单侧唇腭裂中牙槽嵴裂的手术治疗

为16例单侧唇腭裂中的牙槽嵴裂患者,采用自体髂骨骨松质(13例)或羟基磷灰石(3例)充填,并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中12例随访1～5年,自体骨移植者有9例,全部发生骨连续,并有7     

肌肉复位术矫正单侧唇裂术后鼻底畸形

目的 探讨单侧唇裂术后鼻底畸形矫正的有效手术方法.方法 对2007年8月至2010年8月收治的50例单侧唇裂术后鼻底畸形患者,针对不同的畸形程度,采用鼻底肌肉复位术矫正鼻底畸形,并以肌肉组织充填鼻翼基底,弥补患侧上颌骨发育不足;复位鼻唇肌,以保持两侧肌张力的均衡,恢复鼻翼形态.结果 术后50例患者的鼻畸形均得到很大程度的改善,术后移位的鼻小柱回到正常位置,左右鼻翼根部和鼻底宽度基本对称,鼻翼根部畸形、鼻底过宽、鼻小柱偏斜均得到较明显改善.对患者手术前后的相关数据进行统计检验,差异有统计学意义(P＜0.05).结论 单侧唇裂继发鼻畸形的病因复杂,可通过对易位的鼻孔压肌翼部、降鼻中隔肌复位术,有效地改善畸形.     

Aesthetic camouflage of bilateral cleft lip scars

Two operative scar lines remain after bilateral cleft lip repair. A method has been devised in which the two scar lines are reduced into one. The characteristics of this method include (1) an inconspicuous scar, (2) elevation of the nasal tip using the prolabium, (3) repair of the whistling deformity, (4) a natural-looking mustache, (5) formation of a pout, and (6) psychological benefits. Good results have been obtained with this method. The disadvantage of this method is the maxillary retardation. However, this does not occur in adults and can be corrected easily in children.Presented at the 7th Congress of Japanese Society of Cleft Palate, July 22, 1983; 29th Congress of Japan Society of Plastic and Reconstructive Surgery, June 12, 1986; and 9th Congress of Japan Society of Aesthetic and Plastic Surgery, November 15, 1986     

单侧唇裂继发鼻畸形的临床整复

目的:对68例单侧唇裂术后鼻畸形整复术的患者进行回顾性分析,探讨鼻畸形整复的最佳治疗方式。方法:以68例唇裂术后鼻畸形患者为研究对象,男性45例,女性23例,年龄7~36岁,平均21.4岁,左侧41例,右侧27例。采用内收鼻翼外角、消除鼻前庭皱褶,鼻翼悬吊、矫正鼻翼塌陷,延长鼻小柱。术后持续戴鼻模3~6月。结果:68例患者开放性鼻畸形整复术后,随访59例(80.23%)共3~36月,术后效果达到优34例,良22例,差3例。无一例创口感染,鼻畸形得到明显改善。结论:单侧唇裂术后继发鼻畸形的整复治疗,通过对鼻翼软骨、鼻唇软组织等多方面的矫正修复,可明显改善鼻畸形。开放式的鼻畸形整复术是单侧唇裂术后继发鼻畸形治疗的有效方式。     

Incidence of cleft Lip and palate in the state of Andhra Pradesh, South India

Objective:

To assess the incidence of cleft lip and palate defects in the state of Andhra Pradesh, India.

Design Setting:

The study was conducted in 2001 in the state of Andhra Pradesh, India. The state has a population of 76 million. Three districts, Cuddapah, Medak and Krishna, were identified for this study owing to their diversity. They were urban, semi-urban and rural, respectively. Literacy rates and consanguinity of the parents was elicited and was compared to national averages to find correlations to cleft births. Type and side of cleft were recorded to compare with other studies around the world and other parts of India.

Results:

The birth rate of clefts was found to be 1.09 for every 1000 live births. This study found that 65% of the children born with clefts were males. The distribution of the type of cleft showed 33% had CL, 64% had CLP, 2% had CP and 1% had rare craniofacial clefts. Unilateral cleft lips were found in 79% of the patients. Of the unilateral cleft lips 64% were left sided. There was a significant correlation of children with clefts being born to parents who shared a consanguineous relationship and those who were illiterate with the odds ratio between 5.25 and 7.21 for consanguinity and between 1.55 and 5.85 for illiteracy, respectively.

