共查询到20条相似文献,搜索用时 31 毫秒
1.
目的探讨在裂隙宽大的Ⅱ度腭裂修复术中,利用裂隙顶端口腔黏膜瓣修复鼻侧黏膜、降低缝合后张力的术式的临床应用效果。方法选择27例宽大型Ⅱ度腭裂患者为研究对象,在常规两瓣法的基础上,将裂隙顶端三角形口腔黏膜瓣翻转,与两侧鼻侧黏膜缝合修复裂隙宽大的Ⅱ度腭裂鼻侧黏膜。结果27例患者均手术顺利,术后无活动性出血、呼吸道阻塞及伤口感染发生。随访1~3个月,伤口愈合良好,无伤口裂开及腭漏发生,上腭瘢痕不明显。结论应用裂隙顶端口腔黏膜瓣修复宽大型Ⅱ度腭裂鼻侧黏膜,可以降低鼻侧黏膜缝合时的张力,相应增加两侧黏骨膜瓣宽度,降低术后腭漏的发生及减轻腭部瘢痕的形成。 相似文献
2.
A combinaation vomer mucoperiosteal flap and nasal floor mucoperiosteal flap is described which is used to achieve nasal coverage in unilateral cleft palate patients requiring pushbacks. A posteriorly based readily accessible vomer flap is raised on the cleft side and used as nasal lining for the palatal mucoperiosteal flap on the non-cleft side. On the cleft side, a symmetrically sized nasal floor flap is easily elevated under direct vision and used to cover the nasal aspect of the corresponding mucoperiosteal palatal flap. 相似文献
3.
Hwang K 《The Journal of craniofacial surgery》2012,23(2):543-545
ABSTRACT: The author created an innovative method of W-pushback and levator repositioning without having to make an incision to the nasal mucosa for submucous cleft palate repair.The W-shaped mucoperiosteal flap is outlined where the 2 peaks of W are the alveolar processes of both canine teeth and the midpoint of W is the anterior limit of the cleft notch of the hard palate. A short incision, medial to and behind the maxillary tuberosity and curved forward onto the palate and extended forward just medial to the alveolar process, is joined by a second incision from the apex of the cleft to the region of the canine tooth. The W-shaped mucoperiosteal flap is raised until the midline notch of the hard palate is exposed. The nasal mucosa and abnormally inserted levator veli palatini muscle to the posterior border of the hard palate bone are detached. By leaving the nasal mucosa intact, the detached levator veli palatini muscle is approximated at the midline and so the zona pellucida is obliterated. The cleft uvulas are cut in half and closed. The approximated W-flap is joined to the small anterior flap by 1 or more sutures (the W-pushback).Three patients were operated on with this technique without serious complications.The author believes that this method can make the levator sling and increase the length of the soft palate without making an incision to the nasal mucosa. 相似文献
4.
This article describes a simple, new surgical technique to provide a complete two-layer closure of palatal defect resulting from a surgical complication of trans palatal resection of skull base chordoma. The nasal layer was reconstructed with triangular shape oral mucoperiosteal turn over hinge flap based on anterior margin of palatal defect and rectangular shaped lateral nasal mucosal hinge flaps. The oral layer was reconstructed with conventional pushback V-Y advancement 2-flaps palatoplasty. Each layer of the flaps were secured with two key mattress suture for flap coaptation. This technique has some advantages: simple, short operation time, one-stage procedure, no need of osteotomy. It can close small- to medium-sized palatal defect of palate or wide cleft palate and can prevent common complication of oronasal fistula, which could be caused by tension. 相似文献
5.
双岛黏骨膜瓣修复不完全性腭裂 总被引:1,自引:0,他引:1
李志来 《实用口腔医学杂志》2005,21(3):400-402
目的:探索双岛黏骨膜瓣修复不完全性腭裂的效果。方法:采用双岛黏骨膜瓣修复12例不完全性腭裂,将2个黏骨膜瓣分别置于软腭的口、鼻腔面,延长软腭;临床观察黏骨膜瓣生长情况,软腭后推程度以及对语音的影响。结果: 12例黏骨膜瓣存活良好,无穿孔、复裂、感染、坏死等并发症;软腭明显后推, 语音有一定改善。结论:双岛黏骨膜瓣由腭前神经血管束供养,营养丰富,成活力强,能有效地使软腭后推,是修复不完全性腭裂的一种良好方法。 相似文献
6.
