COMPREHENSIVE MANAGEMENT FOR CHILDRENS WITH CLEFT LIP - PALATE at Children Hospital 1 HCMC - VIETNAM
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1 COMPREHENSIVE MANAGEMENT FOR CHILDRENS WITH CLEFT LIP - PALATE at Children Hospital 1 HCMC - VIETNAM DR. NGUYEN VAN DAU, Ph.D. DR. HO VAN PHUNG Odonto Maxillofacial Surgery Department
2 TABLE OF CONTENTS OBJECTS INTRODUCTIONS CONTENTS CONCLUSIONS
3 ABBREVIATIONS CL: Cleft lip CP: Cleft Palate OH: Obstetric Hospital PH: Pediatric Hospital GH: General Hospital CT: Comprehensive Treatment OPH: Obstetric- Pediatric Hospital OMFH: Odonto - MaxilloFacial Hospital PNAM: Pre-surgical Nasal-Alveolar Molding CCHH: Central Children Hospital of Hanoi
4 INTRODUCTIONS SITUATION OF CLEFT LIP PALATE DISEASE AT VIETNAM EPIDEMIOLOGY - Birth incidence of cleft 1: (CHC Hanoi) China: 1/555; Japan: 1/600, World: 1/ millions newborn 3,000 new cleft cases/ years TREATMENT - Primary correction (Closure Cleft) - Did not receive approriate protocol/ proper age - Problems on Cosmetic, function, Psychology PATIENTS NEED COMPREHENSIVE TREATMENT HOSPITALS TEAMS * Operated Practical Place: - PH, OMFH, GH of cities or provinces. - Mobile surgery Team (VN & oversea countries) * On recent years, appearing Obstetric- Pediatric Hospital VIETNAM CONDITION WHAT S KIND OF MODEL OF CT IN VIETNAM ROLES? COLLABORATION?
5 COMPREHENSIVE TREATMENT FOR CLEFT CHILDREN AT CHILDREN HOSPITAL 1 From
6 INTRODUCTIONS CHILDREN HOSPITAL No 1 - HCMC - Referal hospital in the Southern Region - 40 specialized units Approriated for CT - 7,000 cases / 10 years carried out CT - Now, 1,000 cleft cases repaied /year 95% Cleft childrens with good health CLEFT S TEAM 5% Cranial Facial Deformity Syndroms Adding Other General Diseases SPECIAL CLEFT S TEAM
7 THE CAUSES OF CLEFT LIP & PALATE ( Source: Children Hospital 1) GENETIC CAUSES: 15% ENVIRONMENTAL CAUSES: 65 % NOT FINDING THE CAUSE: 20%
8 THE CAUSES OF CLEFT LIP & PALATE GENETIC CAUSES ( Source: Children Hospital 1)
9 THE CAUSES OF CLEFT LIP & PALATE ENVIRONMENTAL CAUSES The mothers contact with the Agents Which cause Genetic mutation (8-12 weeks) Diseases: Rubella, Flu, Mumps, Diabet, Arthritis, Pregnancy Polyhydramnios Medication: Antibiotic: Amoxicillin, Oxytetracyclin Sedative: Phenoparbital Antihypertensive: Oxprenolol Anti seizure: Phenyltoin, Carbamazepin, Dilantyl, Trimethadion) Antalgic drugs, Antipyretics, Anti imflamation: (Aspirin, ibupropen) Cancer: Methotrexate, Urethan Acnes: Accutane Drugs affect behavior: Cocain, Heroin
10 THE CAUSE OF CLEFT LIP & PALATE ENVIRONMENTAL CAUSES (continue) Chemicals agent: Tobaco, wine, Insecticide, Dioxin. Physical agent: X Ray, Radiation, Degree, High Attitude, Lead contact. Waste matter: air, hard. Nutrition: Diet, obesity Lack of substance (Acid Folic, vitamin B6, B12, zn) Pregnancy age: so young, so old. Stress: economy, family, sentiment
