鼻牙槽嵴塑形矫治器在单侧完全性唇腭裂腭部畸形矫治中的效果评价

目的 评价鼻牙槽嵴塑形（PNAM）矫治器对单侧完全性唇腭裂患者腭部畸形的矫治效果。方法 研究对象分为3组,每组19例。A、B组均为非综合征单侧完全性唇腭裂患者,A组在唇腭裂手术前先行PNAM矫治,B组术前未行PNAM矫治。C组为3月龄左右鼻唇部及腭部发育正常婴儿。获取A组PNAM矫治前及PNAM矫治后唇裂术前、B组唇裂术前和C组的标准腭部模型正位照片,对模型照片进行测量。采用SPSS 21.0软件进行分析。结果 A组PNAM矫治后与矫治前相比,患者的牙弓宽度（AW）、牙弓周长（AC）、腭部面积（PA）明显增加（P<0.05）,腭部裂隙宽度（CPW）、牙槽突裂隙宽度（CWA）、牙槽突裂隙矢状向距离（CWAS）与水平向距离（CWAH）、前颌突倾斜度（PMD）、裂隙面积（CA）明显减小（P<0.05）;但与C组相比仍有差距（P<0.05）;B组AW、CPW、CA及PA较A组矫治前均明显增加（P<0.05）。多元方差分析表明,3组上颌结节间距离（TW）均无统计学差异（P>0.05）。结论 PNAM矫治是早期有效改善患者腭部原发畸形的非手术治疗手段之一。     

唇腭裂婴儿术前鼻牙槽骨塑形治疗后鼻孔、牙槽和腭部裂隙的变化

目的探讨鼻牙槽骨塑形器应用于完全性唇腭裂婴儿术前矫形的临床效果。方法通过对16例完全性唇腭裂婴儿进行术前鼻牙槽骨塑形矫治．记录治疗前后患侧鼻孔的宽度、高度,鼻小柱长度和上腭牙槽骨裂隙的变化,观察矫治效果。结果经过90～150d的治疗．9例双侧完全性唇腭裂婴儿和7例单侧完全性唇腭裂婴儿的鼻小柱长度和鼻孔宽度高度均有明显的改善．牙槽骨裂隙宽度和硬腭前部裂隙宽度均明显缩小。结论鼻牙槽塑形器能明显改善完全性唇腭裂婴儿的鼻翼和鼻小柱外观,减小牙槽骨和硬腭前部裂隙的宽度,有利于鼻部发育,减少手术难度,提高整复效果。     

新生儿完全性唇腭裂术前鼻撑和正畸治疗的临床观察

目的 观察新生儿完全性唇腭裂术前鼻撑和正畸治疗的效果。方法对38例完全性唇腭裂，通过模型测量矫治前后牙槽裂距的改变，观察治疗效果；用鼻外形的评价标准对术后患儿进行初步评价。结果经过108—152天的治疗，26例单侧完全性唇腭裂齿槽左右裂隙较矫治前平均缩小5．3mm，前后裂距较矫治前平均缩小3．5mm；鼻外形评价的优良率为76％。12例双侧完全性唇腭裂齿槽左侧裂隙平均缩小4．7mm，右侧裂隙平均缩小4．2mm，左右裂距平均扩大1．6mm，前后裂距平均缩小5．1mm，前牙槽突宽度平均增大1．2mm；鼻外形评价的优良率为66％。结论对完全性唇腭裂患者在新生儿期做术前鼻撑和正畸治疗，患儿易适应，有利鼻发育，可减小手术的难度，提高整复效果。     

完全性唇腭裂婴儿术前正畸治疗的临床研究

目的 观察术前鼻-牙槽突矫治器(PNAM)在完全性唇腭裂婴儿术前矫治中的作用.方法 采用术前鼻-牙槽突矫治器对45例非综合征性完全性唇腭裂患儿(平均年龄为18.33 d)进行唇裂术前正畸治疗,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度、鼻孔高度和牙槽骨裂隙宽度,并用SPSS 10.0软件进行统计分析.结果 经PN...     

上颌-鼻软骨整形矫治器在婴儿双侧完全性唇腭裂术前正畸中的应用

目的 探讨上颌-鼻软骨整形矫治器在婴儿期双侧完全性唇腭裂术前正畸中的应用价值.方法 对50例双侧唇腭裂患儿,随机分为试验组(n＝30)与对照组(n＝20),试验组于出生10 d～1个月内进行上颌-鼻软骨整形矫治器矫治,对照组均不做术前正畸.两组患儿正畸治疗前(T1)后(T2)对比上唇裂隙、上前牙槽突裂隙关闭程度,对比两组唇腭裂联合整复术后3个月鼻翼外观满意度,作出评价.结果 两组患儿T1、T2两侧上唇裂隙及牙槽突裂隙宽度差别无统计学意义(P＞0.05).患儿术后鼻翼外观满意度试验组87%,高于对照组60%(P＜0.05).结论 该治疗有效减少上唇及上颌骨牙槽突的裂隙宽度,改善鼻外观,达到降低手术难度,增加手术效果的目的.     