Conclusion:

The birth rate of clefts was found to be comparable with other Asian studies, but lower than found in other studies in Caucasian populations and higher than in African populations. The incidence was found to be similar to other studies done in other parts of India. The distribution over the various types of cleft was comparable to that found in other studies.     

单侧唇腭裂中牙槽嵴裂的手术治疗

为１６例单侧唇腭裂中的牙槽嵴裂患者，采用自体髂骨骨松质（１３例）或羟基磷灰石（３例）充填，并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中１２例随访１～５年，自体骨移植者有９例，全部发生骨连续，并有７例或从骨移植区长出。羟基磷灰石者３例无一例有牙萌出。认为缺损修补以自体骨移植为好，羟基磷灰石不宜用于未成年人。     

伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复

目的探讨伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复方法。方法对34例伴有齿槽嵴裂的单侧唇裂术后继发畸形的患者,在行齿槽嵴植骨的同时,行彻底的鼻整形手术。结果术后随访1~3年,植骨区成活良好,鼻畸形较整形前明显改善,接近正常外形,效果满意。结论在行齿槽嵴植骨的同时,行彻底的鼻整形手术,能够取得满意的效果,并且节省了医疗费用,缩短了治疗时间。     

Anatomical closure technique of the nasal floor for patients with complete unilateral cleft lip and palate

Abstract

We describe a new technique for the reconstruction of the nasal floor at the same time as cheiloplasty in patients with complete unilateral cleft lip and palate. We operated on patients aged between 3 and 36 months in public secondary and tertiary level institutions. None of these patients had had a previous operation for the correction of the cleft lip or palate. The operation required the design of two mucous flaps, one lateral and one medial to the defect, to reposition the tissues anatomically and repair the congenital deficiency. Three hundred and fifty-eight patients have been treated using this technique, most of whom (n = 233, 65%) were boys, and 288 (80%) presented with a right complete unilateral cleft. Postoperative evaluation showed that 22 patients (6%) had asymmetry of the nasal base equal to or less than 1 mm, 18 (5%) had nasovestibular fistulas, and 5 (1%) required revision. We conclude that this technique greatly reduces the number of asymmetrical nasal floors and the incidence of nasovestibular fistulas.     

A status report on management of cleft lip and palate in India

Introduction:

This national survey on the management of cleft lip and palate (CLP) in India is the first of its kind.

Objective:

To collect basic data on the management of patients with CLP in India for further evaluation.

Materials and Methods:

A proforma was designed and sent to all the surgeons treating CLP in India. It was publicized through internet, emails, post and through personal communication.

Subjects:

293 cleft surgeons representing 112 centers responded to the questionnaire. Most of the forms were filled up by personal interview.

Results:

The cleft workload of the participating centers is between 10 and 2000 surgeries annually. These centers collectively perform 32,500–34,700 primary and secondary cleft surgeries every year. The responses were analyzed using Microsoft excel and 112 as the sample size. Most surgeons are repairing cleft lip between 3-6 months and cleft palate between 6 months to 1 year. Millard and Tennison repairs form the mainstay of lip repair. Multiple techniques are used for palate repair. Presurgical orthopedics, lip adhesion, nasendoscopy, speech therapy, video-fluoroscopy and orthognathic surgery were not always available and in some cases not availed of even when available.

Conclusion:

Management of CLP differs in India. Primary surgical practices are almost similar to other studies. There is a lack of interdisciplinary approach in majority of the centers, and hence, there is a need for better interaction amongst the specialists. A more comprehensive study with an improved questionnaire would be desirable.     

Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip

Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports.     

A revised classification of the cleft lip and palate

BACKGROUND:

Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis.

OBJECTIVES:

To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate.

METHODS:

The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors’ revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA).

RESULTS:

A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients.

DISCUSSION:

The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency.

CONCLUSION:

The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.     

干细胞在唇腭裂患者牙槽突裂中应用的研究进展

干细胞具有自我更新能力及多向分化潜能,已被广泛应用于多个领域。相对于唇腭裂患者牙槽突裂的常规手术治疗方法,干细胞具有来源广泛、取材方便、免疫原性低等优点,整形外科医生已逐渐关注唇腭裂患者牙槽突裂干细胞治疗的研究。该文对胚胎干细胞、人间充质干细胞、颌面部来源干细胞在唇腭裂患者牙槽突裂中应用的研究进展进行了综述。