Cleft lip and cleft palate
Download
1 / 41

Cleft lip and cleft palate - PowerPoint PPT Presentation


  • 229 Views
  • Uploaded on

唇顎裂 (Cleft lip and cleft palate). 民間傳說 . 母親在懷孕期間因拿剪刀、釘釘子、搬家、移動櫥櫃等因素純屬臆測,不足採信。 . 生長發育的問題. 口裂 (oral cleft) 發生於胚胎期之第 6--10 週之內,這段時期內正常融合之失敗以及不適當之發育可能影嚮上唇、齒槽脊、硬顎及軟顎之軟組織及骨骼部份。 .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Cleft lip and cleft palate' - alva


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Cleft lip and cleft palate

唇顎裂 (Cleft lip and cleft palate)


民間傳說

  • 母親在懷孕期間因拿剪刀、釘釘子、搬家、移動櫥櫃等因素純屬臆測,不足採信。


生長發育的問題

  • 口裂(oral cleft)發生於胚胎期之第6--10週之內,這段時期內正常融合之失敗以及不適當之發育可能影嚮上唇、齒槽脊、硬顎及軟顎之軟組織及骨骼部份。


Cleft lip and cleft palate can occur on one side (unilateral cleft lip and/or palate), or on both sides (bilateral cleft lip and/or palate).

在胚胎早期發育時,嘴唇部份是由兩側組織漸漸往身體中線連結起來。如果在連結的過程中有一些差錯,而不能按照預定的進度達到連結時,就會產生各種不同的裂縫(cleft)。

唇顎裂的發育


Cleft lip and cleft palate1
Cleft lip and cleft palate cleft lip and/or palate), or on both sides (bilateral cleft lip and/or palate).

  • comprise the fourth most common birth defect in the United States. One of every 700 newborns is affected by cleft lip and/or cleft palate.


唇顎裂 cleft lip and/or palate), or on both sides (bilateral cleft lip and/or palate).

  • 根據統計,約每五百至六百位新生兒中就有一位唇顎裂患者出世。

  • 通常唇顎裂所侵犯之區域包括上唇、齒槽脊、硬顎以及軟顎。


Cleft lip
Cleft lip cleft lip and/or palate), or on both sides (bilateral cleft lip and/or palate).

  • A cleft lip is a separation of the two sides of the lip. The separation often includes the bones of the upper jaw and/or upper gum.



Cleft palate
Cleft palate唇裂的程度從小的切跡,到唇以及鼻孔的齒槽突間的完全裂開都有

  • A cleft palate is an opening in the roof of the mouth in which the two sides of the palate did not fuse, or join together, as the unborn baby was developing.


顎裂唇裂的程度從小的切跡,到唇以及鼻孔的齒槽突間的完全裂開都有

  • 小至只牽涉到懸雍垂uvula,產生類似魚尾fish tail的外觀。或者它可能延伸到軟顎以及硬顎,更嚴重的病會裂到齒槽突和上唇。顎裂是由於兩邊的側顎突中胚層彼此未能融合了而且鼻中隔以及正中顎突(median palatine process )或是原生顎的融含不成所致。




Embryology
Embryology胚胎發育之第二及第三個月胚胎顏面部呈現急速面廣泛之變化

  • Cleft lip and cleft palate are congenital defects, or birth defects, which occur very early in pregnancy.


Detection of Cleft Lip: Ultrasound胚胎發育之第二及第三個月胚胎顏面部呈現急速面廣泛之變化


Etiologic factors
Etiologic factors 胚胎發育之第二及第三個月胚胎顏面部呈現急速面廣泛之變化

  • The majority of clefts appear to be due to a combination of genetics and environmental factors.



Embryology facial development
Embryology: Facial Development

  • 1. Development of human face starts during the 4th week of embryonic development.

  • 2. By 6th week, the external face is completed.

  • 3. Between the 6th and 8th weeks, the palatal development divides the nasal and oral cavities.

  • 4. By 12th weeks, the completion of soft palate


Fusion
Fusion 聚合

  • Fusion is the growing together process of two facial swellings, which were initially separated by a space.


