腭黏骨膜组织瓣转移修复颊黏膜缺损的临床应用研究

目的：评价腭黏骨膜组织瓣转移修复颊黏膜缺损的临床效果。方法：对近5 a间27例颊黏膜缺损患者采用腭黏骨膜组织瓣转移修复,其中全腭黏骨膜瓣17例,半侧腭黏骨膜瓣10例。观察腭黏骨膜组织瓣存活,供区的愈合及患者术后功能恢复情况。结果：25例患者腭黏骨膜瓣全部成活,2例腭黏骨膜瓣术后发生部分坏死。所有病例腭黏骨膜瓣供区形态恢复完整,无张口受限。结论：利用腭黏骨膜瓣转移修复颊黏膜缺损是一种简便且有效的方法。     

腭帆提肌重建联合颊脂垫瓣修复对大龄腭裂的临床效果

目的探讨腭帆提肌重建联合颊脂垫瓣修复对大龄腭裂的临床效果。方法选取我院收治的76例大龄腭裂患者,采用随机数字表法分为观察组(38例,腭帆提肌重建+颊脂垫瓣修复)和对照组(38例,腭帆提肌重建+碘仿纱布修复)。比较两组的预后情况。结果术后3个月,观察组的治疗总有效率明显高于对照组,腭瘘的发生率明显低于对照组(P<0.05)。术后随访1年,观察组的上颌牙弓长、牙弓前段宽、牙弓后段宽、高鼻音与鼻漏音评分、语言清晰度和腭部瘢痕分级均明显优于对照组(P<0.05)。结论腭帆提肌重建联合颊脂垫瓣修复治疗大龄腭裂的临床效果显著,可减少并发症的发生,促进患者上颌牙发育,改善语音功能。     

前臂游离皮瓣修复舌癌术后组织缺损的语音效果评价

目的：初步探讨前臂游离皮瓣修复舌癌术后组织缺损后患者语音清晰度的改善状况。方法回顾性分析39例舌癌患者,其中24例采取前臂游离皮瓣修复并且皮瓣全部成活,15例采取直线拉拢缝合。术后6个月之后开始对舌体形态及功能进行评估,检查舌体的运动度并以“普通话测试表”对患者术后的语音清晰度进行主观评价。结果两组患者的原发灶愈合良好,进食及语言功能均有恢复,其中前臂游离皮瓣修复组与直接拉拢缝合组的舌体前伸及上抬差异无显著性(P>0.05);两组的术后语音清晰度比较差异有显著性(P<0.05),前臂游离皮瓣修复组患者的语音清晰度高于直接拉拢缝合组。结论应用前臂游离皮瓣修复舌癌术后组织缺损可有效改善患者的术后语音功能。     

腭裂术中保留腭小神经的手术配合

腭裂是口腔颌面整形外科最常见的畸形之一.整复腭裂的目的:一是创造良好的"腭咽功能",为实现腭裂术后语音的正常提供条件;二是恢复腭部的正常解剖关系,封闭腭部的裂隙,使口腔与鼻腔分开;三是恢复腭部的生理功能.如何尽可能地保留各解剖部位的组织结构并将其恢复到正常状态,是实施腭裂修复手术过程中始终需要考虑的问题[1].     

1例上颌窦癌行颞肌筋膜瓣修复腭部缺损患者的护理

介绍了1例上颌窦癌行颞肌筋膜瓣修复腭部缺损患者的护理。重点阐述了术前的心理护理、术后的颞肌筋膜瓣的观察、口腔护理和饮食护理。经过有效的护理，患者住院3周，无并发症发生，康复出院。     

口腔癌患者游离组织瓣修复术后语音训练的效果研究

目的 对组织瓣修复口腔癌的患者进行语音训练,并评价训练的效果.方法 将55例口腔癌实施同期游离组织瓣修复术的患者分为干预组(28例)和对照组(27例),干预组从术后第3用开始实施语音训练,对照组除常规治疗和护理外不进行语音训练.分别于术前、术后2周、术后3个月和6个月采用"汉语语音清晰度测试字表"评价两组语音清晰度.结果 两组患者的语音清晰度变化趋势经组问比较,差异有统计学意义(P<0.01).干预组患者评分高于对照组.结论 对游离组织瓣修复口腔癌的患者进行语音训练可明显改善其语音清晰度.     

