Simultaneous reconstruction of columella and philtrum using prolabial flap combined with Abbe flap in secondary bilateral cleft lip and nasal deformity

Open rhinoplasty and Abbe flap techniques are traditionally useful tools for the reconstruction of secondary bilateral cleft lip nasal (BCLN) deformity. We aimed to investigate the long-term outcomes of simultaneous columella and philtrum reconstruction using prolabial flap combined with Abbe flap in secondary BCLN deformity.From January 2009 to July 2014, 26 patients (17 males and 9 females; mean age 21 years) with secondary BCLN deformity were recruited. All patients had severe short columella and philtrum deficiency. The whole superiorly based prolabial flap was harvested and trimmed for columella reconstruction. An Abbe flap from the central lower lip was elevated to reconstruct the esthetic philtral unit. No flap necrosis occurred postoperatively. The average follow-up was 2.7 years. The columella length was 4.7 ± 1.3 mm preoperatively and 10.4 ± 2.1 mm postoperatively. The philtrum length increased to 14.4 ± 2.6 mm postoperatively from a preoperative 8.9 ± 2.4 mm. Regarding the overall impression of the reconstruction, 22 patients ranked it as very good or good.In secondary BCLN deformity, the prolabial flap combined with Abbe flap technique is an effective alternative for the treatment of severe short columella complicated with severe philtrum deficiency.     

唇裂术中口轮匝肌的解剖学修复

目的：探索唇裂患者口轮匝肌解剖学修复的方法。方法：解剖分离患侧口轮匝肌深怪、浅层的鼻唇不及鼻束。深层及浅层鼻唇束与健侧相应仙束缝合。鼻束与位与鼻小柱下方鼻唇束形成的旋转的肌瓣缝合。结果：对10例唇裂患者进行口轮匝肌的解剖学修复，术后切口瘢痕较小。动态及静态上唇形态满意。结论：口轮匝肌的解剖学修复有利于唇裂患者动态及静态的形态修复。     

口轮匝肌功能重建修复单侧完全性唇裂

目的 探讨口轮匝肌功能重建在单侧完全性唇裂修复术中的应用及效果评价。方法 回顾分析2007年—2011年我科收治的82例单侧完全性唇裂患者,其中52例唇裂整复术中同期行口轮匝肌功能重建术,而30例仅行单纯唇裂整复术。2组患者均随访6个月,测量比较2种治疗方法整复后的患者术后鼻唇外形。结果 在唇裂整复术同期应用口轮匝肌功能重建组的患者,术后可获得更好鼻唇对称性,患侧上唇高度及鼻孔高度明显优于未行口轮匝肌重建组（P<0.01）,并可获得满意的人中、鼻堤、红唇形态。结论 单侧完全性唇裂整复术中同期施行口轮匝肌功能重建能有效地恢复口轮匝肌连续性及其生理功能,有助于提高单侧完全性唇裂的治疗效果。     

Influence of vomer flap on craniofacial growth in patients with cleft lip and palate: A systematic review

The aim of this review was to evaluate the impact of the vomer flap on craniofacial growth in patients with cleft lip and palate. The review was conducted according to the PRISMA checklist and is registered in the International Prospective Register of Systematic Reviews (PROSPERO — CRD42018095714). Two investigators performed the research using the PubMed/MEDLINE, Embase, and Web of Science databases for studies published until November 2018. The focused question was ‘Does the vomer flap have a lesser impact on craniofacial growth in patients with cleft lip and palate?’. A total of 13 articles was selected for this review, comparing the vomer flap technique with other flap surgery techniques. The outcomes analyzed were: facial development (primary outcome); and the growth of the maxilla and mandible, occlusion, occurrence of fistula, and speech development (secondary outcomes). It was concluded that there is no difference in impact between vomer flap and the other flap surgery techniques on craniofacial development.     

口轮匝肌对称重建整复单侧唇裂术后唇畸形的效果评价

创新单侧唇裂术后唇畸形的整复技术并评价其术后效果。     

咽后壁瓣断蒂对腭咽闭合影响的探讨

目的 探讨咽后壁瓣成形术后腭咽闭合功能不全(velopharyngeal insufficiency,VPI)及其并发症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)治疗中咽后壁瓣断蒂的作用.方法 1993至2008年于北京大学口腔医学院·口腔医院唇腭裂治疗中心接受咽后壁瓣断蒂术患者20例(不完全腭裂11例、完全性唇腭裂9例),20例断蒂术前均行鼻咽纤维镜、头颅定位侧位X线片检查及语音录音,对有OSAHS主述者行睡眠呼吸监测.全部患者术后48 h后进行语音评价.术中单纯断蒂14例,断蒂后重新改变咽成形术式6例.结果 ①14例成形术后语音改善不明显,仍存在过高鼻音,咽后壁瓣断蒂术后语音改善明显;②3例成形术后虽发音正常但出现呼吸道阻塞症状,断蒂术后呼吸睡眠状况改善,语音仍正常;③3例成形术后发音正常,因正颌手术的麻醉需要断蒂,断蒂后的语音无明显改变.结论 咽后壁瓣成形术后出现OSAHS或仍存在VPI,需手术断蒂或其他类型咽成形术治疗;断蒂的时间应在咽后壁瓣成形术半年后.     

