重视麻醉在唇腭裂整复术中的作用

近20年来,随着各种慈善组织进入我国,开展唇腭裂整复术的医院逐渐增多,提高了国内唇腭裂整复的整体水平。但在普及过程中,也出现了一些问题,尤其是在麻醉方面。本文从唇腭裂患者和婴幼儿的特点及其唇腭裂治疗出发,阐述了麻醉医师在唇腭裂整复中的作用和地位,同时提出了"龟兔赛跑的新理念",强调了团队合作的重要性。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对于唇腭裂治疗的经验,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唇腭裂和麻醉团队的治疗。     

以协作组形式治疗唇腭裂患者

本文介绍了香港大学牙科学院唇腭裂治疗中心以协作组形式对唇腭裂患者进行治疗的情况，唇腭裂患者从出生到成人均在此中心得到序列治疗，在儿童生长发育的不同阶段采取相应的治疗手段。建立一个相互协作的中心是治疗唇腭裂患者的有效措施并可取得最佳的治疗效果     

Anne Marie Kuijpers-Jagtman教授访问北京医科大学

应北京医科大学口腔医学院邀请,荷兰Nijmegen大学正畸科教授,唇腭裂中心主任AnneMarieKuijpers-Jagtman博士于1999年9月8日访问了北京医科大学口腔医学院正畸科并就唇腭裂患者的上颌发育进行了专题讲座。AnneMarieKuijpers-Jagtman教授从事唇腭裂治疗和研究二十多年,经验丰富。她首先简单地介绍了Ni-jmegen大学正畸科及唇腭裂治疗中心的情况,然后就唇腭裂患者上颌骨发育普遍较差的原因发表了看法。唇腭裂患者上颌骨发育问题是受到世界上普遍关注的问题,同时也是唇腭裂治疗中的难点之一。AnneMarieKuijpers-Jagtman教授认为:影响唇腭裂…     

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…     

唇腭裂患者及其家长的心理特点与心理护理

随着唇腭裂序列治疗的不断发展,唇腭裂患者及其家长的精神心理受到越来越多的关注,对其心理障碍的预防和治疗己成为唇腭裂序列治疗的重要组成部分。唇腭裂患者多在儿童及青少年期接受手术及相关治疗,对此期唇腭裂患者及家长的心理护理及相关健康教育是唇腭裂护理的重要内容之一。本文结合临床实践并在文献复习的基础上,对唇腭裂患者及家长的心理护理进行了相应介绍。     

单侧完全性唇腭裂上下牙弓关系评价研究

目的　评价单侧完全性唇腭裂（UCLP）患者上、下颌牙弓关系的协调性,并与亚洲和欧洲几大著名唇腭裂治疗中心的研究结果进行比较,为唇腭裂继发牙牙合畸形的诊断、矫治设计和序列治疗提供依据。方法　回顾性分析2013年3月至2014年3月于青岛大学附属医院口腔正畸科就诊的52例UCLP患者治疗前的记存模型,按照Goslon Yardstick 评价系统和Eurocleft三分类法进行牙弓协调性评价。与中国台湾长庚医院、日本东京大学医院及欧洲6所唇腭裂治疗中心（A～F）的同类研究结果相比较,并进行统计学分析。结果　本中心UCLP患者Goslon Yardstick平均等级为3.75 ± 0.93,Goslon Yardstick等级为4的患者最多,占36.5%,59.6%患者属于差及较差的等级。与台湾长庚医院、东京大学医院及欧洲唇腭裂D治疗中心的结果相接近（P＞0.05）,比其他5所欧洲唇腭裂治疗中心患者的牙弓协调性差（P＜0.05）。结论　UCLP患者上、下牙弓协调性差。青岛大学附属医院接受正畸治疗的UCLP患者,上下牙弓协调性与台湾长庚医院、东京大学医院、欧洲唇腭裂D治疗中心接近,比其他5所欧洲唇腭裂治疗中心牙弓协调性差。     

