大龄腭裂患者咽后壁组织瓣咽成形术及其语音研究

目的：探讨针对大龄(8岁以上)腭裂患者的特点，同期行腭裂关闭术和咽后壁组织瓣转移术并研究其对语音的影响，以提高修复效果。方法：对24例大龄腭裂患者行腭裂裂隙关闭手术以及咽后壁组织瓣咽成形术治疗，术前术后用鼻咽纤维镜检测其腭咽闭合情况，评价患者鼻漏气及过重鼻音改善情况。结果：24例腭裂修复术后创口均达到Ⅰ期愈合，软腭后退良好，腭咽闭合改善明显，为发音创造了条件，语音也有不同程度改善。结论：大龄腭裂患者同时采用腭裂关闭术及咽成形术的方法修复，有利于改善软腭的形态和发音。     

两瓣后推加咽后瓣成形术修复腭裂80例临床回顾分析

目的:观察两瓣后推 咽后瓣成形术修复腭裂的治疗效果。方法:对80例腭裂患者行两瓣后推 咽后瓣成形术,术后观察腭咽闭合情况,并进行语音机能评定。结果:本组腭裂修复术后,患侧软腭的长度较术前明显延长,平均延长16.7mm±3.5mm(P<0.01),术后语音有不同程度的改善。结论:两瓣后推 咽后瓣成形术是一种有效地腭裂修复手术方式。     

过宽裂隙的腭裂修复术探讨

目的：探讨修复过宽腭裂的方法，以获得良好的腭咽闭合功能。方法；对治疗26例过宽腭裂的手术方法及疗效进行回顾性总结。结果：26例过宽腭裂修复术后均获得了满意疗效，腭咽闭合功能有不同程度的改善。结论：过宽腭裂修复手术中，增大腭大血管神经束的游离度，重建软腭肌环是保证手术成功的首要条件。     

单一全层"Z"字瓣改形的腭裂修补术

目的：探索腭裂治疗的一种新方法。方法：对Furlow氏双“Z”字瓣逆向腭裂修复术进行改良，于软腭中部采用单一“Z”字瓣改形，延长软腭，简化 ，避免腭瘘，复裂等并发症产生。结果：采用此法对11例单侧腭裂患者进行整复治疗，术后切口均I期愈合，随访6－36个月无腭瘘，复裂发生；语言评价结果为发音优2例，良8例，差1例。结论：本术式为腭瘘，复裂发生率较低，语音能恢复较好的一种腭裂修补术。     

兰氏和双反Z法腭裂修复术后患儿语音清晰度对比

目的比较兰氏和双反Z法腭裂修复术后患儿的语音清晰度,寻找重建腭咽闭合的最佳手术方法。方法选取2009年至2013年在我院口腔颌面外科就诊的先天性软腭裂患儿69例,其中行双反Z法腭裂修复术35例(双反Z法组),行兰氏法腭裂修复术34例(兰氏法组)。患儿3.5岁后随访,由3名语音师进行单盲性审听,比较两组患儿术后语音清晰度。结果语音测评结果显示,双反Z法组患儿术后患者语音清晰度平均达到88.72%±6.05%,明显高于兰氏法组的71.31%±3.46%,语音改善明显。结论双反Z法能够充分缩小咽腔、延长软腭,重建软腭肌肉结构,更有利于恢复良好的腭咽闭合功能。     

腭后推上提和颊肌黏膜瓣修复10岁以上患者过宽腭裂

目的 探索修复10岁以上患者过宽腭裂畸形的手术方法.方法 通过腭后推、上提、腭大孔凿开、腭骨水平板凿断、双侧软腭后推、宋儒耀软腭上提术,结合一侧带蒂颊肌黏膜瓣转移修复过宽腭裂畸形.结果 2002年以来,运用该方法治疗13例10～25岁的腭裂患者,术后颊肌黏膜瓣完全成活,双侧软腭与咽后壁上提的组织瓣愈合良好,软、硬腭同时得到延长,腭咽闭合不全获得充分矫正,语音有明显改善,无腭瘘发生.结论 该方法具有无张力关闭过宽裂隙,软腭延长效果显著、持久,腭咽闭合效果良好,语音改善较明显的优点,尤其适合修复10岁以上患者过宽腭裂畸形.     

