Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4442_Библиотеки_им_академика_М_И_Перельмана.pdf
256
Fig. 8.50 Case 1. A
5-year postoperative view
of the infant shown in
Fig.8.48 after undergoing
nasal repair using the VYZ
technique
Fig. 8.51 Case 2.
Preoperative view of a
3-month-old infant with
complete bilateral cleft lip
P. Rossell-Perry
8 Surgical Techniques forBilateral Cleft Lip Nose Repair
Fig. 8.52 Case 2. A
1-year postoperative view
of the infant shown in
Fig.8.51 after undergoing
nasal repair using the VYZ
technique without
presurgical orthopedics
(frontal view)
Fig. 8.53 Case 2. A
1-year postoperative view
of the infant shown in
Fig.8.51 after undergoing
nasal repair using the VYZ
technique (worm eye view)
257
258
Fig. 8.54 Case 3.
Preoperative view of a
3-month-old infant with
complete bilateral cleft lip
Fig. 8.55 Case 3. 1-year
postoperative view of the
infant shown in Fig.8.54
after undergoing nasal
repair using the VYZ
technique without
presurgical orthopedics
(frontal view)
P. Rossell-Perry
8 Surgical Techniques forBilateral Cleft Lip Nose Repair
Fig. 8.56 Case 3. A
7-year postoperative view
of the infant shown in
Fig.8.54 after undergoing
nasal repair using the VYZ
technique (worm eye view)
259
Fig. 8.57 Case 3.
Preoperative view of a
3-month-old infant with
severe complete bilateral
cleft lip (premaxilla
position intraoral view)
260
Fig. 8.58 Case 3.
Postoperative view of the
infant shown in Fig.8.57
after undergoing bilateral
surgical lip adhesion
Fig. 8.59 Case 3. A
6-year-old postoperative
view of the infant shown in
Fig.8.57 after undergoing
nasal repair using the VYZ
technique (frontal view)
P. Rossell-Perry
8 Surgical Techniques forBilateral Cleft Lip Nose Repair
Fig. 8.60 Case 3. A
6-year postoperative view
of the infant shown in
Fig.8.57 after undergoing
nasal repair using the VYZ
technique with surgical lip
adhesion (worm eye view)
261
Surgical Treatment forCombined Bilateral Cleft Lip Nose
Bilateral cleft lip and associated nose deformity present in a wide spectrum including combination of complete or incomplete cleft lips and microforms. The lip and
nose deformity is frequently asymmetric requiring a different management for each
side. Commonly the degree of severity of the cleft lip correlates with the degree of
severity of the nasal deformity being the most severe the one associated with complete cleft lip and protruding premaxilla. This type of cleft lip is the most difcultto- achieve nose symmetry after the surgical repair because the “control side”
(observed in unilateral cleft lips) is not normal and each side requires different surgical treatments. Nasal symmetry is the primary guiding principle during bilateral
cleft lip and nose repair. Alternatives for primary cleft rhinoplasty in bilateral cleft
lips are presented in Table8.1 [11].
262
Cases (Figs.8.61, 8.62, 8.63, 8.64, 8.65, 8.66, 8.67 and8.68)
Table 8.1 Surgical protocol for repair of bilateral cleft lip nose
Type of
cleft lip
Complete Presurgical treatment+bilateral
Incomplete Complete side: VYZ technique
Microform Complete side: VYZ technique
Fig. 8.61 Case 1.
Preoperative view of a
3-month-old infant with
combined bilateral cleft lip
Complete Incomplete
Complete side: VYZ
VYZ technique in both sides
Incomplete side: rotational
composite ap technique
Microform side: nasal sill
lenticular excision
technique
Incomplete side:
rotational composite
ap technique
Rotational composite
ap technique in both
sides
Incomplete side:
Rotational composite
ap technique
Microform side: nasal
sill lenticular excision
Microform
Complete side: VYZ
technique
Microform side: nasal
sill lenticular excision
Incomplete side:
rotational composite
ap technique
Microform side: nasal
sill lenticular excision
Nasal sill lenticular
excision in both sides
P. Rossell-Perry
8 Surgical Techniques forBilateral Cleft Lip Nose Repair
Fig. 8.62 Case 1. A
1-year postoperative view
of the infant shown in
Fig.8.61 after undergoing
nasal repair using
combined techniques
Fig. 8.63 Case 1. A
10-year-old postoperative
view of the infant shown in
Fig.8.61 after undergoing
nasal repair using
combined techniques
(frontal view)
263
264
Fig. 8.64 Case 1. A 10
year-old postoperative
view of the infant shown in
Fig.8.61 after undergoing
nasal repair using
combined techniques
(worm eye view)
Fig. 8.65 Case 1.
Preoperative view of a
3-month-old infant with
combined bilateral cleft lip
P. Rossell-Perry
8 Surgical Techniques forBilateral Cleft Lip Nose Repair
Fig. 8.66 Case 1. A
1-year postoperative view
of the infant shown in
Fig.8.65 after undergoing
nasal repair using
combined techniques
Fig. 8.67 Case 1. A 7
year-old postoperative
view of the infant shown in
Fig.8.65 after undergoing
nasal repair using
combined techniques
(frontal view)
265