先天性腭裂患者术中凿断翼钩对语音及中耳功能的影响

目的：研究在腭裂修复术中，凿断翼钩对腭裂患者中耳及语音的影响。方法：复习133例腭裂手术患者的临床资料，所有患者均排除全身多发畸形及腭心面综合征；手术采用von Langenbeck方法90例，Veau两瓣法43例；术中凿断翼钩的67例，未凿断翼钩的66例。术后在颅颜中心和耳鼻喉科定期复查，进行语音评估和检查中耳有无感染、有无听力障碍。采用Statistica4．0进行统计学分析。结果：翼钩凿断的患者中．最早在11个月后出现中耳炎．最晚在76个月出现中耳炎，平均13．4个月；未凿断翼钩的患者中，最早在12个月出现中耳炎，最晚在120个月出现中耳炎，平均13．9个月。两者无显著差异（P〉0．05）。凿断翼钩有完整评估资料的44例患者中，平均随访51．7个月．其中腭咽闭合（VPC）36例，临界（M）5例，腭咽闭合不全（VPI）3例，分别占81．8％、11．4％和6．8％；未凿断翼钩的44例中，平均随访53．5个月，VPC32例，M8例，VPI4例，分别占77．3％、14．8和7．9％。两者无显著差异（P〉O．05）。结论：翼钩在腭裂手术中的凿断与否，与腭裂患者在术后出现中耳感染之间无显著相关性，与术后出现腭咽闭合不全的几率也无必然的联系。     

腭裂修复术中凿断翼钩对腭咽闭合功能影响的研究

本文应用Ｘ线检查方法,对８３例单侧腭裂术后患者进行了术中凿断翼钩是否影响患者术后腭咽闭合功能的研究。结果表明：（１）腭裂术中凿断翼钩后,患者鼻咽腔的横向收缩力明显减小;软腭抬高角度也有减小的趋势。（２）两大瓣术中凿断翼钩可使闭合条件明显提高,说明该手术方法如凿断翼钩有延长软腭的作用。     

翼钩凿断和板间切开对中耳功能的影响

目的:了解翼钩凿断和板间切开对中耳功能的影响。方法:对20只新西兰大耳白兔行翼钩凿断和板间切开后,观察腭腱膜及中耳腔粘膜的变化,以明确手术对中耳功能的影响。结果:翼钩组均出现腭帆张肌松弛,中耳腔粘膜杯状细胞明显增多;板间切开组无1例出现上述变化。结论:翼钩凿断不利于咽鼓管的开张,而板间切开影响较小,因而主张腭裂手术时应尽量不凿断翼钩以保持其解剖位置和功能。     

单瓣旋转推进腭裂修复术的临床作用

临床资料 1.分别选择单侧Ⅱ°、Ⅲ°,双侧Ⅲ°腭裂各2例,均为唇裂术后患者,其中2例裂隙宽大. 2.手术方法 2.1 按两瓣法常规作松弛切口,凿断翼钩,适当游离腭前神经血管束,掀起黏骨膜瓣(图1).     

完全性唇腭裂早期腭裂修复对上颌骨发育的影响研究

目的:观察完全性唇腭裂婴儿早期腭裂手术对上颌骨发育的影响.方法:35例完全性唇腭裂患儿分为两组,早期修复组20例,随访时平均年龄9.99±0.84岁.婴儿期未接受腭裂修复者为对照组15例,随访时平均年龄10.24±1.14岁.两组病例分别进行头颅侧位片与上颌牙颌模型测量分析.结果:两组患儿上颌骨及牙弓的测量数据显示差别无显著意义(p＞0.05).结论:完全性唇腭裂患儿早期行腭裂修复术对上颌骨发育不会产生明显影响,可早期进行腭裂手术,有利于患儿正常语音的发育.     

