腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用

目的　探讨腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用。方法　采用腭帆提肌重建联合咽后壁瓣术,共修补47例先天性腭裂患者,其中单侧完全性腭裂21例,不完全性腭裂26例。结果　所有患者均一期愈合,未出现腭瘘,随诊1~3年,语音清晰度满意。结论　腭帆提肌重建联合咽后壁瓣术较好地恢复了腭帆提肌正常的解剖结构和位置,获得了良好的腭咽闭合,并有效地降低了术后腭瘘的发生率,是一种值得推荐的功能性腭裂修复方法。     

腭帆提肌止点后上推移术与传统腭裂整复术的比较

目的 :研究腭裂功能性整复术 ,提出一种新术式———腭帆提肌止点后上推移术。方法 :在腭帆提肌及相关肌肉尸体解剖基础上 ,应用腭帆提肌止点后上推移腭裂整复术实施 2 0例 ,术后应用鼻咽镜、语音分析进行腭咽闭合功能及语音评价 ,与传统术式进行对照研究。结果 :2 0例手术术后均一期愈合。鼻咽镜检查示全部病例腭咽肌肉运动良好 ,发音时达到完全腭咽闭合 ,语音均得到改善。结论 :腭帆提肌止点后上推移术使软腭充分向后上提拉完成腭咽闭合 ,较好地解决了传统术式术后存在腭咽闭合功能不全的问题 ,是一种较好的腭裂功能性修复方法     

腭帆提肌重建在腭裂整复术中的应用

目的：分析腭裂整复术中腭帆提肌重建的难点,总结腭帆提肌重建的手术经验。方法：对我科2007年4月至2008年4月住院的50例2.5～6岁腭裂患者,完全腭裂31例,不完全腭裂19例施行腭帆提肌重建手术。结果：1例手术后第5天发现硬、软腭交界处口腔黏膜有一0.4cm瘘口,术后12d出院时瘘口已基本闭合;其余患者均一期愈合。结论：腭帆提肌重建手术的关键是肌肉的充分解剖分离,手术中注意减少两侧吻合端的损伤和局部出血,最好能在手术显微镜下进行,以保证肌束的解剖分离和对位效果。     

Sommerlad腭帆提肌重建术修复腭裂临床体会

腭裂修复的目的是修复腭部的解剖形态．改善腭部的生理功能．重建良好的腭咽闭合,为正常吸吮、吞咽和语音、听力等生理功能恢复创造条件。sommerlad腭帆提肌重建术能恢复腭帆提肌的正常解剖位置．有助于充分发挥其生理功能．获得良好的腭咽闭合．本研究对181例腭裂患者用Sommerlad腭帆提肌重建术进行修复．获得了满意效果,现报道如下．     

应用提肌重建术修复腭裂的初步报告

腭裂修复的主要目的是重建腭咽闭合恢复语言功能。近年来,国外不少学者强调腭帆提肌对腭咽闭合的作用,主张通过手术恢复腭裂病人腭帆提肌的正常位置。这类手术属“功能性修复”,一般称为提肌重建术。     

腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用

目的：探讨腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用效果。方法：应用腭帆提肌重建联合腭咽环扎术修复较宽大腭裂26例,观察其修复腭裂后的伤口愈合和语音恢复效果。结果：术后均一期愈合,无复裂和瘘发生。随访16例患者,其鼻漏气得到有效控制,语音清晰度状况优良。结论：腭帆提肌重建联合腭咽环扎修复术可较好的恢复腭部的形态和腭咽功能,具有方法简单、创伤小和效果好的特点。     

颊肌黏膜瓣在腭裂术后硬腭穿孔修补术中的临床应用

目的　研究颊肌黏膜瓣在腭裂术后硬腭穿孔修补术中的可行性及临床应用。方法　10例6～13岁唇腭裂患者腭裂术后并发硬腭部穿孔及前庭瘘,穿孔大小约5～10mm×8～15mm ,手术方法:将硬腭前分穿孔周边偏口腔侧切开达骨面,在口腔侧向鼻腔侧翻瓣,鼻腔侧黏膜作内翻缝合。制作同侧颊肌黏膜组织瓣并将瓣旋转绕过牙槽裂达腭侧与口腔侧黏骨膜对位褥式加间断缝合,碘仿纱布加压固定,术后10d拆线,无需断蒂。结果　所有病例伤口均一期愈合,组织瓣血供良好,未出现复裂。结论　应用颊肌黏膜瓣修补腭裂术后硬腭前分穿孔能达到良好效果,该组织瓣血供丰富,可操作性强,为修补腭裂术后穿孔提供一种有效的方法。     