先天性隐性腭裂的诊断与治疗

目的 诊断与治疗先天性隐性腭裂患者。方法 纵行剖开软腭的膜性粘连，口腔侧硬腭粘膜瓣后推，鼻腔侧软腭粘膜瓣X字成形，腭帆提肌吊带重建，颊肌粘膜瓣移转修复硬腭裂隙入腭部创面，以恢复软腭的解剖学长度和生理性动度。结果 共治疗12例患者，均得到成功的修复，发音效果满意。结论 我们介绍的诊断依据和手术方法对隐性腭裂患者的诊断和治疗是行之有效的，具有推广价值。     

Pierre-Robin综合征的腭裂修复术

目的：探讨Pierre-Robin综合征患者腭裂的修复方法并观察其临床效果。方法：行慢诱导盲视经口插管，采用改良Langebeck氏法修补腭裂，术后采取头高侧卧位或俯卧位，注意防治呼吸道梗阻。结果：共治疗21例患者，均得到了成功的修复，婴儿组发音效果满意。结论：选择合适的病例，熟练的手术操作，术中术后呼吸道梗阻的防治，可对Pierre-Robin综合征患者进行良好的腭裂修补。     

软腭全层五瓣旋转推进法与二瓣法腭裂修复术的术后语音评价

我们设计了一种新的功能性腭裂修复术式即软腭全层五瓣旋转推进法腭裂修复术(五瓣法)，并应用于临床70余例．效果较好。现对五瓣法和二瓣法的术后语音进行比较分析。     

三维立体概念和整形外科学原则在腭裂修复术中的应用

目的：提出腭裂修复手术方法中的三维立体概念和应遵循的整形外科学原则。方法：以兰氏手术和腭粘膜瓣后推手术修复的腭裂患者各取30例，进行回顾性分析，分析腭裂修复手术方法中的三维立体概念和应遵循的整形外科学原则。以侧位X线片和鼻咽内窥镜显示腭咽闭合情况，测量软腭的解剖学长度和生理性动度。结果：兰氏手术后患者24例腭咽闭合不全；腭粘膜瓣后推手术后患者只有1例腭咽闭合不全。结论：由于腭粘膜瓣后推手术修复腭裂符合三维立体概念并且遵循了整形外科举原则，因而手术后的效果优于兰氏手术。     

32例小婴儿腭裂修复术

目的 探讨腭裂手术修复的时机。方法 对３２例２５ｄ～３个月的婴儿单侧或双侧腭裂进行手术修补,对发音效果及上颌骨发育进行随访。结果 手术全部获得成功,其语音质量和发音的准确度都与同龄正常儿童无异或接近正常,近期内未发现上颌骨发育障碍。结论 在手术熟练和条件具备的情况下,２５ｄ～３个月内是腭裂修复的好时机。     

先天性腭裂手术时机选择的临床研究

目的:探讨患儿腭裂手术修复的最佳时机。方法:对1997～2005年间在我院治疗的1～12个月的354例唇腭裂患儿进行手术修复,按年龄分四组分别对其术中、术后各项指标及发音效果进行对比、分析和评估。结果:手术全部获得成功,354例患儿术中、术后均未出现严重的并发症,其中1～3个月年龄组患儿术中出血少,术后恢复快,术后体重普遍增加;年龄组越大,术中出血量越多、术后体重普遍下降,术后恢复较慢;术后发音效果1～3月年龄组语言效果优于其他各年龄组;近期内未发现明显上颌骨发育障碍。结论:在手术技术成熟和条件具备下,3月左右是腭裂修复的最佳时机。     

早期修复腭裂的单侧手术

探讨一种治疗腭裂的新方法。方法本法对传统方法作了六项改进。手术时，在腭部的一侧作完发迹的六项操作以后，手术侧的腭部即彻底松驰，可以充分后退，增加该侧腭部先天不足的长度，并随意向近中侧移动，与对侧的裂接触，不需要在对侧再作同样的手术操作即可将裂隙缝合。     

α-氰基丙烯酸酯医用胶在腭裂修复术中的应用与分析

目的:介绍α-氰基丙烯酸酯医用胶在腭裂修复术中的使用方法,分析应用效果及注意事项。方法:采用α-氰基丙烯酸酯医用胶对97例两大瓣法腭裂手术创面进行处理。将两大瓣与腭部创面定位粘合。松弛切口创面止血,封闭两大瓣边缘与硬腭缝隙。粘合固定上颌结节后方松弛切口碘仿塞。结果:术后仅4例创面有明显渗血。97例口腔呼吸道通畅,易于护理,无误吸及呼吸道梗阻并发症,两大瓣与硬腭粘合贴附可靠。术后碘仿塞固位好,仅7例提前脱出。术后创面愈合正常,效果满意。结论:α-氰基丙烯酸酯医用胶在腭裂修复术中,可有效粘合腭粘膜瓣,封闭创面减少渗血,固定碘仿塞,有利于术后呼吸道护理及创面愈合,操作方法简便安全。     