Makoto Noguchi Yoshiyuki Suda Shizuyo Ito Gen iku Kohama 《Journal of cranio-maxillo-facial surgery》2003,31(3):137-141
BACKGROUND AND OBJECTIVE: Palatal surgery for cleft lip, alveolus and palate is considered to have the most powerful negative impact on maxillary growth. The aim of this study was to compare dento-alveolar development of the permanent dentition and morphology of the palate after surgery in unilateral cleft lip, alveolus and palate patients following two types of palatoplasty: supraperiosteal flap vs mucoperiosteal flap technique.PATIENTS: Thirty-eight patients born between 1976 and 1983 with a complete unilateral cleft of lip, alveolus and palate were studied. Fifteen patients were treated with supraperiosteal flaps (SP group), and the other 23 patients with mucoperiosteal flaps (MP group). In this cross-sectional study, dental casts of stage IV A of Hellman's dental age in each patient were used. METHODS: The following distances were measured: (1). transverse distance C-C', (2). transverse distance M-M', (3). palatal length, (4). palatal height. RESULTS: No statistically differences were seen between the SP and MP groups regarding C-C' and M-M'. However, palatal length and palatal height were significantly greater in the SP than in the MP group. CONCLUSION: The technique that leaves no denuded palatal bone is considered to be advantageous for the development of the alveolar process. 相似文献
7.
M B Honnebier D S Johnson A A Parsa A Dorian F D Parsa 《The Cleft palate-craniofacial journal》2000,37(2):127-129
OBJECTIVE: Oro-nasal fistula is a common complication of palatoplasty. Current methods for fistula repair utilize mucoperiosteal flaps or pedicled flaps. These procedures are often cumbersome and leave a raw nasal surface, which may increase the incidence of postoperative risks and problems. In addition, the recurrence rate of the fistula is as high as 34%. We propose a simple two-layer method of fistula repair to avoid recurrences. DESIGN: A standard mucoperiosteal flap is raised on the oral side. A buccal mucosal graft is harvested from the cheeks and sutured to the nasal side of the flap that is then inset into the fistula. SETTING: Patients were either referred to the senior author's private practice (four patients) or were patients who had previously been operated on by the senior author himself (three patients). SUBJECTS: Study subjects consisted of seven patients, four males and three females, ages 14 months to 8 years. All patients had previously undergone cleft palate repair, complicated by subsequent oro-nasal fistula formation. INTERVENTIONS: All patients underwent oro-nasal fistula repair under general anesthesia with a local mucoperiosteal flap lined with buccal mucosal grafts placed on the nasal side of the flap. RESULTS: In all cases, the fistula was completely closed at first attempt without complications. Patients were followed for a minimum of 2 years, without evidence of recurrence. CONCLUSIONS: Our proposed surgical procedure for fistula closure using a standard mucoperiosteal flap lined with a buccal mucosal graft is a suitable alternative for the repair of postpalatoplasty oro-nasal fistulas. Further study and long-term follow-up is needed to establish this method as a new standard form of repair. 相似文献
8.
Stephen Bresnick John Walker Noreen Clarke-Sheehan John Reinisch 《The Cleft palate-craniofacial journal》2003,40(3):280-283
OBJECTIVE: Patients with Treacher Collins syndrome have abnormal vascular supply to the palate, yet it is unknown whether there are increased postoperative healing problems following palatoplasty. This study investigated the correlation between Treacher Collins syndrome and postoperative palatal fistula formation. DESIGN: Retrospective chart review was performed. PATIENTS: Children undergoing palatoplasty at Children's Hospital Los Angeles from 1987 to 2000 were evaluated. Ten children with Treacher Collins syndrome, 92 children with other syndromes and cleft palate, and 458 nonsyndromic patients with isolated cleft palate were studied. INTERVENTIONS: All children were treated with a one-stage, double-reversing Z-plasty cleft palate repair. MAIN OUTCOME MEASURES: Outcome measures included intraoperative observations of surgical anatomy and postoperative clinic follow-up of fistula formation. Palatal fistula rates between patients with Treacher Collins syndrome, other syndromes, and no syndrome were compared with chi-square analysis. RESULTS: Children with Treacher Collins syndrome had significantly greater palatal fistula rates (50%) than children with other syndromes (8.7%) or no syndrome (4.1%). Treacher Collins patients demonstrated large palatal fistulas and poor flap vascularity. CONCLUSIONS: Children with Treacher Collins syndrome and cleft palate have significantly higher palatal fistula risk than other children with cleft palate when double-reversing Z-plasty palate repair is performed. Our findings suggest that children with Treacher Collins syndrome and cleft palate may have poor vascularity to palatal flaps created during palatoplasty. Furthermore, we recommend that surgeons performing palatoplasty minimize the dissection of mucoperiosteal flaps around the greater palatine arterial pedicle and utilize closure techniques creating the least vascular disruption of palatal tissue. 相似文献
9.
