先天性牙槽粘连伴腭裂1例

口腔粘连是指上颌骨和下颌骨之间的纤维或软组织粘连,这些粘连可以出现在口腔的不同位置,牙槽粘连为其表现之一。牙槽粘连是一种罕见的先天性畸形,很少独立存在,常伴有其他先天性缺陷,如唇裂、腭裂、微小舌、小颌畸形或颞下颌关节异常,其中腭裂最为常见。现报道1例先天性牙槽粘连伴腭裂患儿,经过手术治疗后创口愈合良好,并讨论其病因及治疗。     

腭裂修复术同期鼓室置管的疗效及并发症防治

目的　探讨腭裂伴渗出性中耳炎患儿的联合治疗。方法　比较38例(49侧耳)单纯性腭裂修复术与24 例(39侧耳)腭裂修复同期行鼓膜切开、PE管置入术对中耳积液的消除及听力的影响,并对置管术的适应证、操作要点、并发症的防治进行讨论。结果　腭裂修复同期鼓膜切开置管组术后6月48·7%的患耳中耳积液消失,明显高于单纯腭裂修复组。听力损害的患儿置管后听力平均提高17 dB。结论　有中耳积液的腭裂患儿在腭裂修复术同期行鼓室切开、PE管置入术,有助于改善患儿的中耳功能。     

腭裂儿童合力和咀嚼效能的测定

本研究采用ＭＰＭ－３０００咬合力计和ＵＶ－２６５岛津自动记录分光光度计对１０５例术前腭裂儿童的力和咀嚼效能进行测定,并与对照组（同龄正常儿童）进行了比较,结果表明：软腭裂和部分腭裂的患儿两项指标与对照组之间均无显著差异,而单侧完全腭裂和双侧完全腭裂的患儿则都明显的低于对照组。从一个方面反映出,腭裂畸形程度对患儿口颌系统功能的影响,提示对完全腭裂患儿要进行早期正畸治疗。     

1例应用舌瓣修复腭裂术后巨大穿孔的研究报告

先天性唇腭裂是较为常见的畸形,其中腭裂对患儿的颌骨发育、语言及饮食等功能影响巨大。目前腭裂的主要治疗方法为手术修复,由于多种原因影响,腭裂术后出现复裂或穿孔很常见[1]。     

腭裂儿童He力和咀嚼效能的测定

本研究采用MPM－3000咬合力计和UV－265岛津自动记录分光光度计对105例前腭裂儿童的He力和咀嚼效能进行测定，并与对照组（同龄正常儿童）进行了比较，结果表明：软腭裂和部分腭裂的患儿两项指标与对照组之间均无显著差异，而单侧完全腭裂和双侧完全腭裂的患儿则都明显的低于对照组。从一个方面反映出，腭裂畸形程度对患儿口颌系统功能的影响，提示对完全裂患儿要进行早期正畸治疗。     

综合征性腭裂与腭裂术后腭咽闭合不全

腭裂修复术后的语音恢复 ,一直是备受外科医师和语音治疗师关注的焦点问题之一 ,随着腭裂修复手术年龄的下降 ,术后的语音效果得到明显提高 ,但无论手术年龄多小 ,仍有 5 %～ 10 %的患者术后存在腭裂语音[1] ,而腭裂语音的产生与术前的口鼻腔相通和术后的腭咽闭合不全有直接的关系。为什么腭裂术后有一定比例的患者发生腭咽闭合不全 ?除了学者们公认的影响因素 ,如 :手术年龄、手术技术以及患者的解剖生理条件外[1] ,腭裂伴有其他先天畸形也是非常重要的影响因素。据文献报道共有 178种伴有唇腭裂的综合征、序列征、联合征以及其他畸形 ,占…     

腭裂语音的元音语图模式特征

对腭裂语音异常机制的研究是腭裂序列治疗的前提。近年来 ,应用语图分析语音受到病理性语音研究者的重视 ,但结合汉语普通话的语音特点的腭裂语音研究尚未见报道。作者对腭裂术前患儿和健康儿童的语图模式进行比较 ,了解腭裂语音的变化及语图模式的发展规律 ,分析其发音异常所在 ,对语音矫治提供理论基础。1　材料和方法选择吉林大学口腔医学院拟行手术的腭裂患儿 2 9例 ,年龄 5～ 15岁 ,男 19例 ,女 10例 ,其中完全性腭裂 2 2例 ,不完全性腭裂 7例 ,均无明显智力及听力损害 ,无重度牙颌畸形 ,无上呼吸道感染影响鼻通气因素 ,无舌运动障碍 ,…     