早期修复腭裂的单侧手术

目的探讨一种治疗腭裂的新方法。方法本法对传统方法作了六项改进世。手术时,在腭部的一侧作完改变的六项操作以后,手术侧的腭部即彻底松弛,可以充分后退,增加该侧腭部先天不足的长度,并随意向近中侧移动,与对侧的裂缘接触,不需要在对侧再作同样的手术操作,即可将裂隙缝合。结果共用本法修复单侧和双侧腭裂151例,患者年龄4个月至5岁。手术后,无一例死亡,亦无一例复裂。年龄很小,尚未开始说话的婴幼儿患者,经本法修复腭裂以后,其语言的质量和发音的准确度都与同龄正常儿童无异。结论单侧手术的手术创伤、手术失血和手术时间都较同时在腭部两侧施行手术的传统方法更小、更少和更短。它是早期修复腭裂的一个较为安全的方法。     

早期修复腭裂的单侧手术

目的探讨一种治疗腭裂的新方法。方法本法对传统方法作了六项改进。手术时，在腭部的一侧作完改变的六项操作以后，手术侧的腭部即彻底松弛，可以充分后退，增加该侧腭部先天不足的长度，并随意向近中侧移动，与对侧的裂缘接触，不需要在对侧再作同样的手术操作，即可将裂隙缝合。结果共用本法修复单侧和双侧腭裂１５１例，患者年龄４个月至５岁。手术后，无一例死亡，亦无一例复裂。年龄很小，尚未开始说话的婴幼儿患者，经本法修复腭裂以后，其语言的质量和发音的准确度都与同龄正常儿童无异。结论单侧手术的手术创伤、手术失血和手术时间都较同时在腭部两侧施行手术的传统方法更小、更少和更短。它是早期修复腭裂的一个较为安全的方法。     

Cleft lip and palate patients prior to delayed closure of the hard palate: evaluation of maxillary morphology and the effect of early stimulation on pre-school speech

Speech and maxillary development were analysed in two groups of patients with unilateral cleft lip and palate; both groups had early jaw orthopaedic treatment and a surgical regimen that included two-stage lip surgery (mean ages of 2 and 19 months) and soft palate repair (8 months). Closure of the hard palate was postponed until the children were 8 to 10 years of age. The first group comprised 10 consecutive patients who were analysed at 5 and 7 years of age, and the second group seven patients who were studied at the age of 5. Both groups were thus investigated before the repair of the cleft in the hard palate. In addition to surgical and jaw orthopaedic treatment, the second group of patients received early stimulation of lip and tongue tip movements. Our results indicated that hypernasality was less a problem than was retracted palatal or velar articulation of dental consonants. These deviations tended to be reduced, however, after early stimulation. There seemed to be no clear association between the size of the residual cleft in the hard palate and the extent of speech development. The average size of the residual cleft in our patients was comparatively small, and decreased further during follow up. We conclude that preschool children with unilateral cleft lip and palate may develop good speech, in spite of the residual cleft, if they use an intraoral plate and are given extra lip and tongue tip stimulation, together with early speech therapy if necessary.     

A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results.

During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed.     

5459例唇腭裂患者临床资料分析

目的：对20年来唇腭裂的治疗及唇腭裂患者的构成情况进行回顾。方法：对5459例唇腭裂患者病历资料分类整理，进行统计学分析。结果：唇腭裂各类型性别比例差异有显著性意义，唇腭裂患者的首次手术年龄差异有显著性意义，其主要修复方式随年代的变化而不同。结论：唇腭裂患者中男性明显多于女性。自1980年以来，唇腭裂患者的首次手术年龄呈逐渐下降趋势，主要手术方法也有很大的变化。     

Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair

Many methods of cleft palate repair have been described. Two effective methods are commonly used for repair of soft palate clefts: the Wardill-Kilner V-Y push back and the Furlow double opposing Z-plasty; each has advantages and disadvantages. The aim of this study was to compare between the V-Y push back technique and the Furlow Z-plasty technique regarding effectiveness in palatal reconstruction and improvement of velopharyngeal closure in cases of cleft soft palate. Also, operative duration time and blood loss were considered. This study was conducted on 60 patients diagnosed to have cleft soft palate. The patients were randomly classified into two equal groups A and B. In group A, the cleft palate was repaired using V-Y push back technique while in group B the cleft palate was repaired using Furlow double opposing Z-plasty technique. Flexible nasopharyngoscopy and perceptual speech resonance evaluation were used to assess the velopharyngeal closure and speech outcome, respectively. Nasalance score was measured for nasal and oral sentences in both groups. The average operative duration time and blood loss were lesser in Z-plasty than in V-Y pushback technique. Two of the cases subjected to V-Y pushback technique developed fistula while none of the cases subjected to Z-plasty showed this complication. Velopharyngeal closure and speech outcome was better after Z-plasty than after V-Y pushback technique with significant nasometric data. The Furlow Z-plasty is better than the V-Y pushback technique in the repair of clefts involving the soft palate as it has a higher success rate regarding speech outcome and velopharyngeal closure; also, it has a lower operative time and blood loss.