唇腭裂患儿的鼻牙槽塑形治疗:29例临床分析

目的:采用鼻牙槽塑形器对唇腭裂患儿进行术前唇、牙槽裂隙及鼻畸形矫正,观察鼻牙槽塑形疗效,总结矫治过程中出现的问题及解决对策,为鼻牙槽塑形治疗的开展提供参考。方法:选择在本院接受鼻牙槽塑形治疗的患儿29例,其中单侧唇腭裂19例,双侧唇腭裂10例;初诊年龄为出生后3～150d,矫治周期2.5～3个月,每2周复诊,调整矫正器。结果:参照鼻牙槽塑形治疗评价标准,17例患儿矫治成功,唇、牙槽裂隙明显缩小,鼻不对称畸形明显改善,鼻小柱延长;9例好转,唇、鼻畸形部分纠正,利于手术;3例患者放弃治疗。结论:鼻牙槽塑形成功的关键因素包括初诊年龄、印模、腭护板和鼻撑的调整、鼻模的应用;正畸科需要与口腔颌面外科、整形外科医师取得共识,尽早给患儿开始治疗,以提高手术效果。     

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

目的:探讨唇腭裂新生儿术前鼻-腭-牙槽骨矫形的方法与技术并进行初步疗效评价.方法:对10 例单侧唇腭裂新生儿(包括2 例伴对侧I度唇裂)进行术前鼻-腭-牙槽骨矫形主要包括鼻矫形、恢复牙弓形态、减小腭部裂隙;矫形后用改良Millard法行单侧唇裂唇鼻畸形同期整复术.采用SPSS 15.0统计软件包对所得数据进行t检验.结果:10 例唇腭裂新生儿经3 个月左右术前鼻-腭-牙槽骨矫形,鼻小柱高度、鼻塌陷畸形显著改善及鼻小柱歪斜度减小(P<0.01);唇部软组织裂隙宽度显著变窄(P<0.05),牙槽裂隙及腭部裂隙显著变窄(P<0.01).经矫形的患儿术后鼻对称性得到很好的恢复;唇部形态恢复佳.结论:唇腭裂患者术前进行鼻-腭-牙槽骨矫形是值得采用的序列治疗方法.     

50例唇腭裂患儿手术前、后血液生化指标及腭裂隙内骨再生评价

目的: 探讨唇腭裂患儿手术前、后血液生化指标的变化,以及手术对腭裂隙内骨再生的影响。方法: 选取2014年4月—2016年4月进行手术的唇腭裂患儿50例,比较手术前、后白细胞、血小板、血浆白蛋白和球蛋白比值(简称白球比)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)等,以及牙弓前段、中段、后段宽度,腭部面积、腭部裂隙宽度,牙槽突裂隙宽度,牙槽突裂隙矢状向距离、水平向距离,前颌突倾斜度、裂隙面积的差异。采用SPSS 19.0软件包对数据进行统计学分析。结果: 手术后患儿白细胞、血小板、血浆白蛋白和白球比、ALT和AST等指标显著低于手术前(P<0.05);手术后再生骨桥阳性率为80.0%,再生骨桥平均长度为(12.3±3.6)mm,平均宽度为(12.3±2.3)mm,牙弓前段平均宽度为(31.6±2.9)mm,牙弓中段平均宽度为(41.2±6.2)mm,牙弓后段平均宽度为(51.6±6.9)mm,均显著小于手术前(P<0.05);手术后腭部面积、腭部裂隙宽度、牙槽突裂隙宽度、牙槽突裂隙矢状向距离、水平向距离、前颌突倾斜度、裂隙面积与手术前存在显著差异(P<0.05)。结论: 唇腭裂患儿手术后血液生化指标发生明显变化;腭裂隙内骨再生骨桥形成,有利于唇腭裂患儿牙弓及上颌骨发育。     

术前正畸对完全性唇腭裂牙槽突植骨疗效的影响

目的　探讨牙槽突植骨术前正畸治疗对于完全性唇腭裂牙槽突植骨长期疗效的影响。方法　选择牙弓狭窄、上颌前牙舌倾或扭转 ,可以伴有前牙反 \ ,牙槽突植骨手术不易进行的完全性唇腭裂患者 16例 ,男 9例 ,女 7例。其中单侧完全性唇腭裂 10例 ,双侧完全性唇腭裂 6例 ,共有裂隙 2 2侧 ,患者年龄 8～ 2 2岁。在牙槽突植骨前进行正畸治疗 ,植骨术后定期拍摄上颌体腔片或上颌前部咬合片 ,观察植骨疗效 ,手术后观察期为 0 5～ 4年。牙槽骨高度的评价采用Bergland标准进行。结果　术前正畸 ,特别是通过开展狭窄的上牙弓 ,能够使因存在错畸形而不易进行牙槽突植骨的唇腭裂患者顺利完成手术 ,牙槽突植骨的临床成功率达 86 %。结论　对于上牙弓狭窄 ,错畸形严重的完全性唇腭裂患者 ,应该在植骨手术前进行正畸治疗。     