腭成形术对不同年龄腭裂上颌骨发育影响的研究

目的：研究不同年龄阶段腭裂成形术对患者术后上颌骨三维方向上发育的影响。方法：４０例腭裂术后患者按接受手术时的年龄分成３组，即小年龄组（２～５岁）；中年龄组（９～１１岁）；大年龄组（１５岁以上），分别与同年龄组未接受手术的患者（共３０例）进行了Ｘ线头影测量片及牙牙合模型测量的对比分析。结果：小年龄组接受手术，上颌骨发育长度及宽度均受限（Ｐ＜０．０５）。中年龄组接受手术，上颌骨宽度受影响（Ｐ＜０．０５），大年龄组手术，上颌骨各方向发育不受影响。结论：腭成形术对少年期上颌骨生长有明显抑制作用，手术年龄越小，影响程度越重。因此，改良手术方法和开展序列化治疗实属必要     

两种腭裂修复方式治疗过宽不完全腭裂的临床效果比较

目的:比较兰氏法和改良兰氏法修复过宽不完全腭裂的临床效果。方法:选取2012年1月~2014年12月于徐州医科大学附属徐州市立医院接受腭裂修复术的不完全腭裂患儿40例,年龄2~5岁,裂隙宽度均大于2.5 cm,按接受腭裂修复的不同方式分为2组,实验组:20例,行改良兰氏法(兰氏法联合颊肌黏膜瓣)修复腭裂,对照组:20例,行兰氏法修复腭裂。2017年1月~2019年9月(术后5~7年)进行随访,此时两组患者年龄7~9岁,平均年龄为8岁。分别观察两组患者术区恢复状态,应用锥形束CT(CBCT)观察比较上颌骨发育情况,使用头颅侧位片评价腭咽闭合功能,并且进行语音清晰度评估。结果:相比于对照组,实验组的患者恢复较好,术区瘢痕轻微,上颌骨发育好,腭咽闭合完全,语音清晰度高。结论:对于裂隙过宽的腭裂患者,使用联合颊黏膜瓣的兰氏法可有效避免裸露的骨面,减轻了瘢痕增生,有利于上颌骨发育,增进腭咽闭合,提高了语音清晰度是一种更为值得推广的腭裂新手术方法。     

腭裂术后患者牙颌结构测量分析

目的 探讨幼年接受腭裂手术患者牙颌结构的畸形特点，分析其发生机制。方法 对55例腭裂术后患者（手术年龄4－7岁，现年龄18－25岁）颌面部形态、牙齿及咬合关系进行临床检查及电子计算机X线头影测量，将测量值与正常人资料相比较。结果 腭裂修复术后患者上、下颌切牙突度比正常人显著减小，上颌骨长度比正常人显著缩短，下颌角变钝。结论 腭裂术后患者牙颌结构存在明显发育畸形，其形成机制十分复杂，上颌骨发育不足及畸形与手术有关，下颌部畸形多为代偿性变化。     

婴儿期腭裂手术对语音的影响

目的：评价婴儿期接受腭裂修复术患者的语音功能。方法：选择1周岁以内的腭裂患者60例行腭裂修复术，术后随访测定其语音功能情况、与大龄腭裂儿童乃至成人腭裂患者之间的差别。结果：婴儿期腭裂手术患者的术后语音功能明显优于大龄腭裂患者，基本接近于正常同龄儿童的语音。结论：一岁以内腭裂修复术有利于语音语言功能的发育。     

腭裂整复手术的基本理论与临床

一、腭咽闭合的生理基础腭帆提肌的解剖生理腭帆张肌与凿断翼钩的问题咽上缩肌与咽腔解剖派氏垫 ( Passavant ridge)的评价腭咽闭合过程中的生理代偿功能二、腭裂的修复手术1 .手术时间的选择——婴幼儿语言发育时期为一岁左右国际上序列治疗的时间 ,对腭裂修复术为 1 2 -1 8个月早期手术的优点 :1恢复语言功能2避免中耳感染 (十聋九哑 )3有利于软腭的生长发育早期手术的缺点 :手术创伤和腭部裸露的骨面形成的瘢痕 ,影响上颌骨发育导致牙颌畸形故有两期手术的治疗方式 ,兼顾上述优缺点早期——修复软腭手术期——修复硬腭2 .手术方法及其特…     

Bone-anchored maxillary protraction in patients with unilateral cleft lip and palate:: Is maxillary expansion mandatory?

ObjectivesTo assess the effectiveness of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate (UCLP) and whether it was enhanced when preceded by maxillary expansion.Materials and MethodsThe sample consisted of 28 growing children (9–13 years old) with UCLP and Class III malocclusion. They were divided into two equal groups. In group I, patients were treated with BAMP not preceded by maxillary expansion. In group II, patients were treated with BAMP preceded by maxillary expansion. To assess treatment changes in three dimensions, Cone-beam computed tomography images were taken 1 week after surgical placement of the miniplates (T1) and after 9 months of treatment (T2).ResultsBAMP produced forward movement of the maxilla in both groups (3.17 mm) and (3.37 mm) respectively, without significant differences between the two groups except for clockwise rotation of the palatal plane in group I (1.6⁰).ConclusionsBAMP is an effective treatment modality for correcting midface deficiency in patients with UCLP whether or not maxillary expansion was carried out.     

