中国唇腭裂治疗面临的挑战与机遇

我国是目前世界上唇腭裂患者最多的国家之一,每年又有3万左右的新增病例。在我国大部分地区,如何整体提高对唇腭裂患者治疗的效果仍然是一个值得重视的临床课题。本文通过对国内著名口腔医学院校及医疗中心进行问卷调查,对我国唇腭裂治疗的现状进行了研究。作为国内最大的唇腭裂治疗中心之一,愿在此和国内同行一起分享本中心对于唇腭裂序列治疗的经验,并希望能借此提高我国唇腭裂治疗的水平,使更多的唇腭裂患者能够得到专业团队的治疗。     

国家级继续教育项目——唇腭裂整复术以及语音治疗学学习班通知

上海第二医科大学附属第九人民医院和上海第二医科大学唇腭裂治疗研究中心承担的国家级《唇腭裂整复术以及语音治疗学》继续教育学习班(全国继续教育项目,编号:2003-08-02-009),定于2004年5月21日至25日在上海举办,为期5天。上课内容:唇腭裂整复术及进展;唇腭裂麻醉特点;病理语音学基础;唇腭裂患者语音特点及治疗;唇腭裂患者序列正畸和正颌外科治疗;唇腭裂患者听力和心理等。课程由长期从事以上课题研究并获各级科技奖励的教授及研究人员主讲,注重理论联系实际,内容丰富,形式多样,欢迎参加。招生对象:口腔科,耳鼻咽喉科,整形外科医师,语音治…     

国家级继续教育学习班通知唇腭裂整复术以及语音治疗学

全国继续教育项目 (编号 :2 0 0 3- 0 8- 0 2 - 0 0 9)上海第二医科大学附属第九人民医院和上海第二医科大学唇腭裂治疗研究中心承担的国家级《唇腭裂整复术以及语音治疗学》继续教育学习班 ,现定于 2 0 0 4年 5月 2 1日至 5月 2 5日在上海举办 ,为期 5天。上课内容 :唇腭裂整复术及进展 ;唇腭裂麻醉特点 ;病理语音学基础 ;唇腭裂患者语音特点及治疗 ;唇腭裂患者序列正畸和正颌外科治疗 ;唇腭裂患者听力和心理等方面内容。课程由长期从事以上课题研究并获各级科技奖励的教授及研究人员主讲 ,本学习班注重理论联系实际 ,内容丰富 ,形式多样 ,…     

唇腭裂序列治疗指南

唇腭裂序列治疗是指以唇腭裂患者达到良好外形、正常功能和心理健康为目标, 通过多学科协作, 共同制订治疗计划, 以外科整复为主要手段, 在最佳的时间点进行最合适治疗的团队治疗模式。唇腭裂序列治疗团队是一个多学科组成的医疗团队, 建议至少包括口腔颌面外科医师、口腔正畸医师、病理语音师、心理咨询师等组成。本指南是由中华口腔医学会唇腭裂专业委员会于2019年正式申请立项并获学会批准, 于2022年正式发布。本指南描述了适宜中国唇腭裂患者人群的序列治疗相关诊疗技术, 涵盖唇裂、牙槽突裂及腭裂的初期、二期手术、正畸治疗、语音治疗、护理、心理等方面, 适用于中国开展唇腭裂序列治疗的临床工作。     

唇腭裂序列治疗与关键技术的应用

建立具有中国特色的唇腭裂多学科序列治疗专家共识,对提高我国的唇腭裂治疗水平具有较为现实的指导意义。本文将21家医疗单位唇腭裂序列治疗中唇腭裂的外科前治疗,唇、腭裂的外科修复,正畸治疗,牙槽突裂的植骨修复,唇裂鼻畸形的整复,唇裂术后继发畸形的二期整复,腭裂术后穿孔的处置,腭裂术后腭咽闭合不全的诊断与治疗,语音治疗,腭裂分泌性中耳炎的处置,颌骨畸形的外科矫治,心理评估和咨询及围手术期的护理等治疗经验进行了归纳总结并达成一致意见。其中对唇裂、腭裂、牙槽突裂和腭咽闭合不全的外科关键技术的应用和对语音治疗、正畸治疗和颌骨畸形牵张成骨等主要方法的应用也形成了共识。笔者希望通过这一努力,能够引导更多医护人员参与唇腭裂序列治疗和关键技术的创新工作,最终形成中国唇腭裂治疗指南。     