单侧不完全唇裂整复的人中再造研究

目的探讨单侧不完全唇裂整复的人中再造研究。方法采用Millard法对41例单侧不完全唇裂患儿进行整复手术。将鼻底部错位肌肉切断,解剖裂隙两侧口轮匝肌5mm,并作患侧肌肉断面1/2处水平剖开3mm,人中正中作纵向1mm深切口,唇红组织两侧作附加切口。通过相应的缝合方法,形成明显的人中结构。术后六个月复诊评估疗效。结果41例整复患儿中,术后人中形态满意28例,较满意6例,满意率为82.9%。结论单侧不完全唇裂整复中,采用Millard手术方法及口轮匝肌功能性修复,再造人中形态是非常有效的。     

罗库溴铵用于小儿唇腭裂修复术的量效关系及肌松残余的观察

目的:观察全凭静脉麻醉下不同剂量的罗库溴铵应用于小儿唇腭裂修复术时的起效时间和肌松效应以及拔管时肌松残余发生率.方法:择期全麻小儿唇腭裂修复术96例,年龄1～6岁,按随机数字表分为3组(n=32).麻醉入睡后,采用TOF-Watch(@) SX肌松监测仪进行肌松监测,定标成功后,静注罗库溴铵,A、B、C组应用剂量分别为0.6、0.9、1.2 mg/kg,观察记录麻醉效果.结果:3组患儿气管插管条件优良率为100％.起效时间随剂量增加而缩短(P＜0.05).肌松维持时间随剂量增加而延长(P＜0.05).恢复指数Ⅲ组与Ⅱ组、Ⅰ组相比明显延长(P＜0.05),Ⅱ组与Ⅰ组相比无统计学差异(P＞0.05).肌松残余发生率Ⅲ组高于Ⅱ组和Ⅰ组(P＜0.05),Ⅱ组与Ⅰ组间差异无统计学意义.结论:罗库溴铵0.6、0.9 mg/kg在小儿唇腭裂修复术中获得满意的插管条件,起效和恢复迅速,术后肌松残余发生率低.     

双岛黏骨膜瓣修复不完全性腭裂

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。     

“Flip-over flap” in two-stage cleft palate repair

Purpose

This study served to evaluate a two-stage concept in cleft palate repair, including key use of a triangular hinge (“flip-over”) flap, in order to prevent palatal fistulae. It uses data from a prospective registry established in 1991.

唇腭裂患者牙槽嵴数字化模型建立及分析的初步探讨

目的 通过三维激光扫描建立唇腭裂患者牙槽嵴的数字化模型，为唇腭裂患者的模型分析建立科学方法。方法 唇裂修复术前于全麻状态下对1例右侧完全性唇腭裂患者的上颌无牙颌制取模型，用激光扫描仪扫描，通过计算机逆向工程软件进行模型重建。结果 此法可在重建模型上设定测量参考点9个，并可测出各标志点间的距离；模型可切割后测量和计算。结论 激光扫描三维分析方法是分析唇腭裂患者牙槽嵴形态及方向改变的一种理想方法，应用此模型可量化分析唇腭裂患者随生长发育而变化的上颌牙槽嵴形态。     

Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review

The vomer flap technique for repair of the hard palate is assumed to improve maxillary growth because it causes less scarring in growth-sensitive areas of the palate. The aim of this systematic review was to investigate the effect of techniques using the vomer flap compared with the palatal flap on facial growth in patients with cleft lip and palate. All papers published before 21 July 2012 were sought in the databases PubMed and MEDLINE. Search terms included “facial growth”, “cleft lip and palate”, “palatal repair technique”, and “vomer flap”. Additional studies were identified by hand searching the reference lists of the papers retrieved from the electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the methods. Six studies met the selection criteria. Outcomes assessed in 4 studies were dentofacial morphology after vomer or palatal flap, maxillary dental arch in 1 study, and dental arch relations in 2 studies. The quality of the methods used in 3 studies was poor. Contradictory results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the vomer flap technique has more or less of an adverse effect on maxillary growth than the palatal flap. Further well-designed, well-controlled, and long-term studies particularly of the vomer flap (2-stage) and palatal flap (von Langenbeck or two-flap, 1-stage) are needed.     