开展唇腭裂患者心理干预的必要性和途径

心理干预是唇腭裂序列治疗的重要组成部分。目前在唇腭裂序列治疗过程中,对患者的心理问题尚未引起足够的重视,缺乏开展实践工作的经验。为此,笔者在深入剖析唇腭裂患者心理问题成因和心理特点的基础上,提出把唇腭裂患者心理健康确定为唇腭裂序列治疗的最终目标,并结合我国的实际情况和经验,提出在现阶段开展唇腭裂心理干预的可行途径。     

唇腭裂治疗的几种模式

唇腭裂治疗 ,目前在国内、国外存在着几种模式 ,除了国内多数医院采用的唇腭裂分次进行治疗外 ,还有先行软腭裂修复和外科前矫形治疗后 ,再行腭裂修复。一、唇腭裂同期一次修复唇腭裂同期一次修复 ,多在发展中国家采用 ,由于经济及文化的原因 ,家属仅要求外科修复裂隙 ,作为治疗的唯一目的 ,因此存在较多的问题 ,但对于成年患者及较大儿童 ,仍是一种可选择的经济节约的治疗方式。二、婴儿期先行软腭裂修复的治疗模式华西医大口腔医院 ,对 47例完全性唇腭裂的患者 ,在婴儿期 ,先行软腭裂修复 ,同期进行唇粘连 ,第二阶段完成硬腭裂修复及唇裂…     

Prahl-Andersen教授来访

应北京大学口腔医学正畸科的邀请,2002年11月22日,来自荷兰阿姆斯特丹牙科研究中心的Prahl—Andersen教授来我院进行学术交流,并就唇腭裂患者的早期治疗及序列治疗作了独特的专题讲座。 Prahl—Andersen教授在唇腭裂正畸治疗方面有着丰富的临床经验和丰硕的研究成果;作为唇腭裂治疗小组的一名成员,她亦积极致力于唇腭裂患者治疗的推广工作,为改善唇腭裂患者的生存质量而努力至今。     

牙槽突裂植骨与正畸

唇腭裂是一种较为常见的口腔颌面部先天发育畸形,其国内的发病率约为0.82‰～1.6‰。由于唇腭裂患者先天的颌面部发育缺陷及手术创伤的影响,常形成牙颌面畸形。据唇腭裂术后统计,其错殆畸形的患病率为97%。随着对唇腭裂先天畸形病理生理认识的不断深入,唇腭裂的治疗已发展成为由多学科共同合作的综合序列治疗,大大提高了对唇腭裂患者形态和功能的治疗效果。而序列治疗中,牙槽突裂植骨和正畸治疗对于唇腭裂患者的功能和美观是至关重要的。本文就牙槽突裂植骨术与上颌尖牙或侧切牙的萌出、上颌骨扩     

Seasonal variation and regional distribution of cleft lip and palate in zambia

Objective: To assess variations in seasonality and regional distribution of orofacial clefts in babies born in Zambia. Design: A retrospective chart review was done using records of all cleft procedures performed by the only plastic surgeon in Zambia (G.J.). Delivery data from the University Teaching Hospital (UTH) were also examined to estimate the birth prevalence of orofacial clefts (55,108 live births between 2001 and 2005). Patients: All cleft patients operated in Zambia from 2000 to 2006 (413 patients). Results: A low birth prevalence of clefts (1/4239 live births) was found using UTH delivery data. Surgical data showed no difference for the frequency of one gender over another overall (M:F ratio is 1.04; p = .70). More bilateral clefts occurred in cleft lip and palate (CLP) patients than in cleft lip (CL) patients (p < .01), and more unilateral left-sided clefts occurred in CL than in CLP patients (p = .03). The data reflected seasonal variation in month of birth of cleft lip with or without cleft palate (CL+/-P) patients (p < .01), with a peak in April and May and more births in March through August (57.2%) than in September through February (42.8%). There was regional variation in cleft births among the nine Zambian provinces (p < .01). Conclusions: This study shows seasonal variation in clefts that may be explained, at least in part, by environmental factors affecting the development of CL+/-P. Access to treatment is likely the major determinant of regional disparity in clefts. These results provide a basis for further epidemiological studies of orofacial clefts in Zambia.     