联合应用Sommerlad与Furlow术式治疗腭咽闭合不全

目的基于Sommerlad腭帆提肌重建和Furlow反向双"Z"两种术式的优缺点,探讨联合两种术式的改良设计治疗腭咽闭合不全的可行性和有效性。方法对腭裂修复术后确诊腭咽闭合不全的患者,采用Sommerlas术式重建腭帆提肌,恢复肌肉功能的同时,采用Furlow术式延长软腭,重建腭咽闭合生理功能的解剖学结构。术后3个月经鼻咽纤维镜检查评估腭咽闭合功能。结果改良的联合术式设计可明显提高腭咽闭合不全患者的腭咽闭合率。结论将2种不同术式联合应用,有很强的可行性和可操作性,组织精细解剖复位和准确可靠的缝合技术是确保该术式成功实施的关键。可用于腭裂术后继发腭咽闭合不全的治疗。     

“T”型颊粘膜肌瓣修补腭裂的方法

腭裂修补的主要目的是关闭裂隙,增加软腭长度,重建腭帆提肌,以获得正常的语言效果。同时,尽量减少手术创伤,以免术后影响颌骨发育。使用硬腭粘骨膜瓣后推增加软腭长度,这在鼻腔粘膜延长上是不够的。有时还可形成瘘。另外,由于广泛分离了粘骨膜,故对颌骨发育影响较大。为了解决上述问题,作者应用“T”型颊粘膜肌瓣修补腭裂,效果良好。     

改良腭咽肌瓣重建腭裂术后腭咽闭合功能的临床研究

目的:研究改良腭咽肌瓣重建腭咽闭合功能治疗中的应用。方法:对25例腭裂术后腭咽闭合不全的患者实施改良的腭咽肌组织瓣转移术。结果:手术效果好,高位形成新的咽环,腭咽肌瓣同软腭协同作用完成腭咽闭合。鼻音计检测鼻音化率明显降低,语音功能改善。结论:改良腭咽肌组织瓣转移术用于治疗腭裂术后腭咽闭合功能不全,具有创伤小,手术时间短,并发症较少,手术效果稳定可靠。     

Sommerlad腭帆提肌重建术修复腭裂后腭咽结构特征的分析

目的 分析Sommerlad腭帆提肌重建术后腭咽闭合完全患者生长发育期腭咽结构特征与腭咽功能之间的关系。方法 对18例Sommerlad腭帆提肌重建术修复不完全性腭裂术后腭咽闭合完全患者（T1组）、14例Langenbeck法修复不完全性腭裂术后腭咽闭合不全患者（T2组）及正常人13例（对照组）进行鼻咽纤维镜检测和X线头颅侧位片分析,比较3组间腭咽闭合度、软腭长度、咽腔深度、Adequate ratio（软腭长度/咽腔深度）的差异,分析软腭与咽后壁接触点PPW在腭咽三角的位置关系。结果 T1组18例患者腭咽闭合完全;T2组有7例患者腭咽闭合度达到70%,5例为50%~70%,2例在50%以下。T1组软腭长度、Adequate ratio与对照组无明显差异（P>0.05）,腭咽结构图与对照组相似。T2组软腭长度和Adequate ratio分别为（22.9±2.3） mm、0.95±0.14,均小于T1组[（25.7±2.3） mm、1.43±0.26]及对照组[（29.9±2.7） mm、1.45±0.26],其差异有统计学意义（P<0.05）;PPW点在腭咽三角的位置相对于对照组偏上。结论 Sommerlad腭帆提肌重建术后腭咽闭合完全患者的腭咽结构与正常人相似;Langenbeck法修复术后腭咽闭合不全患者表现为咽腔过深,Adequate ratio值小于1.0,整个腭咽三角呈逆时针偏转上移的特征。     