不同面动脉供血皮瓣重建颊黏膜缺损疗效观察

目的探讨面动脉供血的垂直颈阔肌皮瓣、颏下岛状皮瓣修复颊黏膜癌术后缺损的临床效果。方法颊黏膜癌术后局部软组织缺损患者33例,其中15例以垂直颈阔肌皮瓣修复（颈阔肌组）,18例以颏下岛状皮瓣修复（岛状皮瓣组）;观察并比较2组皮瓣完全成活率、口腔皮肤瘘发生率及功能恢复情况。结果颈阔肌组2组皮瓣部分坏死,完全成活率为86.7%,4例发生口腔颈部皮肤瘘;岛状皮瓣组皮瓣部分坏死1例,完全成活率为94.4%,2例发生口腔颈部皮肤瘘;2组皮瓣完全成活率、口腔皮肤瘘发生率比较差异无统计学意义（P〉0.05）;2组均有轻度张口受限,颈阔肌组口腔功能恢复较好。结论垂直颈阔肌皮瓣与颏下岛状皮瓣均可用于颊黏膜癌术后中小型缺损的重建,但垂直颈阔肌皮瓣术后患者口腔功能恢复优于颏下岛状皮瓣。     

婴儿期腭成形修复手术技巧的初步探讨

目的：探讨婴儿期腭裂腭成形修复手术的手术技巧及临床应用。方法：回顾360例腭裂患儿的腭成形修复手术，对手术方法的选择，切口及悬雍垂的处理，粘骨膜瓣的剥离及松驰，腭帆提肌解剖及功能重建等步骤采取相关之手术技巧，总结分析其临床效果。结果：360例腭裂患儿中术后有3例(完全性腭裂伴唇裂者)在硬腭前份牙槽突裂隙处并发腭瘘，其余患者术口均为Ⅱ／甲愈合，腭部外型良好，软腭活动度满意。在手术过程中运用一定的技巧和使用一些特定器械有利于缩短手术时间，减少出血，保护软腭肌肉及血管，顺利完成腭裂的形态和功能修复。结论：腭裂婴儿在解剖结构和生理功能上有某些特殊性，其腭成形修复手术有一定独特性，运用适当的技巧能提高手术的成功率。     

腭黏膜瓣修复软腭裂术的手术配合37例

传统修复软腭裂的手术方法是两大瓣法，此法破坏硬腭部骨膜与腭板的附着，破坏腭中缝，手术创伤大，剥离范围广，术中出血较多，瘢痕增生明显。我科应用弧形切口术式，并将软腭部鼻腔黏膜进行“Z”形分离，交叉缝合，用腭黏膜瓣修复软腭裂37例，取得了较好的效果，现报道如下。     

鼻唇沟瓣在口腔颌面部组织器官缺损重建中的临床应用

目的:观察鼻唇沟瓣在口腔颌面部组织器官缺损重建中的临床效果。方法:回顾性分析应用鼻唇沟瓣修复口腔颌面部组织器官缺损36例患者的临床资料。结果:36例患者术后鼻唇沟瓣全部存活,随访6个月~2年患者进食、吞咽、语言等功能接近正常,术区无明显瘢痕增生,面部器官无牵拉变形。结论:鼻唇沟瓣适宜口腔颌面部组织器官缺损的修复重建,操作简单,值得推广应用。     

腭帆提肌重建术修复腭裂时凿断翼钩对中耳功能影响

目的探讨腭帆提肌重建术修复腭裂时凿断翼钩对腭裂病人听力及中耳功能的影响。方法选取72例腭裂病人,随机分为2组。实验组42例,行腭裂修复术时凿断翼钩,解剖并重建腭帆提肌;对照组30例,解剖并重建腭帆提肌,但术中不凿断翼钩。术前及术后6个月两组均作声阻抗和脑干听觉诱发电位检查以判定疗效。结果两组病人术后听力及中耳功能均获得改善（t=3.38、2.18,P〈0.05;χ^2=61.46、51.42,P〈0.01）,实验组与对照组比较差异无显著性（P〉0.05）。结论腭帆提肌重建术修复腭裂有助于腭裂病人听力及中耳功能的改善,手术中凿断翼钩与否对术后听力及中耳功能的改善无显著影响,提示腭帆提肌重建在维持中耳功能中的作用占主导地位。     