努力提高我国唇腭裂综合序列治疗的总体水平

唇腭裂是我国口腔颌面部最常见的先天性畸形之一 ,其手术修复治疗早已在国内普遍展开 ,不少单位的唇腭裂修复术和综合序列治疗已取得了良好的效果 ,并受到国外同行的重视。由于目前各医疗单位唇腭裂手术、综合序列治疗的水平不一 ,效果也不尽相同。我国的唇腭裂综合序列治疗尽管早已受到各方的认同 ,但与发达国家比较仍有差距。如何尽快使我国唇腭裂综合序列治疗达到或接近国际水平 ,既是我们的历史使命 ,同时是从事这一专业的同道们追求的目标 ,也是唇腭裂患者和家属的希望。 2 0世纪 80年代后期我国开始综合序列治疗 ,90年代在一些医学院…     

婴儿期一次性手术整复完全性唇腭裂及牙槽突裂

目的 :探讨婴儿期一次性手术修复完全性唇腭裂及牙槽突裂的安全性与可能性。方法 :在气体 -静脉复合麻醉下 ,对 4 2例婴儿完全性唇腭裂及牙槽突裂施行一次性手术整复。在监护室复苏成功后返专科病房治疗 ,术后 4～7d出院。结果 :4 2例患儿均麻醉平稳 ,无麻醉意外及并发症 ,且手术顺利 ,平均失血 4 2 .7± 6.5 m l,平均手术操作时间为 13 9.2± 18.6min。术后均复苏成功 ;伤口多为一期愈合 ,仅 2例腭部出现裂孔。结论 :在专业小儿麻醉及复苏技术保障下 ,婴儿期一次性手术整复完全性唇腭裂及牙槽突裂是安全可行的。     

唇腭裂患者面中部骨骼畸形的颅颌面外科整复

唇腭裂患者均伴不同程度的颅颌面发育障碍。由于先天的发育缺陷、异常的牙功能机制及唇腭裂修复术的创伤和疤痕限制等原因,唇腭裂患者面中部畸形较一般的牙颌面发育畸形更为严重复杂。这些形态畸形和功能障碍的治疗有其特殊性。1　唇腭裂伴发面中部骨骼畸形整复治疗史略...     

关于《唇腭裂新生儿术前矫治方法与技术的探讨及术后疗效评价》的评述

先天性唇腭裂是常见的颌面部先天性畸形之一,唇腭裂整复治疗的方法一直备受关注,因患儿鼻、唇、腭牙槽突外形的恢复对其心理和身体发育都有重要的意义.目前有两种治疗方法,一种是单纯的手术整复,另一种是新生儿在术前先行矫治器治疗,以阻止畸形发展,同时尽可能减少原有畸形,为手术创造良好的组织条件,提高唇腭裂的外科修复效果.     

双侧唇裂修复术的临床体会

唇腭裂为口腔颌面部常见的先天畸形之一,国内发生率约为1.625‰左右[1],双侧唇裂或唇腭裂约占唇裂发生率的9%～15%左右[2]。对单侧唇裂或唇腭裂的整复治疗、研究比较集中,其整复方法及其原则已趋于成熟、统一[3]。但对双侧唇裂或唇腭裂的解剖特点、整复术式、术后远期效果评价等,与单侧唇裂研究相比还远远滞后。双侧唇裂,尤其是双侧唇裂伴腭裂的患者行一期唇裂修复后仍伴发许多继发畸形,这些畸形及修复效果的优劣最终影响患者的身心健康[4]。造成这种畸形的因素除解剖结构上的原因,还有手术方法的选择、手术技巧等因素的存在。经过对二期畸…     

先天性颌间闭锁症唇腭裂幼儿唇裂修复1例报道

报道1例先天性颌间闭锁症伴唇腭裂幼儿修复唇裂的全麻方法及手术效果。通过先天性唇腭裂裂隙,盲插法插入气管导管,全麻下修复先天性唇裂。气管导管插管顺利,麻醉安全平稳,术后效果基本满意,但拔管后白唇显短,红唇凹陷,鼻翼修复困难。     

Dental treatment need and dental general anesthetics among preschool‐age children with cleft lip and palate in northern Finland

Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental treatment among cleft lip and palate patients in northern Finland, as well as their need for dental treatment under general anesthesia. The records of 183 cleft lip and palate patients, treated in Oulu University Hospital from 1997 to 2013, were reviewed. Data on dental caries were analyzed in association with cleft type, considering also the presence of syndromes. The frequency of dental general anesthetic (DGA) use, and of treatments, were also analyzed. Dental treatment need was most frequently observed, in this rather limited study population, in patients with the most severe deformities, namely bilateral cleft lip and palate, of whom 60% had caries. Among the study population, 11.5% (n = 21) had a syndrome. Of those, 57.1% had dental caries at the age of 3 or 6 yr, and only four could be treated without a DGA. Dental treatment under general anesthesia was performed in 14.8% of cleft patients without a syndrome, but in 38.1% of those with a syndrome. General anaesthesia is required for the provision of dental care more often in cleft (17.5%) than in non‐cleft (0.2%) patients, and especially for those with a syndrome.     