Sucking performance of babies with cleft conditions.

OBJECTIVE: To describe the sucking performance of bottle-fed babies with cleft conditions. PARTICIPANTS: Forty 2-week-old-babies with cleft lip (CL; n = 8), cleft palate (CP; n = 22), and cleft lip and palate (CLP; n = 10) were examined. METHODS: Suction, compression, and other sucking parameters were measured during bottle-feeding and compared to determine if they varied with cleft condition or feeding ability. RESULTS: All babies with CL and one with CLP demonstrated suction. Thirteen of 22 babies with CP demonstrated suction but only three maintained regular pressure changes over time. Between-group differences in the amplitude of suction and compression were associated with cleft condition. Cleft lip participants demonstrated the greatest amplitude of suction followed by those with CP and CLP. Cleft lip and CP participants generated similar amplitudes of compression. This was greater than their counterparts with CLP. Good feeders (n = 15) generated high levels of suction, while satisfactory (n = 15) and poor feeders (n = 10) did not generate any during bottle-feeding. CONCLUSION: Between-group differences in intra-oral pressures were confirmed when babies were examined by cleft condition. Babies with smaller clefts (i.e., CL or minor soft palate clefts) were more likely to generate normal levels of suction and compression compared to their counterparts with larger clefts. Since good feeders were more likely to have smaller clefts it was not surprising that they demonstrated higher suction pressures than babies with satisfactory or poor feeding ability. Compression values were not significantly different across the feeding ability groups. These data may inform feeding management strategies.     

Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.     

Preferential associations between oral clefts and other major congenital anomalies

Objectives: To identify preferential associations between oral clefts (CL = cleft lip only, CLP = cleft lip with cleft palate, CP = cleft palate) and nonoral cleft anomalies, to interpret them on clinical grounds, and, based on the patterns of associated defects, to establish whether CL and CLP are different conditions. Design And Settings: Included were 1416 cleft cases (CL = 131, CLP = 565, CP = 720), among 8304 live- and stillborn infants with multiple congenital anomalies, from 6,559,028 births reported to the International Clearinghouse for Birth Defects Surveillance and Research by 15 registries between 1994 and 2004. Rates of associated anomalies were established, and multinomial logistic regressions applied to identify significant associations. Results: Positive associations with clefts were observed for only a few defects, among which anencephaly, encephaloceles, club feet, and ear anomalies were the most outstanding. Anomalies negatively associated with clefts included congenital heart defects, VATER complex (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia), and spina bifida. Conclusion: The strong association between all types of clefts and anencephaly seems to be attributable to cases with disruptions; the association between CP and club feet seems to be attributable to conditions with fetal akinesia. Some negative associations may depend on methodologic factors, while others, such as clefts with VATER components or clefts with spina bifida, may depend on biological factors. The different patterns of defects associated with CL and CLP, indicating different underlying mechanisms, suggest that CL and CLP reflect more than just variable degrees of severity, and that distinct pathways might be involved.     

Influence of season on prevalence of cleft lip and palate

According to the multifactorial threshold (MFT) model, cleft lip and palate (CLP) result from the influence of exogenous and endogenous genetic factors. Based on nearly 1000 cases of cleft lip with or without cleft palate treated in the clinic for maxillofacial surgery of the Martin-Luther University Halle-Wittenberg during the period 1946-1995, we investigated the influence of season on the occurrence of this malformation. Seasons of the year reflect various exogenous factors that may be accessible to prevention. The calculated date of conception served as comparison value between the study group and controls. The clefts of type III (CLP; P = 0.48), isolated CP (P = 0.933) or male patients with clefts of type I showed no significant deviation from the distribution in the control group over the year. We proved a significant maximum in spring, summer and autumn and a minimum in winter for the conception date of female patients with type I clefts (P = 0.033, relative risk = 2.6). Some of the seasonal factors implicated in the aetiology that play a role in the development of clefts could be:     

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.     

