用大体标本测量研究唇裂修复时上颌软组织潜行分离对上颌骨发育的影响

目的：通过大体标本测量，研究兔上颌骨的发育情况，旨在了解唇裂修复时上颌软组织潜行分离是否影响上颌骨的发育。方法：25只七周龄日本大耳白兔随机平均分为五组，每组5只，除第一组外，其余各组通过手术造成人工单侧唇裂，齿槽突裂和腭裂模型，第三、四、五组采用不同的方法修复唇型。结果：第四、五组左侧颌骨的长度比其它组短，结论：唇裂手术中行上颌软组织广泛潜行分离将影响上颌骨的发育，导致上颌发育障碍。     

唇裂修复术中上颌软组织潜行分离对上颌骨发育影响的实验研究

目的　应用 X线头颅侧位片测量和大体标本测量 ,观察兔上颌骨发育情况 ,了解上颌软组织潜行分离是否影响上颌骨发育。方法　日本大耳白兔 2 5只随机分为五组 ,每组各 5只。第一组作为对照组 ,以确定面部生长正常 (长度、角度 )值。第二组手术造成人工 (左侧 )单侧唇裂、齿槽突裂和腭裂模型 ,不作任何修复。第三组人工单侧唇腭裂模型 ,仅采取直线缝合法修复唇裂。第四组唇腭裂模型 ,以直线缝合法修复唇裂 ,但在缝合之前对左侧上颌骨行广泛软组织潜行分离。第五组修复唇裂方法 ,并对整个上颌骨软组织作潜行分离。结果　第四、五组 SNA角明显小于第一、二、三组 ;第一、二、三组之间相差较小。鼻根点至上齿槽座点的距离 ,第四、五组比其它三组短 ;上颌骨前后经 ,第四、五组左侧的长度也比其它三组短 ,而宽度则较宽。结论　唇裂手术中行上颌软组织广泛潜行分离将影响上颌骨发育 ,导致上颌骨发育障碍     

唇裂修复时上颌软组织潜行分离对面部发育影响的实验研究

唇裂手术中,常在前庭沟作松弛切口,并潜行分离上颌软组织,以便使唇裂易于缝合。这样做是否影响面中部的发育,目前颇有争论。许多医生不管唇裂裂隙宽度如何,都予以采用。Miland强调,在部分唇裂也应和完全唇裂一样作广泛的软组织潜行分离。Walker等则提出相反意见,认为这种操作可引起颌面部继发性发育畸形。为了探讨这个问题,作者设计了如下实验研究。将60只家兔分为4组,每组15只。第一组不作手术用作对照,第二组通过手术造成     

Millard法修复唇裂对上颌骨生长发育影响的 动物实验研究

目的：探讨Ｍｉｌａｒｄ法修复唇裂对上颌骨生长发育的影响。方法：本研究将３０只（３０天龄）日本纯种幼兔随机分成正常对照组（１０只）、人工造裂组（１０只）和Ｍｉｌａｒｄ法修补裂组（１０只）。术后２０周（３０周龄）处死全部动物并行头颅测量。结果：Ｍｉｌａｒｄ法修复唇裂后上颌骨的前后向较造裂组及正常对照组生长发育受限，同时上颌高度、后牙弓宽度及面后份宽呈代偿性增长，鼻中隔向裂隙侧偏曲。结论：Ｍｉｌａｒｄ法修复唇裂有抑制上颌骨生长的作用。     

两种常用唇裂修复术对上颌骨生长发育影响的对比研究

目的　为了客观全面地评价当今常用两种唇裂修复方法对上颌骨生长发育影响的异同。方法　实验采用 40只 (30天龄 )纯种日本长耳白兔 ,随机分成正常对照组 (10只 ) ,造裂组 (10只 ) ,Millard法修补唇裂组 (10只 ) ,Tennison法修补唇裂组 (10只 ) ,术后 2 6周 (30周龄 )处死全部动物 ,行头颅测量。结果　两种手术方法均可造成上颌骨较正常对照组和造裂组明显的上颌骨生长抑制 ,Tennison法又较 Millard法会引起更明显的上颌骨生长发育受限 ,两种方法对上颌骨生长发育影响差异的主要原因是术后上唇组织移动规律的不同所致。结论　 Millard法与 Tennison法修复唇裂对上颌骨生长发育的影响程度不同     

完全性唇腭裂婴儿期唇腭裂手术对上颌骨发育的近期影响

目的:观察婴儿早期行唇腭裂手术对完全性唇腭裂患儿上颌骨发育的近期影响.方法: 35 例完全性唇腭裂患儿分为2 组,婴儿期接受唇腭裂手术的20 例为唇腭裂一期修复组,随访时平均年龄(9.99± 0.84) 岁;15 例于婴儿期行唇裂手术未接受腭裂修复的为单纯唇裂修复组,随访时平均年龄(10.24± 1.14) 岁;另20 名无先天性唇腭裂的10 岁龄学童作为正常对照组;3 组分别取头颅侧位片与上牙颌模型,进行测量分析.结果: 2 组唇腭裂患儿之间的上颌骨发育无明显差异,与正常对照组相比较,均有生长抑制.结论:婴儿期行唇腭裂手术的完全性唇腭裂患儿在10 岁左右上颌骨发育与正常儿童存在明显差异,腭裂手术不是引起差异的主要原因,可早期完成该手术.     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