口腔黏膜瓣用于非综合征型单侧完全性唇裂鼻底修复的效果评价

目的: 探讨非综合征型单侧完全性唇裂患儿一期手术中采用口腔黏膜瓣进行鼻底修复的效果,并对鼻底、鼻翼外形对称性等指标进行评价。方法: 对2014年9月—2016年9月采用口腔黏膜瓣进行鼻底修复的16例非综合征型单侧完全性唇裂患儿的临床资料进行回顾分析,根据患儿术前、术后1周、术后1年恢复情况,拍摄正面、仰视照片,测量健、患侧鼻底宽度,鼻小柱高度,鼻孔高度及宽度,鼻的长度及宽度。采用SPSS19.0软件包对数据进行统计学分析。结果: 16例患儿术后均未出现口腔-鼻腔瘘及鼻底凹陷,鼻翼塌陷得到明显改善,术后1年鼻底宽度对称比0.79±0.15,鼻孔宽度对称比0.856±0.17,鼻孔高度对称比1.44±0.17,鼻小柱高度对称比1.62±0.48。结论: 非综合征型单侧完全性唇裂患儿一期修复手术中采用口腔黏膜瓣,进行鼻底修复,不仅能减少口腔-鼻腔瘘的发生,还能严密封闭鼻底裂隙,恢复鼻底形态,并保持良好的鼻翼外形及鼻孔对称性。     

Impact of nasalis muscle repair in unilateral cleft lip patients

Background

Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry.

前方牵引治疗单侧完全性唇腭裂患者术后前牙反[牙合]畸形的研究

目的探讨前方牵引治疗单侧完全性唇腭裂（UCLP）患者术后前牙反[牙合]畸形的效果。方法进行前瞻性临床研究设计,UCLP术后骨性前牙反[牙合]患者治疗组18例,年龄9．63±1．24岁,观察对照组14例,平均8．71±1．92岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗或观察前后拍摄头颅侧位片并测量,进行成组设计和配对设计t检验。结果UCLP治疗组前方牵引后,上颌骨前移;下颌后移合并后下旋转;上下颌间关系和面型改善明显,上颌与下颌改变的比值为1：1．7。对照组上下颌不调、前牙反覆盖、凹面型加重。结论UCLP术后轻中度骨性前牙反[牙合]畸形,前方牵引能够促进上颌骨向前,改善上下颌骨关系和软组织面型,应该早期矫形治疗。     

老年患者头颈部游离组织瓣移植的临床分析

目的 探讨游离组织瓣移植在老年患者头颈部缺损修复中的可行性和应用价值。方法 1999年5月至2002年9月由同一手术小组完成的连续81例65岁以上老年患者的89块头颈部游离瓣移植，分析所采用游离瓣的类型、受区血管、游离瓣成活情况及术后并发症的发生情况，并分析有可能影响游离瓣成活的各种因素。结果 前臂皮瓣、腓骨瓣和腹直肌皮瓣为最常用的三种游离瓣，占全部游离瓣的95．5％；游离瓣的临床成功率为98．9％，术后血栓的发生率为3．4％，抢救成功率为66．7％；受区和供区总的并发症发生率为30.9％，但大多数并发症均不严重，没有造成严重的后果；吸烟、饮酒、放疗等均非影响游离瓣移植成功的重要因素。结论 老年患者头颈部游离组织瓣移植安全可靠，与普通患者相比其成功率和并发症无明显差别。     

唇腭裂患者心理干预影响的初步研究

目的 探讨心理干预对成人唇腭裂患者心理状况的影响.方法 对34例住院成人唇腭裂患者按照随机分组原则分为对照组和干预组.对照组在住院期间仅进行手术治疗,干预组在进行手术治疗的同时接受心理干预.人院后、出院前分别对两组患者进行测评,以评价心理干预对成人唇腭裂患者心理状况的影响.施测工具为交往焦虑量表、自尊量表及社会支持量表...     

福建省唇腭裂流行病学研究

目的为了解福建省唇腭裂发病情况并分析致畸因素。方法对１９８６年１０月至１９９２年１２月６年内福建省２２所医院的出生缺陷监测资料进行唇腭裂发病情况的研究。结果在１３９８８２名新生儿中发现唇腭裂２０４例，福建省唇腭裂发病率为１．４６‰（１∶６８４），尚不属国内高发区。６年的年度发病率未见有明显的变化。２０４例唇腭裂中有２８例伴有其他系统畸形。结论本研究母亲年龄、孕次、产次对唇腭裂发生的影响作用不肯定；吸烟、接触有害物质及孕期用药等因素与唇腭裂发病率有重要关系。     

单侧完全性唇腭裂术后反的矫治

唇腭裂患者术后常存在较严重的错畸形，其矫治是比较复杂和困难的。本研究的目的，在于通过对３２名单侧完全性唇腭裂术后反患者正畸治疗的临床观察，探讨该类患者正畸治疗的特点。得出以下结果：①为获得良好的牙弓形态及牙颌关系常需齿槽骨植骨；②扩弓治疗时间较长且多需不对称扩弓，扩弓效果需长时间保持；③方丝弓矫治器治疗结束后，患者侧貌的改善主要局限在牙齿－齿槽区；④３４．３％的患者需要作正颌外科治疗。研究结果提示，为获得更理想的侧貌改善，应对唇腭裂患者早期应用前方牵引治疗。