单瓣法修复腭裂22例临床观察

目的观察单瓣法手术治疗Ⅱ度腭裂和单侧完全性腭裂的临床疗效。方法应用单瓣法修复22例腭裂患儿,利用其患侧的腭黏骨膜瓣关闭裂隙,并制备腭骨瓣后退延长软腭。结果本组22例患儿均未输血;术中测量软腭后退长度平均7.5mm;术后切口愈合良好,发音效果改善明显。结论单瓣法治疗Ⅱ度腭裂和单侧完全性腭裂,创伤小、出血少、效果好、操作简便。     

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。     

腭裂修复术同期中耳穿刺治疗分泌性中耳炎

腭裂是颌面部常见的先天性畸形 ,腭咽部组织结构发育缺陷 ,使腭裂患者常并发分泌性中耳炎 (ｓｅｃｒｅｔｏ ｒｙｏｔｉｔｉｓｍｅｄｉａ ,ＳＯＭ )发生率远高于正常人群 ,约占4 0 %～ 6 0 %[1,2 ] ,严重妨碍患儿的语言、智力和心理等方面的正常发育。既往对腭裂患儿以单纯修复腭裂 ,关闭裂隙 ,听力恢复被忽视。近几年 ,多家学者报道改善中耳功能 ,提高听力水平 ,已成为腭裂并发ＳＯＭ患者序列治疗的一个重要方面。近 5年来 ,我科对腭裂并发ＳＯＭ患儿在行腭裂修复的同期行中耳穿刺 ,抽出中耳腔粘稠积液 ,获取较好疗效 ,报告如下。1　材料与…     

Pierre Robin综合征低龄患者行腭裂修复术围手术期的风险评价

目的 评价Pierre Robin综合征低龄患者施行腭裂修复术围手术期的风险，并探讨控制风险的手段。方法 2001年5月-2004年2月北京大学口腔医学院收治Pierre Robin综合征患者共6例，均由同一名颌面外科医师采用von Langenbeck术式进行腭裂修复，围手术期行血氧监测，术前及术后第4天行多导睡眠仪监测。结果 所有患者均在麻醉插管时出现不同程度的低氧血症，只有1例在术后2h内出现了呼吸困难伴严重的低氧血症。睡眠监测结果显示，患者手术后睡眠呼吸紊乱的程度比术前并无明显加重。结论 低龄PierreRobin综合征患者实施腭裂修复术围手术期的风险主要是严重的低氧血症，经过全面的术前风险评价及严格的风险控制，多数患者在低龄阶段由经验丰富的医师进行腭裂修复手术是安全的。     

Preoperative pharyngeal depth is associated with postoperative velopharyngeal function following primary cleft palate repair at the age of five and above

To determine prognostic factors for postoperative velopharyngeal function following the primary cleft palate repair at the age of five and above.This study reviewed patients with cleft palate who had undergone Furlow palatoplasty at age 5 or older from 2009 to 2014. We obtained intraoperative measurements, including velar length, pharyngeal depth, cleft width, maxillary width, cleft palate index (cleft width/maxillary width) and palatopharyngeal ratio (velar length/pharyngeal depth), as well as speech evaluation results at least 1 year after surgery. Logistic regression and retrospective analyses were performed to determine factors associated with speech performance after the primary cleft palate repair.Among the six intraoperative measurements of velopharyngeal morphology, only pharyngeal depth was incorporated into the regression model, and was found to have an inverse association with postoperative velopharyngeal function, Exp (B) 0.883 (95% CI 0.798-0.976). Moreover, a pharyngeal depth greater than 16 mm was significantly associated with a higher risk of postoperative velopharyngeal insufficiency (P < 0.01).Pharyngeal depth is potentially a prognostic indicator for the primary management of cleft palate in older patients. Pharyngoplasty may need to be considered when the pharyngeal depth is large and the patient’s access to surgery is limited.     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

Outcomes in pharyngoplasty: a 10-year experience.

OBJECTIVE: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation. DESIGN: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes. PARTICIPANTS: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency. RESULTS: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p > .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low. CONCLUSIONS: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.     