唇腭裂手术对上颌骨矢状向生长发育影响的研究

目的：研究唇腭裂手术对单侧完全性唇腭裂患者上颌骨矢状向生长发育的影响。方法：混合牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者18例;16岁以上恒牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者15例。所有患者均拍摄头颅定位侧位片,测量分析矢状方向的线距和角度;分别以相应年龄段的非唇腭裂正常者作为对照,采用SPSS11.0软件包对数据进行单因素方差分析（ANOVA）。结果：混合牙列期单侧完全性唇腭裂仅修复唇裂患者表现为上颌长度缩短,而唇腭裂术后患者除上颌长度的缩短外,还存在上颌位置后缩;16岁以上恒牙列单侧完全性唇腭裂仅修复唇裂患者主要表现为上颌位置后缩,存在明显Ⅲ类倾向,术后患者上颌位置后缩外,上颌长度也缩短。结论：唇裂手术及早期腭裂手术对上颌骨矢状向生长可能有干扰作用。     

Millard法修复唇裂对上颌骨生长发育影响的动物实验研究

目的 探讨Ｍｉｌｌａｒｄ法修昨唇裂对上颌骨生长发育的影响。方法 本研究将３０只（３０天龄）日本纯种幼兔随机分成正常对照组（１０只）人工造裂组（１０只）和Ｍｉｌｌａｒｄ法修补裂组（１０只）术后２０周（３０周龄）处死全部动物并行头颅测量,结果Ｍｉｌｌａｒｄ法修复唇裂后上颌骨的前后向较造裂组及正常对照组生长发育受限,同时上颌高度,后牙弓宽度及面后宽呈代偿性增长,鼻中隔向裂隙侧偏曲。结论：Ｍｉｌｌａｒｄ     

Reduction of midfacial periosteal perfusion failure by subperiosteal versus supraperiosteal dissection.

PURPOSE: Detachment of soft tissue is a prerequisite for cleft repair. Recent experimental studies have indicated that supraperiosteal rather than subperiosteal soft tissue detachment causes midfacial hypoplasia, although, the cause has not been clarified yet. We hypothesized that microcirculatory dysfunction may be responsible for hypoplasia development, and established in rabbits an experimental model to study the differences in nutritive perfusion of midfacial periosteum in dependency on the applied technique of soft tissue detachment. MATERIALS AND METHODS: In anesthetized New Zealand White rabbits a cranially broadly based rectangular soft tissue flap was intraorally circumcised on the anteromedial aspect of the maxilla. After either supraperiosteal or subperiosteal soft tissue detachment fluorescence microscopy allowed quantitative in vivo analysis of the nutritive perfusion of midfacial periosteum. RESULTS: Microscopic analysis of individually perfused capillaries showed that blood flow was comparable in supraperiosteally and subperiosteally dissected maxillary periosteum. Nonetheless, both dissection techniques were associated with a remarkable capillary perfusion failure. However, the functional capillary density, which indicates the number of perfused capillaries per tissue area and thus the overall quality of capillary perfusion, was found significantly ( P < .05) lower in supraperiosteally than in subperiosteally dissected periosteum. CONCLUSION: Using a new model for in vivo quantification of periosteal perfusion in the maxilla of rabbits, periosteal perfusion was found significantly more deteriorated after supraperiosteal compared with subperiosteal soft tissue detachment. The marked reduction of periosteal microcirculatory perfusion failure after subperiosteal soft tissue detachment may contribute to the clinically observed protection from manifestation of midfacial hypoplasia after cleft repair.     

唇裂术后上唇压力对上颌骨发育影响的有限元分析

目的:探讨唇裂术后上唇压力对上颌骨的影响及抑制机制.方法:利用ANSYS 17.0软件在腭裂上颌骨有限元模型上添加上唇软组织,赋予材料属性,形成含上唇的唇腭裂上颌骨三维有限元模型,对模型分组,施加上唇压力并进行受力分析.试验组:施加唇裂术后上唇压力,对照组:施加同龄正常儿童上唇压力.结果:试验组形变值大于对照组,在三维...     

Comparison of the effect of supraperiosteal versus subperiosteal dissection on the growing rabbit maxilla.