早期植骨修复腭裂对上颌骨生长影响的实验研究

目的:探讨大白鼠人造腭裂行早期自体骨移植修复对上颌骨生长发育的影响。方法:选取40只4周龄的雄性Wistar大白鼠,随机分为4组,即正常对照组、人造腭裂组、人造腭裂两瓣法修复组、人造腭裂自体骨移植加两瓣法修复组;每组10只。术后10周观察上颌骨的生长发育指标,应用SPSS软件进行统计学处理,再行组间方差分析。结果:上颌骨宽度指标、最大上颌骨长度指标(A-D)、上颌骨高度指标值,植骨修复组均显著小于正常组与人造腭裂组,有统计学意义(P﹤0.01)。两侧硬腭后份宽度指标,植骨修复组显著大于两瓣修复组,有统计学意义(P﹤0.01);其余多项指标,植骨修复组与两瓣修复组均无显著性差异(P﹥0.05),但上颌骨高度的3项指标和长度指标(AD)均值,植骨修复组均小于两瓣修复组。结论:人造腭裂行自体骨移植修复对上颌骨的横向生长有积极意义,但对上颌前后向、垂直向的生长发育较两瓣修复法有进一步受限的倾向。     

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。     

腭裂及其修复术后上颌骨生长变化规律及机制的实验研究

采用连续动态观察狗头颅侧位和上下位定位Ｘ线片的方法，观察比较了正常对照组、腭裂组、腭裂两瓣法修复组和全裂隙植骨修复组的上颌骨长、宽、高三维方向上的变化过程。结果显示：腭裂和腭裂修复术后的上颌骨自身增长率的显著性改变始于术后２－４周，在术后１８周结束，与正常对照组相比，前颌骨的运动轨迹亦不同，揭示鼻中隔软骨的生长方向和前颌骨对上颌骨生长力传导的异常改变可能是腭裂和腭裂修复术上颌骨生长畸形的主要原因。     

Factors related to relapse after Le Fort I maxillary advancement osteotomy in patients with cleft lip and palate.

OBJECTIVE: To identify factors associated with relapse after maxillary advancement in cleft lip and palate patient. SUBJECTS: Seventy-one cleft lip and palate patients underwent Le Fort I maxillary advancement osteotomy between 1988 and 1998, and 58 patients (42 unilateral cleft and 16 bilateral cleft) with complete data were investigated for relapse by clinical and cephalometric analysis. The clinical follow-up period ranged from 1.5 to 8.5 years (mean 2.5 years). RESULTS: Horizontal advancement averaged 6.9 mm. There was a significant correlation between surgical movement and postoperative relapse in both the horizontal and vertical planes. In vertical repositioning, 15 patients had maxillary intrusion and 31 had inferior repositioning. There was a significant difference between the intrusion group and the inferior repositioning group. There was a significant correlation between surgical and postoperative rotation regardless of the direction. Other factors were evaluated by the horizontal relapse rate. Type of cleft and the rate of relapse were statistically associated. A relapse was more likely to occur in patients with bilateral cleft. There were no significant associations with the rate of relapse in type of operations or previous alveolar bone grafting. There was no significant correlation between the rate of relapse and the number of missing anterior teeth, postoperative overbite and overjet, and age at operation. Four of 71 patients experienced major relapse, and 3 of them underwent jaw surgery again. CONCLUSIONS: Based on clinical and cephalometric analysis, two-jaw surgery should be performed in cases of severe maxillary hypoplasia, and overcorrection may be useful in inferior repositioning or surgical rotation. Special attention should be paid to the patient with bilateral cleft, multiple missing teeth, or shallow postoperative overbite.     