唇腭裂相关心理学研究的历史和现状及展望

随着唇腭裂序列治疗的不断发展,唇腭裂患者的心理健康状况受到越来越多的关注,对其心理障碍的研究、预防和治疗也已成为序列治疗中不可或缺的部分;然而,唇腭裂患者心理状况的研究尚处于起步阶段,患者的心理特征和可能存在的心理障碍并不十分明确。本文综述了大量中外学者对唇腭裂相关的心理研究资料,旨在归纳总结该领域研究的历史及现状,并对今后的研究工作提出设想。     

Reproductive history of mothers of children with solitary, nonsyndromic cleft lip and/or palate.

The reproductive history was studied to evaluate if the three types of solitary, nonsyndromic clefts: cleft lip (CL), cleft lip and palate (CLP), and cleft palate (CP) are homogeneous entities. Occurrence of fetal loss, maternal health, and drug consumption of the mother during the pregnancy were compared in cases involving three types of clefts. Data was gathered from 87 children with clefts, 55 males and 32 females. Spontaneous abortions and vaginal bleeding were found to occur significantly more often in the (older) mother of a CLP child. This suggests that the factors involved in the etiology of CLP differ from the factors involved in CL and CP. Therefore, grouping of data of the three types of clefts in studies on the etiology should be avoided.     

Adult patients with treated complete cleft lip and palate. Methodological and clinical studies

The purpose of the present thesis was to investigate the quality of life, satisfaction with treatment, prevalence of temporomandibular disorders, psychosocial distress, and occlusal stability in a treated group of adults with complete cleft lip and palate (CLP). Sixty-eight adults (44 men and 24 women) with a mean age of 24.2 years (range 19.5-29.2) with treated CLP were compared with a gender- and age-matched group with no clefts. The CLP subjects were born between 1968 and 1977 and had undergone standardised plastic surgery at the Department of Plastic Surgery, University Hospital, Link?ping, Sweden. Logopaedic, phoniatric, otological, and orthodontic examinations and treatment had been provided locally, supervised by the Cleft Plate Team. The subjects answered a multidimensional, self-report, standardised questionnaire regarding psychological and somatic conditions. The subjects underwent a clinical TMD examination and an evaluation of the occlusion. The reliability of the multidimensional questionnaire was analysed for the CLP group by a test-retest study within a 2-3 week interval and most questions showed an overall good reliability. A panel of professionals judged the outcome of the surgical treatment on colour slides of the CLP subjects. The dental plaster casts of 39 subjects born with complete unilateral cleft lip and palate (UCLP) were analysed (mean age 24.7 years, range 20.2-29.3) and compared with the dental plaster casts taken at mean age of 19.1 years (range 16.0-20.6). The overall level of quality of life was rather high in both groups. The CLP group rated some detached aspects, such as life meaning, family life, and private economy, significantly lower than did the group without clefts. Overall aspects such as well-being and social life were affected by having a treated cleft but not the more practical and tangible aspects of their daily living. There was an overall high level of satisfaction with all the different part of the body in both groups, but the CLP group reported significantly more dissatisfaction with their nose, lips, mouth, profile, and overall facial appearance than the group without clefts. The professionals and the subjects with CLP were generally not very satisfied with the results of surgical treatment. Thirty of the subjects with CLP (47%) wished to have more operations. The professional group recommended further operations in 38 of the subjects (59%) in particular, rhinoplasties. The CLP group had significantly higher frequencies of cross-bite than the group without clefts, but no differences regarding TMD pain were found between the two groups. In the subjects with treated UCLP, there was a significant deterioration in the occlusal score and the maxillary arch dimensions between 19 and 25 years. This was irrespective of the type of retention. The persisting morphological malocclusion with a low frequency of interferences has had no influence on TMD symptoms in the group of CLP patients studied. The conclusion is that the CLP subjects in the present study seemed to be psychosocially well adjusted to their disability. However, 47 per cent wished to have further surgical treatment. The persisting malocclusions did not provoke TMD symptoms.