1988～1992年中国非综合征性唇腭裂发生率的动态变化

目的　了解我国 1988～ 1992年非综合征性唇腭裂发生率的动态变化趋势及流行病学特征。方法　采用以医院为单位的整群抽样方法 ,对 1988～ 1992年期间我国 5 0 0多所医院孕 2 8周至产后 7天的 3 2 46 40 8例围产儿 ,4349例非综合征性唇腭裂病例进行回顾性分析。结果　我国 5年非综合征性唇腭裂发生率无显著性差异 ,城乡发生率也无显著性差异。男性发生率为 14.9/万 ,女性发生率为 11.7/万 ,差异有显著性 ,非综合征性唇腭裂的性别比为 1.3∶ 1。三类非综合征性唇腭裂各自的发生率为 :CL± P:7.8/万 ,CL:3.8/万 ,CP:1.8/万。结论　我国非综合征性唇腭裂发生率无变化趋势 ,城乡无差异。男性高于女性 ,唇裂合并腭裂为最常见类型。     

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate.

OBJECTIVE: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. PARTICIPANTS: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. OUTCOME MEASURES: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. RESULTS: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). CONCLUSIONS: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.     

2447例唇腭裂患者的临床资料分析

目的　了解先天性唇腭裂的患病状况及特点 ,寻找与唇腭裂发生有关的影响因素 ,为唇腭裂的预防与治疗提供依据。方法　对 1989～ 1998,10年间在原华西医科大学口腔医院颌面外科手术治疗的 2 4 4 7病例进行回顾性临床统计学分析。结果　在本组病例中 ,唇裂 6 4 8(2 6 5 % )、唇腭裂 996 (40 7% )、单纯腭裂 80 3(32 8% )。唇裂伴或不伴腭裂中 ,男多于女 (2 .14∶1) ,单纯腭裂女多于男 (0 77∶1)。单侧唇腭裂明显多于双侧 ,两者之比为 4 84∶1,其中左侧者多于右侧者 ,两者之比为 2 14∶1。有遗传史的病例占病例总数的 7 4 % ,其中唇裂伴或不伴腭裂有遗传史者占唇裂伴或不伴腭裂患者的 8 2 % ,单纯腭裂有遗传史者占单纯腭裂患者的 6 5 %。母亲怀孕前 3月经历危险因素有 95 4例 ,占 39 0 % ,其中唇裂伴或不伴腭裂者 70 0例 ,占唇裂伴或不伴腭裂患者数的 4 2 6 % ,单纯腭裂2 5 4例 ,占单纯腭裂的 31 6 %。A型和O型血患者比例高于正常人群比例 ,而B型血者比例低于正常人群比例 ,单纯唇裂出生于 4～ 6月者人数小于其他季度 ,而单纯腭裂出生于 7～ 9月者人数少于其他季度 ;19例双生子中 ,均为其中之一发病 ,无同时发病者。唇腭裂伴发畸形者共 4 1例 ,占总病例数的 1 7%。结论　本资料提示唇腭裂的发生可?     

Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate.

OBJECTIVE: Diminished maxillary growth is a consequence of labiopalatal repair, and many patients with cleft lip and palate require Le Fort I advancement. The goal of this study was to determine the frequency of maxillary hypoplasia as measured by need for Le Fort I. SUBJECTS: Retrospective cohort study of males born before 1987 and females before 1989. Records of 173 patients with cleft lip and palate and 34 with cleft palate were reviewed. METHODS: Documented age, gender, cleft type, and need for Le Fort I. Pearson chi-square and Fischer's exact analyses were performed to evaluate the frequency of Le Fort I. RESULTS: Of 217 patients with cleft lip and palate or cleft palate, 40 were syndromic; of the remaining 177 patients, 69 had cleft lip, 78 had cleft lip and palate, and 30 had cleft palate. Thirty-seven of 177 patients (20.9%) required Le Fort I, subcategorized by cleft type: 0/69 for cleft lip, 37/78 for cleft lip and palate, and 0/35 for cleft palate (p<.0001). Of the 37/78 (47.4%) cleft lip and palate patients, the frequency of Le Fort I correlated with severity: 5/22 unilateral incomplete cleft lip and palate; 16/33 unilateral complete cleft lip and palate; 1/2 bilateral incomplete cleft lip and palate; 2/4 bilateral asymmetric complete/incomplete cleft lip and palate; 13/17 bilateral complete cleft lip and palate (p<.05). CONCLUSION: Overall frequency of Le Fort I was 20.9% in patients with cleft lip and palate and cleft palate. Of those with cleft lip and palate, 47.7% required maxillary advancement, but none with isolated cleft lip or cleft palate required correction. Frequency of Le Fort I osteotomy correlated with the spectrum of severity of labiopalatal clefting.     

