (1971)

Ref) Modified from Fraser FC : Etiology of CL and palate.

In Grabb WC, Rosenstein SW, Bzoch KR

Definitive risk factor is not yet known

Some environmental factor is studying

:maternal smoking, alcohol, caffeine, BDZ, steroid

• 4~5cups/month

• 2.8~4배

Alcohol

• 3~9배

Steroid

• Anticonvulsant

• 4~11배

Epilepsy

Ref) 구순구개열 chap 9. 구순구개열의 환경위험인자

In Study of relative proportions of cleft types,

Unilat. CLP (30~35%), Isolated CL & CP (each 20~25%), Bilat. CLP (10%)

(From Diegof F, Wyszynski. Cleft lip & palate

Laterality Cleft lip

Left 60%

Right 31%

Bilateral 7%

Uncertain 4%

(From J Korean Med Sc: 2002:17:49~52

1. Regardless sex, race, severity.

Lt. unilat. CL is most common

2. Male dominant (1.7~6.8 :1)

3. 15% of CL is syndrome

(CHD, short frenulum, etc)

태아 머리의 오른쪽을 지해 하는 혈관들이

왼쪽보다 심장과 더 가까이에서

대동맥궁을 떠나므로 더 좋은 혈류를 받지 않을

까?(From J Korean Med Sc: 2002:17:49~52

임신 6~7주:

Epithelization

Mesenchymal replacement

내측 비돌기 와 외측 비돌기 융

합+

+

Ref) 표준성형외과학. 그림5-1

Incomplete Complete Bilateral

Complete:

absence of any connection with extension into nose

vomer exposed

Incomplete:

midline attachment

Simonart band 존재 시 complete로 간주

Simonart band

`s band

Ref) Cleft Palate–Craniofacial Journal, July 2006, Vol. 43 No. 4

Prevalence of a Simonart’s Band in Patients With Complete CL andAlveolus and Complete CL/P

Soft tissue bridge located at the base of the nostril

(prevalence:31.2%, UCL more)

Mild but positive influence

on the final facial pattern

Reduce the need for 2nd surgeries

of the lip & nose

Long-term influence on the morphology

of the maxillary dental arch

Effect of Simonart`s Band

McCash (1957) : 가능하면 빨리 수술을 시행

Stark (1962) :생후 48시간 이내

Straith (1965) : 국소마취로 1~4주

Wilhelmsen & Musgrave (1966) : rule of tens

Rule of 10

1. 생후 10주경

2. 체중이 4.5kg 이상(10 lb )

3. Hg 10gm%

4. WBC <10만

Columella in the midline

Restoration of philtrum

Restoration of cupid`s bow

Correct mucocutaneous jx

of vermilion border

Symmetry of nostril

Symmetry of attachment

of ala nasi

Ref) 악안면 성형외과학 김수관. Chap10. 구개열과 구순열

Rotation & advancement method

Methylene blue로 주요 해부학적 지점을 표시한 모습


절개선을 표시한 모습 (rotation-advancement flap)


회전 및 전진 피판 절개를 시행한 모습


중앙의 잉여조직을 절제하는 모

습


층별 봉합을 시행한 모습


봉합 후 nasal retainer를 정착한 모습


1. 구순구개열, 대한두개안면성형외과학회 군자출판사. Chapter1, 4, 11

2. j Lorean Med Sci 17: 49, 2002.

The cleft lip and palate incidience among the live births

in the republic Korea

3. J Korean Med Sc: 2002:17:49~52

4. 표준 성형외과학 chap.5 구순구개열 그림5-1

5. 악안면 성형외과학. 김수관 저 chap10. 구개열과 구순열 그림10-19~26

6. Cleft Palate–Craniofacial Journal, July 2006, Vol. 43 No. 4

Prevalence of a Simonart’s Band in Patients With Complete CL

andAlveolus and Complete CL/P

Education

Case review(cleft lip)