单侧完全性唇腭裂患儿唇裂修复同期硬腭裂隙封闭的临床观察

目的　探讨单侧完全性唇腭裂患儿时唇裂修复同期硬腭裂隙封闭的可行性及临床效果。方法　47例年龄为3·0~7·5月龄的单侧唇腭裂患儿在唇裂修复同期行硬腭裂隙封闭,分析手术时间、术中出血、术后恢复、创口愈合及腭部裂隙变化情况。结果　所有患儿的手术均顺利完成。手术时间与单纯唇裂修复术相比平均延长13 min , 术中出血平均增加5 ml,术后恢复好,无创口感染及裂开。至患儿9~18月龄二期手术时腭部裂隙比行单纯唇裂修复术平均小0·28 cm,使二期手术时软腭后退充分,腭咽闭合良好。结论　单侧完全性唇腭裂患儿唇裂修复同期行硬腭裂隙封闭是安全和可行的。     

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。     

可吸收医用生物膜修复硬腭裂隙的临床应用

目的　探讨使用可吸收医用膜修复硬腭裂隙的可行性及评价其近期临床效果。方法　68例腭裂患者随机分为实验组和对照组。实验组34例患者在软腭及悬雍垂裂修复的同时剖开硬腭裂隙,植入可吸收医用膜修复; 对照组34例采用常规腭裂修复术。结果　实验组所有患者其软腭及悬雍垂创口愈合良好,无穿孔与裂开;硬腭部创口一期愈合30例,二期愈合3例,1例遗留永久性的口鼻瘘,3例存在口腔前庭瘘。与对照组相比较,其出血量及口腔前庭瘘发生率减少,手术时间无明显延长,术后出血、呼吸困难等并发症无明显增加;术后体温多波动在 37·5℃以下,且逐渐降低,7 d后复查血常规与对照组相比无显著异常。结论　可吸收医用膜用于硬腭裂隙修复, 临床效果肯定且手术操作简单、可行,同时因避免了常规腭裂修复术时在硬腭部掀起粘骨膜瓣的缺点,可减少对颌骨发育的影响。     

基于可吸收生物膜的软腭后退腭裂修复方案及其临床应用

目的:为解决常规腭裂修复术存在的问题,利用组织引导再生技术的原理,设计基于膜引导的腭裂整复方案,为需要后退软腭的腭裂修复提供新的途径或方法。方法:使用聚-DL-乳酸制成厚0.5mm、有一定强度与韧性的可吸收生物膜。先行软腭成形术,然后剖开硬腭裂隙边缘,于口腔侧骨膜瓣与腭骨水平板间形成一间隙,将膜植于其中并固定,利用膜的引导再生特性与桥梁支架作用,引导两侧软组织向中线生长而关闭裂隙。选择3-10岁需行软腭后退的腭裂患者19例,于全麻下行软腭后退成形术及硬腭裂隙植膜的临床试验,临床追踪观察6个月,了解腭裂修复的临床效果。结果:该腭裂修复方案切实可行,全部患者均按设计方案实施了腭裂修复术,方法简单,操作容易。3个月后19例患者均获临床一期愈合,6个月时临床观察软腭形态佳,腭咽闭合良好,达到腭裂硬腭软组织缺损修复、保证软腭充分后退的目的。结论:基于膜引导组织再生技术的后退软腭的腭裂修复方案,是一个创新的腭裂修复方案,手术操作简单、实用,临床效果满意,为腭裂修复提供了新的途径及方法。     

Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen

Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n=7 or unilateral [UCLP]; n=22) or isolated cleft palate (CP; n=9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate.The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.     

A preliminary study of nasal airway patency and its potential effect on speech performance.

The relationship between nasal airway size and articulatory performance was studied in a group of cleft palate patients. Articulation analysis revealed that children with bilateral cleft lip and palate were nearly twice as likely to manifest compensatory articulations as children with unilateral cleft lip and palate or with cleft palate only. When subjects were grouped according to speech performance, aerodynamic assessment indicated that children with compensatory articulations had significantly larger nasal cross-sectional areas than children without compensatory articulations. The findings suggest that children with comparatively large nasal airways may be at increased risk for developing abnormal speech patterns. If these findings are confirmed by further research, such children may be candidates for relatively early palate repair.