遺傳問題

  • (一)若雙親都正常:生育第一位唇顎裂子女的可能性為一比六百。

  • (二)若雙親中有一位唇顎裂患者:生育唇顎裂子女的可能性為一比二十。

  • (三)若雙親中有一位唇顎裂患者且一位子女有唇顎裂:生育第二位唇顎裂子女的可能性是一比四。

  • (四)若雙親是唇顎裂患者:生育一位唇顎裂子女的可能性為一比四。



流行病學

  • 一般而言,兔唇併顎裂者以男性居多且畸型較為嚴重﹐單純顎裂,以女性較多。人種方面,以東方人最多,白人次之,黑人較少。


Racial differences cleft lip with or without cleft palate at birth cl clp
Racial Differences: Cleft lip with or without cleft palate at birth (CL, CLP)

  • Racial group In 1,000 live births

    • Native Americans 3.6

    • Japanese 2.1

    • Chinese 1.7

    • Whites 1.0

    • Blacks 0.3


分類的方法

  • 常口裂侵犯之區域為上唇(upper lip),齒槽脊(alveolar ridge),硬顎(hard palate)及軟顎(soft palate),較有用之分類法是以正常鼻顎管(nasopalatal cannal)之位置分出包括唇部及齒槽脊在內的原始顎(primary palate)及包括硬顎及軟顎在內的次生顎(secondary palate)。


分類的方法

  • Cleft Lip:

    • incomplete, complete (reached the base of nose), unilateral, bilateral

  • Cleft Palate:

    • primary, secondary, combined, incomplete, complete (cleft hard palate + cleft soft palate + cleft uvula), unilateral, bilateral


Cleft Lip

Unilateral (R) complete cleft lip and palate

Bilateral incomplete cleft lip


Team work
Team work

  • 小兒科、外科、兒童牙科、齒顎矯正科、齒科贗復等科專家及言語治療家,除了臨床陣容外社工人員及公共衛生護士亦有很多的貢獻,某些較特殊的問題還須要請神科大夫及內科專家才能解決


Clinical Features of Typical Clefts: CL, CLP, CP

Physical examination

a. Extra-oral examination

b. Intra-oral examination

1. Craniofacial:

Orbital

Auricular

Nasal

Oral

Dental

Pharyngeal

2. Neck:

3. Heart:

8 weeks old; complete left cleft lip and palate with collapsed left nasal alar base


牙齒問題

  • 唇顎裂患者的咬合不正,主要來自上頷骨發育不足及齒列不正。上頷骨的發育不足來自先天性的缺陷及手術修補,以致上下齒弓位置不吻合,而有前齒及/或後齒倒咬的現象。


顎裂患者為什麼耳朵會有問題?

  • 從耳朵內的中耳到咽喉,有一條通道叫歐氏管。歐氏管可以讓中耳的分泌物引流到咽喉中,也可將空氣導入封閉的中耳腔內,維持鼓膜內外二側的壓力平衡。顎裂患者的上顎有缺陷,軟顎的肌肉分佈不正常,使得歐氏管的功能失常,所以經常有中耳積水(又稱為漿液性中耳炎)的問題產生。根據統計,一歲左右的顎裂患者,中耳積水的比例高達95%,是常見的併發症。

  • 中耳積水的症狀主要有聽力減退或耳內有腫脹感。


唇顎裂孩子的語言發展

  • 說話要清楚,需要有正常的發音器官。就唇顎裂兒童而言,顎咽閉鎖(顎蓋板)功能與聽力是決定發音的重要因素。

  • 孩子的語言能力的發展因人而異。因為語言能力的發展牽涉範圍相當廣泛,所以父母必須先認識語言,再瞭解其影響因素及預防保健策略。



唇顎裂的重建手術

  • 唇裂修補及鼻部整形

  • 顎裂修補

  • 牙床植骨


唇裂修補及鼻部整形

  • 患兒將在四個月左右接受唇裂修補手術。若裂隙太大,則手術須分二次完成(初次手術將唇部縫合一部分,幫助裂隙變窄,約六個月以後再做正式的唇修補術),或是再配合牙科矯正,等到約六個月大時才接受手術。唇裂修補同時也施行鼻部的重建,術後上唇及鼻形都會有很大的改善。


顎裂修補手術

  • 顎裂修補的時機約在九到十五個月之間,以硬、軟顎一次修補為原則。約九成的患者在接受一次手術後,即可擁有良好的軟顎功能。多數患者在這次手術需配合耳鼻喉科的診斷,同時清除中耳積水及放置中耳通氣管。


牙床植骨

  • 若唇顎裂影響到齒槽骨,大部份患者需在九到十一歲之間接受牙床的骨移植手術。此手術可以提供裂隙二側牙齒的骨骼支持,幫助牙齒的矯正,改善患側鼻孔底部的塌陷及封閉牙床處殘餘的裂隙,在美觀及功能上皆極為重要。


A

B

C

D

Alveolar Cleft Bone Grafting

Timing: 6-9 years old

http://cudental.creighton.edu/images/ank&cp.jpg

Serial occlusal radiographs of the cleft area of a child from the grafted group. A. after orthopedic arch alignment prior to bone grafting; B. immediately after insertion of bone graft; C. & D. slow progressive resorption of the bone graft. Arrow points to the alveolar cleft and the bone grafted area.



ad