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?