In some cases of extensive palatal defects surgical closure may be regarded as unfeasible, and the condition treated with an obturator prosthesis. In such a case the cleft can be closed in one operation by means of a pharyngeal flap elongated through a pharyngotomy according to Bengt Johanson (1966). Eleven patients who had used obturators were operated on between 1957 and 1978. The mean age of the patients was 39 years. All patients were cleft lip and palate or cleft palate cases; two unilateral, five bilateral, and four with an isolated cleft palate. In most of these patients a temporary tracheostomy was performed after which the pharynx was opened through a neck incision. A flap was created which reached the alveolar ridge. For oral closure, mucoperiosteal flaps were used. Anterior palatal fistulas developed in two cases; one closed spontaneously and the other remained as a 3-mm fistula behind the alveolar ridge. Three patients had postoperative transient dysphagia. Phoniatric evaluation showed that two patients had better speech after operation than before with an obturator. Gross speech improvement at this late age should not be expected and is not the primary goal of the procedure. The aim of surgical closure with an elongated pharyngeal flap is to replace the obturator. 相似文献
10.
Hisao Ogata Tatsuo Nakajima Fumio Onishi Ikkei Tamada Makoto Hikosaka 《The Cleft palate-craniofacial journal》2006,43(6):651-655
OBJECTIVE: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. METHODS: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. RESULTS: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. CONCLUSIONS: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non-push-back method of hard palate repair. 相似文献
11.
软腭及磨牙后区肿瘤手术完整切除后采用腭部岛状瓣一期修复的方法修复10例,取得了很好的效果,修复后粘膜与附近正常粘膜与对侧粘膜的光滑度、质地和弹性无明显差异,颜色略白,对咀嚼摩擦和食物刺激无明显影响,也无张口受限及发音障碍和口鼻返流。该瓣血运丰富易成活,部位隐蔽,瓣切取后对功能无明显影响,能在病灶切除后即刻修复组织缺损,此组织瓣可理想的分隔口鼻腔,并能实现良好的张口度,为临近缺损提供合适的一期重建,是功能外科不可忽视的重建方法。 相似文献
12.
Noguchi M Suda Y Ito S Kohama GI 《The British journal of oral & maxillofacial surgery》2004,42(5):432-435
We compared palatal sensitivity after push-back palatoplasty in patients operated on with a conventional mucoperiosteal flap and with a supraperiosteal flap. We studied 37 patients, whose mean age was 18 years (range 11-28), with unilateral cleft lip, alveolus, and palate who required palatoplasty at our clinic; 18 patients had a supraperiosteal, and 19 a mucoperiosteal flap. Thresholds of palatal sensitivity were measured with Semmes-Weinstein monofilaments. The mean values of thresholds of palatal sensitivity in patients who had a push-back palatoplasty were higher than those in a normal control group. The mean values for patients who had a supraperiosteal flap were significantly lower than those who had a mucoperiosteal flap. 相似文献
13.
Isik D Durucu C Isik Y Atik B Kocak OF Karatas E Bekerecioglu M 《The Journal of craniofacial surgery》2011,22(4):1203-1209
Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique. 相似文献
14.
Tunnel Technique for the Closure of an Oroantral Fistula with a Pedicled Palatal Mucoperiosteal Flap
Akiko Sakakibara Shungo Furudoi Shunsuke Sakakibara Masato Kaji Takashi Shigeta Taiki Matsui Tsutomu Minamikawa Takahide Komori 《Journal of maxillofacial and oral surgery》2015,14(3):868-874
Background
Oroantral fistula may develop as a complication of tooth extraction owing to infection, trauma, or removal of maxillary cyst or tumors. Closure by using a palatal mucoperiosteal flap with the greater palatine vessels is a very traditional and basic technique. The palatal mucosa is thick and is firm. However, deformation can occur with shifting of the mucoperiosteal flap, survival of the flap may be unsuccessful, and patients may have substantial intraoral discomfort felt until healing of the eminence with the arcuation. As a method to relieve these problems, we present a mucoperiosteal tunnel technique for the closure of oroantral fistula by using a palatal mucoperiosteal flap pedicled with the greater palatine vessels.Method
A 42-year-old man and a 69-year-old woman each had a palatal fistula after palatal tumor resection and tooth extraction, respectively. We designed a mucoperiosteal flap pedicled with the left greater palatine vessel. We ablated the mucoperiosteum between the fistula and the mucoperiosteal flap, and passed this flap under the ablated mucoperiosteum as a tunnel.Result
One year after surgery, the fistula had not reappeared and the mucoperiosteal flap harvest did not generate dyskinesis of the soft palate.Conclusion
Tunnel technique for the closure of an oroantral fistula with a pedicled palatal mucoperiosteal flap is obtains good fructification. 相似文献15.