腭裂整复术后腭帆提肌运动能力的观察

目的 观察腭裂及单纯唇裂患者在不同语音状态下腭帆提肌伸缩能力和倾斜角度的差异.方法 使用MRI拍摄3组研究对象:①单纯唇裂组(对照组)8例;②腭裂术后腭咽闭合功能不全组(velopharyngeal incompetence,VPI组)7例;③腭裂术后腭咽闭合功能完全组(velopharyngeal competence,VPC组)l0例,在静止位以及发"a"、"i"、"m"音时腭帆提肌的影像,并分析各图像中腭帆提肌垂直段的长度以及相对于面中份矢状面角度变化.结果 3组儿童随发"a"、"i"、"m"音,腭帆提肌垂直段的长度收缩率依次为[(13.5±11.7)%、(11.1±10.8)%、(8. 2±14.3)%];随发"a"、"i"、"m"音,相对于面中份矢状面角度依次变小[(43.18±4.984)°、(43.08±4.879)°、(39.48±5.046)°];3组研究对象发音时腭帆提肌长度和角度的变化差异无统计学意义(P＞0.05).结论 腭裂患者术后腭帆提肌的运动能力与单纯唇裂患者基本相同.     

Long-term outcome analysis of two treatment methods for cleft palate: combined levator retropositioning and pharyngeal flap versus double-opposing Z-plasty.

OBJECTIVE: Two surgical techniques for repair of a cleft palate include levator retropositioning in combination with a pharyngeal flap and the Furlow double-opposing Z-plasty. This study compared morbidity and speech results from the use of these two methods in an effort to determine which was the superior technique. DESIGN: Patient records from 1986 to 1996 were retrospectively reviewed, and 10 patients with a cleft palate who underwent repair with a levator retropositioning and pharyngeal flap were compared to 14 patients who underwent a double-opposing Z-plasty repair. Postoperative complications including fistula formation, obstructive sleep apnea, and residual velopharyngeal insufficiency were recorded. Speech was assessed perceptually and through the use of nasometry. RESULTS: Both surgical techniques resulted in good speech in the majority of patients. Only two patients in the study, both in the Z-plasty group, had severe postoperative hypernasality. Two patients in the levator retropositioning and pharyngeal flap group developed severe postoperative obstructive sleep apnea, requiring additional surgery. CONCLUSION: The levator retropositioning and pharyngeal flap technique was successful in achieving good speech results, but it also caused more serious postoperative complications when compared to the double-opposing Z-plasty technique.     

Change in levator veli palatini muscle activity for patients with cleft palate in association with placement of a speech-aid prosthesis.

OBJECTIVE: The purpose of this study was to examine whether a speech-aid prosthesis normalizes the activity of the levator veli palatini muscle for patients with cleft palate who exhibit velopharyngeal incompetence. DESIGN: Each subject was instructed to produce repetitions of /mu/, /u/, /pu/, /su/, and /tsu/ and to blow with maximum possible effort. Electromyographic (EMG) activity of the levator veli palatini muscle was recorded with and without a hybrid speech-aid prosthesis in place. PARTICIPANTS: The participants were five patients with repaired cleft palate who were routinely wearing a hybrid speech-aid prosthesis. RESULTS: With the prosthesis in place, the mean value of levator activity changed positively in relation to oral air-pressure change during blowing. Differences in levator activity in relation to speech samples were similar to those in normal speakers. With the prosthesis in place, levator activity for speech tasks was less than 50% of the maximum levator activity for all subjects. The findings were similar to those reported previously for normal speakers. CONCLUSION: Placement of the prosthesis changed EMG activity levels of the levator veli palatini muscle to levels that are similar to normal speakers. It is possible that, with the increase in the differential levator activity between speech and a maximum force task, the velopharyngeal mechanism has a greater reserve capacity to maintain velopharyngeal closure compared with the no-prosthesis condition.     

Sommerlad腭帆提肌重建术后松弛切口情况的研究

目的研究Sommerlad腭帆提肌重建术后两侧松弛切口与裂隙程度之间的关系,探讨使用该术式时不做松弛切口的预测指标。方法选择176例腭裂患者为研究对象,其中不完全性腭裂患者81例,完全性腭裂患者95例（单侧完全性腭裂74例,双侧完全性腭裂21例）,均采用Sommerlad腭帆提肌重建术进行腭裂整复。测量其腭裂裂隙宽度（CPW）和上颌结节内侧宽度（IHW）,计算腭裂裂隙指数（CPI）,CPI=CPW/IHW;记录行松弛切口的例数,并测量术后松弛切口长度。比较不完全性腭裂和完全性腭裂在各指标上的差异,分析CPI与术后松弛切口之间的关系。结果81例不完全性腭裂患者中,45例（55.6%）未做松弛切口,36例（44.4%）行双侧5~30 mm的松弛切口,松弛切口长度为（12.7±10.0）mm;74例单侧完全性腭裂患者中,5例（6.8%）未做松弛切口,28例（37.8%）行单侧兰式松弛切口,41例（55.4%）行双侧兰式松弛切口;21例双侧完全性腭裂中,所有患者（100%）均行双侧兰式松弛切口。完全性腭裂的CPI与松弛切口长度之间无相关性（P>0.05）。不完全性腭裂的CPI与松弛切口长度之间存在相关性（r=0.776,P<0.01）,当CPI<0.31或CPW<12.7 mm时,可不做松弛切口。结论不完全性腭裂患者CPW<12.7 mm时,行Sommerlad腭帆提肌重建术修复时可尽量不做松弛切口,避免了硬腭骨面裸露对上颌生长抑制的影响。     