腭裂术后患儿言语治疗的效果观察

目的观察言语治疗对腭裂术后患儿构音障碍恢复的效果。方法对28例腭裂术后患儿于术后4周开始进行言语训练,3个月为1个疗程,共训练1～3个疗程。训练前后分别进行腭咽闭合功能和语音清晰度测评。结果治疗后,鼻漏气率由（50.64±13.10）%降低到（23.36±13.14）%,8例语音达到正常水平,总有效率100%。结论言语治疗能使腭裂术后患儿构音障碍明显改善。     

Speech production,intelligibility and oromotor function in seven individuals with Möbius sequence

Abstract

Purpose: Möbius sequence is a rare disease characterized by congenital facial and abducent nerve palsy. Other cranial nerves may be affected. Cleft palate, intellectual disability and neuropsychiatric disorders are associated with the diagnosis. The aim was to explore speech production, intelligibility and oromotor function in a group of individuals with Möbius sequence.

Method: Three children (5–11 years) and four adults (26–54 years) were recruited to the study via the Swedish Möbius syndrome association. In addition to cranial nerve dysfunction, two had a hearing impairment, one Asperger syndrome and one a cleft palate. Perceptual assessments included an evaluation of intelligibility in single words and spontaneous speech, the percentage of phonemes correct (PPC) and screening of orofacial functions (NOT-S). Objective measurements were used for the evaluation of nasality, lip force and tongue force.

Result: Three individuals had severely impaired intelligibility, two slightly impaired and two had fully intelligible speech. The PPC varied between 59.3–100%. Five individuals had bilateral facial palsy, two unilateral facial palsy and six tongue impairment. One had a slightly increased nasalance score. Compensatory strategies were being effectively used.

Conclusion: This case series contributes more in-depth knowledge of speech production, intelligibility and oromotor function in this rare condition.     

腭裂的功能性整复-腭帆提肌重建术

Sommedad腭帆提肌重建术可有效恢复腭帆提肌正常的解剖结构和位置，重建提腭吊带，易获得良好的腭咽闭合。充分游离错位的腭帆提肌，将其由原来的前内斜行复位到正常位置，即软腭的后1／3区，重建腭后其语音清晰度状况、高鼻音以及鼻漏气都得到明显的改善。部分能合作的患儿，咽腔造影显示术后腭咽闭合率65％。     

不同逆行岛状皮瓣修复方案在拇指创伤中的疗效比较

[目的] 探讨大鱼际逆行岛状皮瓣和拇指逆行桡背侧皮瓣修复拇指创面患者的临床疗效.[方法] 选取2013年2月至2016年6月在本院接受治疗的拇指损伤患者88例,按照患者拇指手术修复部位分成大鱼际组、拇指桡背组.比较两组患者手术时间、术中出血量、术后视觉痛觉评分(VAS)、主观满意度、患者术后恢复时间、术后关节活动度、感觉、复工时间及拇指血液流量.[结果] 大鱼际组手术时间、术中出血量、术后VAS评分均明显少于拇指桡背组,其差异有统计学意义(P<0.05);大鱼际组指背部位满意度评分明显高于拇指桡背组,而拇指桡背组指腹、指尖部位满意度评分明显高于大鱼际组,其差异均有统计学意义(P<0.05);拇指桡背组术后活动度、感觉测量分数均明显高于大鱼际组,而大鱼际组术后恢复时间、复工时间短于拇指桡背组,术后血液流量大于拇指桡背组,其差异均有统计学意义(P<0.05).[结论] 拇指逆行桡背侧皮瓣修复术适合修复带有感觉功能的指腹部分;而大鱼际逆行岛状皮瓣修复术适合修复不带有感觉功能的指背部分.     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: An ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

腭裂儿童早期术后语音治疗与分析

目的对唇腭裂患儿的早期语言发育进行研究,了解其语言获得情况。方法对105 例无智力与听力障碍腭裂术后患儿采用一对一治疗模式,进行语言的康复治疗,每周1~2 次,每次30~45 min。结果所有患儿训练后语音清晰度显著改善(P<0.001)。结论早期手术可尽早地恢复腭咽闭合功能,且术后语音康复效果较好。     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.