Parent and child ratings of satisfaction with speech and facial appearance in Flemish pre-pubescent boys and girls with unilateral cleft lip and palate

The purpose of this controlled study is to determine satisfaction with speech and facial appearance in Flemish pre-pubescent children with unilateral cleft lip and palate. Forty-three subjects with unilateral cleft lip and palate and 43 age and gender matched controls participated in this study. The Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Both the cleft palate subjects and their parents were satisfied with the speech and facial appearance. The Pearson χ(2) test revealed significant difference between the cleft palate and the control group regarding hearing, nasal aesthetics and function, and the appearance of the lip. An in depth analysis of well specified speech characteristics revealed that children with clefts and their parents significantly more often reported the presence of an articulation, voice and resonance disorder and experienced /s/ /r/ /t/ and /d/ as the most difficult consonants. To what extent the incorporation of specific motor oriented oral speech techniques regarding the realisation of specific consonants, attention to vocal and ear care, and the recommendation of secondary velopharyngeal surgery, with the incorporation of primary correction of the cleft nose deformity simultaneously with primary lip closure, will aid these patients are future research subjects.     

青少年唇腭裂患者自我意识与父母教养方式的相关性研究

目的 调查青少年唇腭裂患者自我意识和父母教养方式的现状,分析二者之间的相关性,为青少年唇腭裂患者的心理干预提供证据支持。方法 以11~25周岁的400例青少年唇腭裂患者为研究对象,采用青少年唇腭裂患者自我意识量表、父母教养方式量表进行问卷调查,了解青少年唇腭裂患者的自我意识和家庭的教养方式,分析二者之间的相关性。结果 有效问卷380份。青少年唇腭裂患者的自我意识与父母教养方式间存在相关关系。青少年唇腭裂患者的自我评价、自信心、他人评价与心理承受力、人际关系及亲子关系得分与父母亲的情感关爱得分呈正相关关系,自信心与父母亲拒绝否认、惩罚与严厉得分呈负相关关系。结论 父母良好的教养方式对青少年唇腭裂患者自信心的建立、社会适应能力的提高、人际关系和亲子关系的维护有重要影响。父母应给予更多的情感关爱,避免一再的拒绝否认、惩罚与严厉。     

Changing face of cleft care: specialized centers in developing countries

The organization and management of specialized cleft lip and palate centers in developing countries are challenging because of the lack of financial resources devoted to the national health care system. The treatment of cleft lip and palate is of low priority for health care and budgets; however, gradual progress is possible. As an example of how care might be improved in the developing world, we suggest guidelines to strengthen the local cleft lip and palate centers in Brazil based on the ideal geographic distribution of cleft centers around the country, to achieve the following objectives: first, avoid patient's migration; second, facilitate patient's adherence; third, focus on a global and continuous multidisciplinary treatment; and fourth, avoid indiscriminate opening of nonprepared cleft lip and palate centers in our country. This ideal scenario would put the cleft lip and palate health attention on the right path in Brazil.     

唇腭裂患儿全身麻醉苏醒期躁动多维干预体系的构建研究

目的 构建并应用唇腭裂患儿全身麻醉苏醒期躁动（EA）多维干预体系,以降低唇腭裂患儿EA发生率。方法 专家函询法构建唇腭裂患儿EA多维干预体系。便利选取2021年11月—2022年6月入住四川大学华西口腔医院麻醉复苏室（PACU）的唇腭裂患儿119例,分试验组59例和对照组60例,试验组应用唇腭裂患儿EA多维干预体系干预,对照组常规干预,采用儿童麻醉苏醒期谵妄量表（PAED）及疼痛评估量表（FLACC）评估干预效果。结果 唇腭裂患儿EA多维干预体系包括3项一级指标、6项二级指标、14项三级指标。试验组在PACU内、转出PACU的躁动发生率低于对照组（P<0.05）,两组术后生命体征、FLACC疼痛评分及并发症的发生率差异无统计学意义（P>0.05）。结论 唇腭裂患儿EA多维干预体系具有科学性,可降低唇腭裂患儿EA的发生率,但对疼痛及术后并发症的发生尚无确定改善效果。