单侧完全性唇裂患者行术前鼻牙槽塑形治疗后牙槽突变化的三维测量分析

目的 应用三维测量分析法对单侧完全性唇裂患者行术前鼻牙槽塑形（PNAM）治疗后牙槽突的变化进行评价。方法 选取2013年11月-2015年6月于广西医科大学附属口腔医院完成PNAM治疗的单侧完全性唇裂患者30例,分别于PNAM治疗前后制取腭部口腔石膏模型,以锥形束CT（CBCT）采集DICOM数据,应用Mimics 15.0进行三维重建,并测量牙槽突裂隙宽度、牙槽突末端宽度、上唇系带中线距离、牙槽突移动距离、牙槽突长度,采用SPSS 17.0软件进行对比分析。结果 PNAM治疗前后,患者的牙槽突裂隙宽度、上唇系带中线距离明显缩小（P< 0.05）,牙槽突末端宽度差异无统计学意义（P>0.05）,较大侧牙槽突移动距离明显大于较小侧（P<0.05）,双侧牙槽突长度均有明显增长（P<0.05）,较大侧牙槽突增长量明显大于较小侧（P<0.05）。结论 印模+CBCT扫描法可以获得准确的牙槽突三维数据,经过PNAM治疗后,牙槽突形态得到显著改善。     

Comparison between palatal configurations in UCLP infants with and without a Hotz plate until four years of age.

OBJECTIVE: To evaluate the efficacy of presurgical orthopedic treatment three dimensionally, we previously developed a novel measuring system and described the efficacy of the treatment until 18 months of age. The aim of this study was to compare palatal configuration in complete unilateral cleft lip and palate (UCLP) infants fitted with a Hotz plate to those without it until four years of age using the same measuring system. PATIENTS: Twenty complete UCLP infants were divided into two groups. A Hotz plate was used with 12 patients who first visited our clinic from January 1990 to March 1992 and was not used with an additional eight patients who first visited from April 1992 to July 1993. MAIN OUTCOME MEASURES: Palatal casts taken from birth until four years of age were measured three dimensionally and were compared between the two groups. RESULTS AND CONCLUSIONS: The width of the palate was larger in the group with a Hotz plate than in the group without it at four years of age. No difference was observed between the anteroposterior distance of the palate in the two groups at four years of age. Similarly, the alveolar arch form did not differ between the two groups. The degree of curvature of the palatal surface was smaller in the group with a Hotz plate than in the group without it. These data were similar to data obtained at 18 months of age.     

单侧唇腭裂鼻-牙槽骨塑形后同期唇-鼻-牙槽骨整复术

目的:探讨唇腭裂婴幼儿术前鼻-牙槽骨塑形后的同期唇-鼻-牙槽骨整复术的方法与技术,并进行初步疗效评价。方法:对31例单侧完全性唇腭裂婴幼儿进行术前鼻-牙槽骨塑形及同期唇-鼻-牙槽骨整复术。术前鼻-牙槽骨塑形主要包括关闭牙槽骨间隙、唇牵张及鼻矫形;早期同期唇-鼻-牙槽骨整复术,即牙龈-牙周膜-牙槽骨整形术和改良Mohler法单侧唇裂唇鼻畸形同期整复术。采用SPSS10.0统计软件包对所得数据进行t检验。结果:31例唇腭裂婴幼儿经2～3个月术前鼻-牙槽骨塑形,唇裂隙宽度显著变窄(P<0.01),裂隙两侧唇组织适度牵张;鼻小柱延长及鼻塌陷畸形显著改善(P<0.05);牙槽裂隙显著变窄(P<0.01)。术后2例失访,29例患者随访6～30个月,结果显示:上唇和鼻形态俱佳,鼻小柱端正,鼻尖形态改善,双鼻孔、鼻底堤状隆起对称;口腔前庭-鼻腔瘘封闭;27例患者牙槽突裂隙关闭,牙槽骨连续性及稳定性增强并在原牙槽裂隙处有牙萌出,其中13例牙槽嵴高度、宽度及厚度不足;2例仍有1～2mm的牙槽裂隙。结论:单侧完全性唇腭裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨,术前进行鼻-牙槽骨塑形和同期唇-鼻-牙槽骨整复术是值得采用的序列治疗方法。     

The clinical use of Hotz-type orthopedic plate

In the present study a Hotz type orthopedic plate was used to improve feeding and physiological growth. In 2 patients with cleft lip it was used to improve feeding and swallowing. In 4 patients with cleft lip and palate it was used to normalize functions and aid physiological growth. The effects of the Hotz orthopedic plate were determined by recording body weight growth, milk volume per day, feeding time and comparison of the study model between before and after using Hotz orthopedic plate. Good physiological growth and improved feeding, were obtoincdinalmostall the patients who wore the Hotz type orthopedic plate correctly.     