Magnetic resonance imaging of the levator veli palatini muscle in speakers with repaired cleft palate.

OBJECTIVE: To obtain detailed anatomic and physiologic information on the levator veli palatini muscle from MRI in individuals with repaired cleft palate and to compare the results with those from normal subjects reported by Ettema et al. (2002). DESIGN: Prospective study. SETTING: University-based hospital. PARTICIPANTS: Four men (ages 22 to 43 years) with repaired cleft lip and palate. MAIN OUTCOME MEASURES: Four quantitative measurements of the levator veli palatini muscle from rest position and dynamic speech magnetic resonance images were obtained: the distance between the origins of the muscle, angle of origin of the muscle, muscle length, and muscle thickness. RESULTS: The length and thickness of the levator veli palatini muscle varied among the subjects and were different from measurements obtained from normal subjects in a previous study. The distance between origin points, length, and thickness of the levator veli palatini muscle were smaller than those of the normal subjects. There were systematic changes of the levator veli palatini muscle, depending upon vowel and consonant types. Levator veli palatini muscle angle of origin and length became progressively smaller from rest, nasal consonants, low vowels, high vowels, and fricative consonants. These changes are consistent with those of the normal subjects. CONCLUSIONS: This study contributes to a better understanding of cleft palate anatomy in comparison with normal anatomy of the levator veli palatini muscle. The use of MRI shows promise as an important tool in the diagnosis and eventual aid to treatment decisions for individuals born with cleft palate.     

Effect of cleft palate repair on the susceptibility to contraction-induced injury of single permeabilized muscle fibers from congenitally-clefted goat palates.

OBJECTIVE: Despite cleft palate repair, velopharyngeal competence is not achieved in approximately 15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resistant type 1 fibers. As an initial step to determining the validity of this theory, we tested the hypothesis that, in most cases, repair induces the transformation to type 1 fibers, thus diminishing susceptibility to injury. INTERVENTIONS: Single permeabilized levator veli palatini muscle fibers were obtained from normal palates and nonrepaired congenitally-clefted palates of young (2 months old) and adult (14 to 15 months old) goats and from repaired palates of adult goats (8 months old). Repair was done at 2 months of age using a modified von Langenbeck technique. MAIN OUTCOME MEASURES: Fiber type was determined by contractile properties and susceptibility to injury was assessed by force deficit, the decrease in maximum force following a lengthening contraction protocol expressed as a percentage of initial force. RESULTS: For normal palates and cleft palates of young goats, the majority of the fibers were type 2 with force deficits of approximately 40%. Following repair, 80% of the fibers were type 1 with force deficits of 20% +/- 2%; these deficits were 45% of those for nonrepaired cleft palates of adult goats (p < .0001). CONCLUSION: The decrease in the percentage of type 2 fibers and susceptibility to injury may be important for the development of a functional levator veli palatini muscle postrepair.     

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目的探讨先天性腭裂患者的腭帆提肌肌纤维型组成和分布,借以了解先天性腭裂患者肌纤维特点。方法对2008年1月至2008年7月于青岛大学医学院附属医院口腔颌面外科就诊的先天性腭裂患者20名,取其腭帆提肌组织进行冰冻切片,采用肌球蛋白ATP酶组织化学染色法,对其进行肌纤维分型研究。结果先天性腭裂患者腭帆提肌经肌球蛋白ATP酶组织化学染色后可分出两种肌纤维型,其中Ⅰ型纤维占(26.4±3.1)%,Ⅱ型纤维占(73.6±6.3)%,两者比较差异具有统计学意义。结论先天性腭裂患者的腭帆提肌肌纤维以Ⅱ型纤维为主。