单侧完全性唇腭裂患者术前鼻牙槽骨整形的回顾性研究

目的：对接受术前鼻牙槽骨整形的单侧完全性唇腭裂患者进行回顾性研究,指导唇腭裂的术前非手术治疗。方法本研究回顾性分析了58例接受术前鼻牙槽骨整形的单侧唇腭裂患者,对正畸后未发生齿槽偏移和正畸后发生齿槽偏移的患者进行相关变量测量,并对测量结果进行统计学分析。结果本研究纳入的58例唇腭裂患者,有4例患者发生正畸后齿槽舌侧偏移,其余的54例患者正畸后未发生齿槽偏移。两组患者的前方齿槽裂隙宽度在矢状方向和垂直方向（PP’-Y、PP’-Z）存在显著差异,健侧齿槽前方与齿槽后方水平方向之间的夹角（∠PTT’）也存在统计学差异。结论单侧完全性唇腭裂患者在正畸前可能潜在齿槽偏移畸形,与前方齿槽在矢状和垂直方向裂隙畸形宽度,及健侧齿槽前方成角角度相关。无齿槽偏移患者可以直接使用矫治器缩窄裂隙宽度,而对于正畸后可能发生齿槽舌侧偏移的患者,需先矫正偏移畸形再缩小裂隙宽度。     

A Longitudinal Study of The Nasal Symmetry in Unilateral Cleft Lip And Palate Patients Treated With Nasoalveolar Molding

Background  Nasoalveolar molding (NAM) has been extensively used as a presurgical technique in the treatment of unilateral cleft lip and palate (UCLP) over the last two decades. It has proven to be a useful tool to reduce the cleft size, improve nasal symmetry, and increase the columellar length. The long-term stability of these findings has not been conclusively proven. Methods  In this longitudinal study, the nasal symmetry of 24 NAM treated UCLP patients was evaluated to assess the 5-year stability of NAM. The basal photographs were shot postcheiloplasty (T1), at 1-year follow-up (T2), at 3-year follow-up (T3), and 5-year follow-up (T4) appointments. Results  In this study, we found that NAM was a useful adjuvant in achieving nasal symmetry in patients with UCLP in the immediate postoperative period. However, as the patients aged, there was a gradual loss of mean nasal height (by 22.83%) and columella length (by 24.89%), a mean gain in nasal width (by 40.25%) and alar base width (by 40.69%), and an increase in the columella deviation (by 3.46%) from the T1 to the T4 follow-up. Conclusion  Although there is no conclusive evidence, the loss of symmetry may be due to the unequal growth on the cleft and noncleft sides. These patients will be followed-up till end of growth for a definite conclusion on the long-term effect of NAM.     

Primary,Early Bone Grafting in Complete Clefts of the Lip and Palate: A Follow-up Study of 53 Cases

Fifty-three patients with complete unilateral and bilateral cleft lip and palate between the ages of 5 1/2 and 13 1/2 years have been followed up. Following preoperative jaw orthopedic treatment, when indicated, these cases were operated with lip closure and bone grafting with four mucoperiosteal flaps as described by Nordin (1960) and Bäckdahl & Nordin (1961). In the 14 bilateral cases this operation was done in two stages, one side at a time, in this series. At the follow-up, facial appearance, hearing, speech assessment, some facial angles and incidence of crossbites were examined. In the 39 unilateral cleft cases, 80% had an acceptable appearance while 20% needed secondary surgery of the lip and nose as rated independently by four doctors. In the 14 bilateral cases 50% needed secondary operation of the lip and nose. Speech assessment in the bone-grafted group was good or superior to that in a non-bone-grafted group of patients with clefts of the primary and the secondary palate. Open nasality and consonant articulations were also taken into consideration. No permanent hearing impairment was noted in these patients although they are prone to chronic ear diseases. No serious maldevelopment of the facial skeleton was noted in our study following primary, early bone grafting. The incidence of crossbite was comparatively low. This type of treatment is continuing at our centre since the results are promising. Comparison of similar studies from other centres with long-term follow-ups are called for.     

Influence of Age,Sex, and Growth Variables on Phalangeal Quantitative Ultrasound Measures: A Study in Healthy Children and Adolescents

Skeletal status by phalangeal quantitative osteosonography (DBM Sonic BP - IGEA) was examined in 1227 healthy children (641 boys and 586 girls) aged 3–16 years. Aims of the study were to evaluate some physical parameters pertaining to the ultrasound transmission crossing the phalanx in a school-age population and to relate these values to age, sex, and growth variables. A correlation was found between AD-SoS (amplitude-dependent speed of sound) and BTT (bone transmission time) and, age, height, weight, and pubertal stage, respectively. No correlation existed between FWA (fast wave amplitude) and SDy (dynamics of the ultrasound signal) and age, height, weight, pubertal stage, and BMI, respectively. AD-SoS increased in boys until 7–8 years of age. Thereafter a plateau was reached up to age 12–13 years, when a rapid increase was observed corresponding to pubertal growth rate acceleration. In girls, AD-SoS increased with age up to 10–11 years with a steeper increase at the time of puberty starting about 2 years earlier than in boys. BTT presented a similar trend. Mean AD-SoS values increased from Tanner pubertal stages 1 to 2 and from stage 3 to 4 in both sexes. Significantly higher mean AD-SoS values in stages 2, 3, and 4 were observed in girls as compared to boys. Mean BTT values increased significantly from stage 1 to 5 in girls and from 1 to 4 in boys. QUS technology showed the ability to assess bone changes in the growing bone.     

A fifteen-year longitudinal study in young adults on the relation of physical activity and fitness with the development of the bone mass: The Amsterdam Growth And Health Longitudinal Study

Although positive effects of physical activity are often reported, there are still uncertainties about the type, intensity, duration, and frequency of these activities that are most effective for (re)modeling bone mass during youth. In the Amsterdam Growth and Health Longitudinal Study, daily physical activity and fitness were monitored from age 13 to 29 years in a group of 182 males and females. At a mean age of 28 years, bone mineral density (BMD) was measured at three sites with dual X-ray absorptiometry (DXA): in the lumbar region (lumbar BMD), the femoral neck (hip BMD), and the distal radius (wrist BMD). Physical activity (PA) was estimated from a cross-check activity interview taking in consideration all daily physical activities during the last 3 months; PA was scored in two different ways: (1) metabolic physical activity score (METPA) by weighting the intensity (multiples of basic metabolic rate [METs]) and duration (minutes per week); and (2) mechanic physical activity score (MECHPA) by weighting the peak strain (ground reaction forces as multiples of body mass) irrespective of frequency and duration of the physical activities. Physical fitness was measured with a neuromotor fitness test (composite of six strength, flexibility, and speed tests) and as cardiopulmonary fitness (maximal oxygen uptake). The physical activity and fitness scores were calculated over two age periods: during adolescence (13–16 years) and during adulthood (21–27 years). The standardized regression coefficients (corrected for gender, biological age, body composition, and calcium intake) show that weight, physical activity (both METPA and MECHPA), and neuromotor fitness during adolescence and in young adulthood are significantly and positively related with the lumbar BMD (β = 0.11–0.40) and hip BMD (β = 0.18–0.26), measured at the mean age of 28 years. This was not the case for cardiorespiratory fitness. No significant correlations at all are found with wrist BMD, a bone site that is less involved in physical activity and fitness. It can be concluded that daily physical activity during adolescence and in the young adult period is significantly related to the BMD at the lumbar spine and femoral neck at age 28 of males and females. Only neuromotor fitness and not cardiopulmonary fitness during adolescence and young adulthood is related to the BMD of males and females at age 28 years.