A comparison of growth impairment and orthodontic results in adult patients with clefts of palate and unilateral clefts of lip, palate and alveolus

OBJECTIVE: To evaluate and compare the long-term aesthetic and functional results of surgical and orthodontic treatment in patients with cleft palate and unilateral cleft lip, palate, and alveolus. DESIGN: 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with isolated cleft palate, mean age of 18.9 years, were evaluated by cephalometric and model analysis a mean of 1.5 years after orthodontic treatment. In each group the surgical treatment has been similar. RESULTS: Model analysis: The sum of every mesiodistal tooth diameter in the maxilla and in the mandible was recorded according to the Bolton analysis. Twenty patients with unilateral cleft lip, palate and alveolus had relatively large upper dental arches and nine had relatively large lower dental arches. Twenty-two patients with cleft palates had large upper dental arches and seven had large mandibular arches. Eleven patients with unilateral cleft lip, palate, and alveolus and 18 patients with cleft palate had a negative space supply (the sum of the mesiodistal tooth diameters compared with the sagittal length of the alveolar ridge) in the region of the lateral teeth. All patients had persistent transverse space deficits that were increased on the side of the cleft in patients with cleft lip, palate, and alveolus. These unilateral transversal space deficits were recorded in 22 patients with unilateral cleft lip, palate, and alveolus and in 8 patients with isolated cleft palate. Sagittal measurements were reduced in 26 patients with unilateral cleft lip, palate, and alveolus and in 23 patients with cleft palate alone. The alveolar midline of the maxilla and the mandible were displaced in 25 patients with unilateral cleft lip, palate, and alveolus and in 19 patients with isolated cleft palate. Lateral cephalometric analysis: The lateral cephalograms taken at the same time as the models showed a mean SNA of 76.8 degrees and a NL-NSL angle of 8.7 degrees, indications of a tendency towards maxillary retrognathia in patients with unilateral cleft lip, palate, and alveolus. Patients with cleft palate had a mean SNA of 79.6 degrees and NL-NSL angle of 8.1 degrees. The anterior facial vertical index was within normal limits in patients with cleft lip, palate, and alveolus (44% vs 56%). An anterior facial height index of 42% compared with 58% in patients with isolated cleft palate indicated a slight reduction in midface height with an increase in the lower face as a consequence. CONCLUSION: Orthodontic and surgical treatment can result in satisfactory results on model analysis. However, there is specific growth impairment of the maxilla 1.5 years after termination of orthodontic treatment and this influences the final cephalometric analysis, particularly in patients with cleft lip, palate, and alveolus.     

Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age.

OBJECTIVE: The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN: Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS: The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.     

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。     

Mandibular morphology in complete unilateral cleft lip and palate.

OBJECTIVE: The purpose of this study was to evaluate and compare mandibular morphology and spatial position in children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centers (Hannover and Brussels) following different surgical treatment protocols. PATIENTS: A total of 62 Caucasian children (40 boys, 22 girls) with nonsyndromic complete unilateral cleft lip and palate (UCLP) were evaluated by means of conventional cephalometric analysis at approximately the age of 10 years. Data of both cleft groups were compared with a control, noncleft group (n = 40) matched according to age and sex. INTERVENTIONS: The Hannover children with cleft (n = 36) underwent lip repair at a mean age of 5.83 +/- 1.16 months. The hard and soft palates were closed at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months, respectively. The Brussels children with cleft (n = 26) were treated according to the Malek surgical protocol with soft palate repair at a mean age of 3.04 +/- 0.20 months and simultaneous lip and hard palate repair at a mean age of 6.15 +/- 0.68 months. RESULTS: Statistical analysis (analysis of variance with post hoc Tukey's test) showed a significant (p =.001) smaller mandibular ramus length (Co-Go) in the Brussels cleft group, compared with the control group. The Hannover-Brussels comparison data revealed that the S-N-B angle was significantly (p =.047) less in the Brussels cleft group. CONCLUSIONS: The influence of surgical procedures in patients with UCLP might not be restricted to the maxilla but could influence mandibular spatial position to the cranial base. Because of these positional changes of the mandible, both cleft groups showed facial balance.