Slide ความรู้เรื่อง แนวทางการรักษาผู้ป่วยปากแหว่ง เพดานโหว่

Cleft Lip and Palate ผศ.นพ กฤษณ์ ขวัญเงิน หน่ วยศ ัลยศาสตร ์ตกแต่ง ภาควิชาศ ัลยศาสตร ์ คณะแพทยศาสตร ์ มหาวิทยาลัยเชียงใหม่ kkhwanngern@gmail.com Facebook = krit khwanngern Line ID = kritkhwanngern

CLP and craniofacial cleft (Diagnosis) CLP → how to diagnosis CLP → what problems CLP → Timetable

Cleft nose deformity Cleft lip Cleft palate

Alveolar cleft

Microform

incomplete

complete

Alveolar cleft Narrow-non collapse, narrow-collapse, Wide-non collapse, wide-collapse

อายุ 11 ปี 10 เดือน 14 วัน Cleft Lip Cleft palate Left Complete NO alveolar cleft, complete

Bifid Uvula

Complete Cleft Palate

Incomplete Cleft Palate Cleft soft palate

SUBMUCOSAL CLEFT

• Bifid uvular • Dehiscence of the levator palatinim. “Zona pellucida” • Notch at posterior edge

Airway Management Position

Tongue stitch Endotracheal intubation

Tracheostomy

Early DOS

Feeding • • • •

Breast feeding Artificial nipple/bottle 45 degree Increase time but decrease duration • Burped more frequently • Palatal Obturator ( NAM + Palatal obturator )

Feeding

Nasogastric Feeding Tube

NAM + Palatal obturator

Obturator

Obturator

John Mulliken; CHB, Harvard

John Mulliken; CHB, Harvard

Palatoplasty

Myringotomy and tube

Mucoperiosteal flap

Palatoplasty

Cheliopalatoplasty : one stage

Anterior palatal defect or Oronasal fistula

Palatal fistula

Large Palatal fistula

Furlow palatoplasty

Pharyngeal Flap

Pharyngoplasty

Surgery First

Orthodontic First

Anterior palatal defect or Oronasal fistula

Malocclusion

Maxillary Hypoplasia

Medial nasal prominences Nasal tip, Philtrum, Cupid’s bow, Premaxilla, Primary palate and nasal septum

Maxillary prominences upper lip except the philtrum

Mandibular prominences lower lip Lip 4 – 7 weeks

Frontonasal prominence Median palatine process Maxillary prominence Lateral palatine process

Palate 5 – 12 weeks

Mother : Genetic ; IRF 6 gene( interferon regulatory factor) and MSX 1 Age / Stress / Social Habit / Nutrition / Environment: Physical / Chemical / Biological

- Ultrasound -> 5 cases / 2556 - Genetic -> O case

Medical Record

Incisive foramen

The Striped Y logo (Kernahan 1971)

Millard ’s modification of Kernahan ’s Diagramic Y (1 977)

Modified Y (Bardach J, Morris HL 1990)

Kriens LAHSHAL classification 1990

The Striped Y logo

Modified Y

(Kernahan 1971)

(Bardach J, Morris HL 1990)

Millard ’s modification of Kernahan ’s Diagramic Y ( 1977)

Kriens LAHSHAL classification 1990

•Questions?