16.
M. Kulewicz Z. Dudkiewicz 《International journal of oral and maxillofacial surgery》2010,39(2):122-128
This study compared craniofacial morphology between three groups of children with complete unilateral cleft lip and palate, treated with different surgical protocols. The study included 66 10-year-old children (42 boys and 20 girls) with a complete unilateral cleft lip and palate (22 patients in each of the three groups). Children aged 7 months underwent one-stage surgery, performed by a single surgeon. During surgery, the soft and hard palate and the lip underwent correction. The difference between the groups depended on the hard palate closure. Group I patients had the mucoperiosteal flap elevated on both sides of the cleft. Group II patients had the mucoperiosteal flap elevated on the non-cleft side, and had only a minimal 2–3 mm mucoperiosteal flap elevated on the cleft side. Group III patients had mucoperiostium elevated from the septum vomer to create a single-layered caudally pedicled flap, and had only a minimal 2–3 mm palatal flap elevated on the cleft side. Craniofacial morphology was defined using lateral cephalometric analysis. Significant craniofacial morphological differences were identified between groups I, II and III. Group III demonstrated the most favourable morphology. This indicates that the technique of hard palate closure has significant influence on craniofacial growth and development. 相似文献
17.
18.
M A Grzonka K H Koch J Koch S Glindemann 《Journal of cranio-maxillo-facial surgery》2001,29(2):106-110
BACKGROUND: Several criteria are described in the literature to diagnose a submucous cleft palate. Commonly the differences in the extent of the submucous cleft will not be as overt as in open clefts. Nevertheless, complete submucous cleft palate may cause imperfect palato-pharyngeal closure so that the affected person needs to undergo speech training and surgical treatment. PATIENTS: We investigated 30 patients who underwent palatal repair to correct this disorder. They were evaluated according to the Koch's documentation system. RESULTS: In all patients an additional malformation of the inner nose was found: The vomer was not fused with the palatal shelves. There were different degrees of severity of this vomerine malformation and they were not necessarily correlated with the extent of the palatal cleft. CONCLUSION: In our opinion, this malformation of the vomer should be seen as a typical symptom of classical submucous cleft palate. Discussion is needed on how the vomerine malformation should be incorporated into the surgical procedure. Since we know from septal surgery that a basal septal perforation will lead to disturbances of nasal breathing. 相似文献
19.
目的 改进牙槽突裂植骨术的技术方法,并对腭侧入路牙槽突裂植骨术的即刻效果进行初步评价。方法 选取20名非综合征性单侧牙槽突裂患者为研究对象,其中不完全性牙槽突裂患者8名,完全性牙槽突裂患者12名。 对20例患者实施腭侧入路牙槽突裂植骨术,在术前和术后分别拍摄锥形束CT(CBCT)片,使用Image-Pro Plus 5.1软 件测量相关数据并进行统计学分析。结果 20名患者中总体植入骨量比率为88%,唇侧植入骨量比率为93%,腭侧植入骨量比率为84%。结论 腭侧入路牙槽突裂植骨术弥补了既往腭侧植入骨量不足的缺点,裂隙内鼻腔瓣三角瓣的切口设计兼顾了鼻底裂隙和唇侧裂隙的关闭,避免大范围的松弛切口以及颊侧黏膜推进瓣的应用。 相似文献
20.
改良腭黏膜瓣整复软腭裂的临床观察 总被引:1,自引:0,他引:1
目的:探讨整复软腭裂的新术式,重建腭咽闭合的效果。方法:采用腭黏膜瓣后推术对25例软腭裂患者进行整复治疗,并对其进行随访,以了解术后腭咽闭合的情况。结果:所有患者术后腭部创口愈合良好,瘢痕不明显,软腭的活动度良好,且均有良好的腭咽闭合功能。结论:对先天性软腭裂的患者实施该术式整复,能较好地恢复腭咽闭合功能,是较为理想的手术整复方法之一。 相似文献