OBJECTIVE: To achieve closure of wide unilateral cleft lip repair without tension of the cleft lip margins, a large undermining, especially of the anterolateral surface of the maxilla, is needed. Two types of dissection are feasible: supraperiosteal or subperiosteal. The aim of this study was to investigate whether there are differences in maxillary growth between healthy rabbits after supraperiosteal or subperiosteal dissection. METHODS: Twenty-four male 7-week-old New Zealand white rabbits were divided randomly into three groups: eight control animals (untreated); eight animals undergoing supraperiosteal dissection of the left surface of the maxilla, and eight animals undergoing subperiosteal dissection of the left surface of the maxilla. All of the treated animals were operated on by the same surgeon at age of 7 weeks and sacrificed at 27 weeks together with control group animals. Seven cephalometric measures (representing aspects of maxillary length, width, and height), on the left side, were taken on the cleaned skull of the rabbits, and the results were analyzed statistically. RESULTS: No significant differences in maxillary growth were noted across the three study groups. CONCLUSIONS: The supraperiosteal or subperiosteal undermining of the anterolateral surface of the maxilla does not seem to interfere with the growth of the normal maxilla in the rabbit.     

Facial anthropometry in cleft patients: a historical appraisal.

OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.     

成年女性未手术不全腭裂患者颌面部软组织形态学研究

目的：通过对成年后未接受手术治疗的女性不全腭裂患者颌面部软组织形态的测量、分析,研究此类畸形对颌面部软组织发育的影响。方法：收集具有完整临床资料的湖北籍不全腭裂女性患者10例。采用颌面部软组织X线头影测量方法,对软组织侧貌进行测量,参考湖北地区女性正常牙合成人颅颌面软组织结构参数,以t检验进行统计学分析。结果：不全腭裂患者的上、下面高比例基本协调,上唇长度和厚度的均值比正常值略小,下唇厚度和突度的均值比正常值略大,但均无显著性差异。结论：不全腭裂对颌面部软组织发育的影响比较小。     

Importance of soft tissue for skeletal stability in maxillary advancement in patients with cleft lip and palate.

OBJECTIVE: Assessment of stability of the advanced maxilla after two-jaw surgery and Le Fort I osteotomy in patients with cleft palate based on soft tissue planning. SUBJECTS: Between 1995 and 1998, 15 patients with cleft lip and palate deformities underwent advancement of a retruded maxilla, without insertion of additional bone grafts. Eleven patients had bimaxillary osteotomies and four patients only a Le Fort I osteotomy. Relapse of the maxilla in horizontal and vertical dimensions was evaluated by cephalometric analysis after a clinical follow-up of at least 2 years. RESULTS: In the bimaxillary osteotomies, horizontal advancement was an average 4 mm at point A. After 2 years, there was an additional advancement of point A of an average of 0.7 mm. In the mandible, a relapse of 0.8 mm was seen after an average setback of 3.9 mm. In the four patients with Le Fort I osteotomy, point A was advanced by 3.8 mm and the relapse after 2 years was 0.9 mm. Vertical elongation at point A resulted in relapse in both groups. Impaction of the maxilla led to further impaction as well. CONCLUSION: Cephalometric soft tissue analysis demonstrates the need for a two-jaw surgery, not only in severe maxillary hypoplasia. Alteration of soft tissue to functional harmony and three-dimensional correction of the maxillomandibular complex are easier to perform in a two-jaw procedure. It results in a more stable horizontal skeletal position of the maxilla.     

可吸收医用生物膜修复硬腭裂隙的临床应用

目的　探讨使用可吸收医用膜修复硬腭裂隙的可行性及评价其近期临床效果。方法　68例腭裂患者随机分为实验组和对照组。实验组34例患者在软腭及悬雍垂裂修复的同时剖开硬腭裂隙,植入可吸收医用膜修复; 对照组34例采用常规腭裂修复术。结果　实验组所有患者其软腭及悬雍垂创口愈合良好,无穿孔与裂开;硬腭部创口一期愈合30例,二期愈合3例,1例遗留永久性的口鼻瘘,3例存在口腔前庭瘘。与对照组相比较,其出血量及口腔前庭瘘发生率减少,手术时间无明显延长,术后出血、呼吸困难等并发症无明显增加;术后体温多波动在 37·5℃以下,且逐渐降低,7 d后复查血常规与对照组相比无显著异常。结论　可吸收医用膜用于硬腭裂隙修复, 临床效果肯定且手术操作简单、可行,同时因避免了常规腭裂修复术时在硬腭部掀起粘骨膜瓣的缺点,可减少对颌骨发育的影响。     

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目的 探讨成年单侧完全性腭裂患者上颌骨发育情况。方法 选择2005年11月至2007年11月中国医科大学口腔医学院收治的16例未伴有唇裂的成年单侧完全性腭裂患者（腭裂组）,通过拍摄标准头颅定位X线片 ,测量相关头影指标,并同时与20名正常成人（正常组）的指标进行比较,评价其上颌骨在三维方向上的发育情况。结果 男性和女性研究群体中,上颌骨相对于颅底的位置关系以及上颌骨长度与颅底长度的比值、面中份的高度与全面高的比值、上颌宽距与上面宽的比值,腭裂组与正常组间差异均无统计学意义。结论 成年单侧完全性腭裂患者上颌骨的长度、高度和宽度的发育基本正常。