11 WHY S THE CLEFTS CHILD HAVE TO BE COMPREHENSIVE TREATMENT?
12 INTRODUCTIONS PAST PERCEPTION OF CLEFT TREATMENT - Close the clefts only - Popular in Vietnam RESULTS: - face malformation - Hearing problem - Speech impediment - Psychological dissorder afffect to quality of life and future of children
13 FACE S MALFORMATIONS THE RESULTS OF CLEFT TREATMENT FOLLOW OLD PERCEPTION ( Source: Children Hospital 1) Tử tù THỌ SỨT
14 INTRODUCTIONS NEW PERCEPTION: COMPREHENSIVE TREATMENT World: Long time + Continuing treatment process Cleft team: including many specialist Children Hospital 1: - Collaboration of specialities hospitals - Social supports - Child s parents
15 CO-OPERATION ON COMPREHENSIVE TREATMENT AT CHILDREN HOSPITAL 1 PUBLIC SPECIALITY HOPITALS CLEFT S CHILDREN SUPPORTED SOCIETIES FAMILIES
16 CO-OPERATION ON COMPREHENSIVE TREATMENT AT CHILDREN HOSPITAL 1 CHILDREN HOPITALS 1 CLEFT S TEAM (Specialists) FAMILIES Economy Knowledge Child care Skills CLEFT CHILDREN LOCAL Authority, Union Health (Service, station) Schools ÍFINANCE Health Insurance Charity Organization Sponsor INFORMATION Newspapers Broadcast Television PARENT CLUB Sharing experience Sympathize Encourage
17 WHEN WHAT WHO WHERE Foetus COMPREHENSIVE TREATMENT PROTOCOL AT CHILDREN HOSPITAL 1 Adults
18 COMPREHENSIVE TREATMENT PROTOCOL FOR CLEFT S CHILDRENS AGE TREATMENT TEAM MEMBERS PLACE Pre Natal Prenatal Imaging Diagnosis Cause factors Genetic Counseling Psychologic Parents Ultrasoud doctor Obstetrician Genetist OMF doctor OBSTETRIC HOSPITAL Newborn 3 months Feeding PNAM Nutrition Detect & Manage associated anomalies OMF doctor Orthodontist Nutritionist Pediatrician PEDIATRIC HOSPITAL OMF HOSPITAL
19 COMPREHENSIVE TREATMENT PROTOCOL FOR CLEFT S CHILDREN AGE TREATMENT TEAM MEMBERS PLACE 3 months - 6 months 12 months - 18 months Unilateral cleft repair Bilateral cleft repair Cleft Palate repair MaxilloFacial surgeon Plastic surgeon Anesthegiologist PEDIAT. HOSPITAL O.M.F. HOSPITAL GENERAL HOSPITAL
20 COMPREHENSIVE TREATMENT PROTOCOL FOR CLEFT S CHILDREN AGE TREATMENT TEAM MEMBERS PLACE 2 years 5 years 6 years Dental care Hearing Speech & Language Therapy Refine lip nose scare Psychology school age Pedodontic doctor Otolaryngologist Speech Pathologist DMF surgeon Psychologist PEDIAT. HOSPITAL O.M.F. HOSPITAL GENERAL HOSPITAL
21 COMPREHENSIVE TREATMENT PROTOCOL FOR CLEFT CHILDREN AGE TREATMENT TEAM MEMBERS PLACE 7 years 11 years Primary orthodontic treatment Early alveolar bone graft Orthodontist DMF surgeon PEDIAT. HOSPITAL O.M.F. HOSPITAL 12 years 15 years Secondary orthodontic treatment Late alveolar bone graft Psychology Puberty age Orthodontist DMF surgeon Psychologist GENERAL HOSPITAL
22 COMPREHENSIVE TREATMENT PROTOCOL FOR CLEFT CHILDREN AGE TREATMENT TEAM MEMBERS PLACE 16 years Adults ORTHOGNATHIC SURGERY NASAL PLASTIC SURGERY O.M.F DOCTOR PLASTIC RURGEON O.M.F. HOSPITAL
23 PRENATAL ECHOGRAM DIAGNOSIS 20 weeks
24 THE PROCESS FROM PRENATAL COUNSELING TO CLEFT LIP REPAIR
25 ABORTION CASES ( Source: Children Hospital 1) S.O.S Ultrasound doctors should not solely advise abortion.
26 PICTURES OF NEONATAL CLEFT CHILDREN ( Source: Children Hospital 1)
27 CLINICAL CHARACTERISTICS OF CL & CP (Source: Children Hospital 1)
28 Unilateral cleft lip closure Standards: - 10 weeks - Weigh > 5kg - Hct> 30% - Hb > 10mg/ml ( Source: Children Hospital 1)
29 BILATERAL CLEFT LIP CLOSURE Standard: - 20 week - Weigh > 6 kg - Hct> 30% - Hb > 10mg/ml ( Source: Children Hospital 1)
30 CLEFT PALATE CLOSURE 1 3 Standards: months - Weighs > 10kg - Hct> 30% - Hb > 10mg/ml 2 4
31 2 5 years old Hearing checcking Speech & language training Tooth treatment
32 5 6 years old Revised Scare School psychology
33 9-10 years old: BONE GRAFT
34 12-15 YEARS OLDS ORTHODONTIC TREATMENT
35 POST OPERATION CASESE
36 POST OPERATION CASESE
37 ESPECIAL CLEFT CASES CL/CP WITH CRANIAL - FACIAL DEFORMITIES (Source: Children Hospital)
38 Case report: 1 month age Neonatal child with: - Complex deformities - Eye s tumor 1 year old - Remove the tumor - Close the face s cleft - Skin graft low eyelids
39 Case report 1 year old 2 years old Closure clefts 12 years old Setting Artificial Eye
40 Case report Lower down nose 3 months 6 months after surgery 27 months Close two side face clefts Preparing for Close lip cleft eyelid skin graft
41 Case report: Cleft lip & Face deformities After 14 year Comprehensive treatment From 4 months Nowaday, 14 years old Close the Cleft lip + philtrum C a s e r e p o r t : 6 years, go to school 5 years old Lower down nose Close eye inner corner Reconstructive Ala Eyelid skin graft Nasal cartilage graft
42 CONCLUSIONS - Cleft Lip Cleft Palate Affect to cosmetic, functions, psychology, general health High number cases, Long time for treatment, High cost children Future, Families, Society COMPREHENSIVE TREATMENT - After 10 years, PH has been CT for 7,000 cases - VIETNAM CT MODEL: COLLABORATION Health servives, Social agencies, Families - HOSPITAL OPH: continuing management, from prenatal to 16 years old CLEFT TEAM, OMF speciality is chief leader OMFH, GH: Cleft child > 16 years old High technique treatment
43 HAPPY FAMILY
44 Speech Therapist Pedodontist Psychologist Obstetrician Otolaryngologist Orthodontist
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