| Congenital cleft lip and palate is one kind of most common developmental malformation in oral and maxillofacial region. The incidence rate demonstrates varieties for different ethnicity and areas. In China, the rate is 1.8:1000 (14.01% of total defect rate), secondary only to that of cerebromedullary tube malformation. The etiology of cleft lips; clefts of the lip and alveolus; clefts of the lip, alveolus, and palate; and isolated cleft palates not associated with a specific syndrome is still an important subject of research and so far has not fully been understood. Genetic as well as environmental factors play an important role in the development of a cleft. It might be important to learn about etiological connection between prevalence rate and characteristics of cleft.Because of the limited factors by the social economy and medical condition, the treatments of cleft lip and palate were mostly subjected to single surgery except for partly team approach, such as presurgical orthopedics. A great deal of research reports have revealed that the benefits of presurgical orthopedics were more evident than that of single surgery. In this study, we modified Grason's model of presurgical orthopedics, that is, presurgical nasolveolar molding (PNAM). On one hand, we designed two nose-supported scaffolds which were put two sides of nasal columella top to support the nasal tip. On the other hand, we momentarily gathered images from the three Dimensional Sensing System (3DSS) to evaluate the treatment effect, especially for those infants. There were two parts in the study.Part 1. Simultaneous lip-nose repair following presurgical nasoalveolar molding for infants with unilateralcleft Iip and palateObjective To evaluate the outcome of presurgical nasolveolar molding (PNAM) therapy in the threatment of patients with cleft lip and palate. To apply a new way to evaluate the outcome of PNAM therapy in the threatment of patients with cleft lip and palate. Methods 10 cases with cleft lip and palate underwent simultaneous lip and nose repair following presurgical nasoalveolar molding.The nasoalveolar molding included gap-closing of alveolar cleft and nose-stent until the age of approximately 3-5 months when the surgery was performed. Student'S t test was used for data analysis with SPSS15.0 software package. Results After nonsurgical nose-alveolar molding in 10 infants with cleft lip and palate about 2-3months, the width of the cleft lips in all cases was significantly narrowed (P<0.01), the soft tissue of both sides of the clefts grew and expanded. The deformity of the columella, the dome,and the wide alar of the nose was significantly reduced following nonsurgical nasoalveolar molding (P <0.01). The width of the alveolar cleft became significantly narrower in these patients (P<0.01). Conclusion In order to obtain satisfactory lip-nose configuration and uninterrupted alveolar bone for unilateral complete cleft lip and alveolus, the presurgical nasoalveolar molding and early simultaneous lip-nose repair are useful in cleft lip and palate team approach.Part 2. Research and analysis of infant cleft lip and palate in north of Shaanxi province.Objective To detect prevalence rate and characteristics of infants cleft by case survey. Methods All 30 patients were newborn infants from hospitals of north of Shaanxi province. The research contents included cleft classification, sex ratio, infected malaria during pregnancy and cleft family history. Results There were 25 unilateral cleft lip (83.67%) and 5 bilateral cleft lip (16.67%), including 24 cleft palate(80.00%). In the group of unilateral cleft lip, the number of left upper lip cleft (16 cases) was more than that of right upper lip cleft (14 cases). The ratio was 1.14. The classification of cleft lip showed that three degree cleft (25 cases, 83.33%) was more than two degree cleft (4 cases, 13.33%) and one degree cleft (1 cases, 3.33%). Three mo thers had medical history of malaria. Most patients (23 cases, 76.67%) were from rural areas, and their parents were mainly illiterate. Conclusion The occurrence of cleft lip and palate in this area might be relevant to family condition, nutrition level an, infection and inheritance during pregnancy, etc. |
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