腭裂修复术对不同年龄患者上下颌牙弓关系影响的研究

目的 通过回顾性研究探讨接受腭裂修复术的年龄对患者上颌牙弓相对于下颌牙弓位置关系的影响. 方法 年龄>10岁、腭裂术后2年以上的单侧完全性唇腭裂患者103例,根据接受腭裂修复手术时的年龄分为3组,A组:≤3.0岁手术组(n=38)、B组:≤6.0岁手术组(n=36)和C组:>6.0岁手术组(n=29).用上下颌牙弓石膏模型,对其牙弓关系行Goslon Yardstick等级评价,并对不同手术年龄组间的Yardstick等级进行统计学检验. 结果 统计学检验显示Yardstick等级在A组与B组间差异无统计学意义(P>0.05),A组与C组间差异有统计学意义(P<0.05),B组与C组间差异无统计学意义(P>0.05). 结论 6.0岁以下行腭裂手术的两组患者的上颌牙弓相对于下颌牙弓的后缩程度无差异,6.0岁以上行腭裂手术患者的上颌牙弓相对后缩程度要明显小于3.0岁以下手术者,稍小于6.0岁以下手术者,上颌牙弓相对后缩程度随手术年龄的增大有减小的趋势.     

Evaluation of the palatal split pattern in surgically rapid maxillary expansion—comparison of two techniques

Purpose

Surgically assisted rapid maxillary expansion is performed to correct transverse deficiencies of the maxilla, and it is indicated in specific clinical situations. The literature presents different opinions in several aspects, mainly regarding the effect of disjunction of the pterygoid plates. The aim of this study was to evaluate the pattern of maxillary expansion obtained with two surgical techniques, with and without disjunction of the pterygoid plates.

Methods

Twenty patients treated with surgically assisted rapid maxillary expansion for correction of transversal discrepancies were included in this retrospective study and divided into two groups: (G1) patients operated without disjunction of pterygoid plates and (G2) patients treated with release of the pterygoid plates.

Results

There were seven male and 13 female patients, and the mean age was 29.9 years. Cone beam computed tomography images obtained after final activation of the expansion device were evaluated and complete disjunction of the midpalatal suture (type I) was present in 75 % of the patients whereas incomplete disjunction of the midpalatal suture (type II) was observed in 25 %. Chi-square test showed no statistically significant difference between groups (p = 0.606).

Conclusion

No difference was found in relation to the maxillary disjunction pattern irrespective of the treatment given to pterygoid plates.

     

腭裂植骨对上颌骨生长发育的影响(动物实验研究)

目的为了寻找拮抗腭裂及腭裂修复术后上颌骨生长抑制的方法，本研究观察了早期延期全裂隙植骨修复动物腭裂模型后，对上颌骨生长发育的影响。方法本研究用４０只狗作实验动物，分成正常对照组和３个实验组，实验组Ｉ外科手术造成右侧完全性腭裂，实验组Ⅱ手术造成右侧完全性腭裂后用两瓣法修补裂隙，实验组Ⅲ手术造成右侧完全性腭裂后用自体肋骨移植并用两瓣法修复裂隙。观察了上颌骨长、宽、高、后面长、宽及鼻中缝与额骨中垂线的夹角变化等指标，并进行统计学分析。结果早期的延期腭裂全裂隙骨移植修复术在拮抗裂隙和裸露骨面对上颌骨横向生长致畸作用的同时，可以诱发新的上颌骨畸形。结论提示临床选用这一修复方法时应采取谨慎的态度     

Comparison of maxillary setback by maxillary tuberosity removal or intentional pterygoid plate fracture in Le Fort I osteotomy: a long-term evaluation

The purpose of the study was to investigate the clinical application and long-term stability of maxillary setback in Le Fort I osteotomy using maxillary tuberosity removal or intentional pterygoid plate fracture (IPPF). Eighty adult class II patients who underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy by the same surgeon between January 2013 and January 2019 were included in this retrospective study. Traditional maxillary tuberosity removal was performed in 40 patients (group I), and the other 40 patients (group II) underwent IPPF to set back the maxilla according to surgeon preference. An obvious change in profile was observed for all of the patients, with no significant relapse at 1 year postoperative. The operation time and intraoperative blood loss were significantly higher in group I than in group II (P =  0.037 and P =  0.021, respectively). In group II, the most superior point of the fracture line was at a mean distance of 12.25 ± 2.04 mm above the most inferior point of the pterygoid plate. More bone fragments were noted when the fracture level was low than when it was high. In conclusion, both maxillary tuberosity removal and IPPF resulted in sufficient and stable maxillary setback, with IPPF showing less blood loss and a shorter operative time.