单侧手术早期修复腭裂

目的 为了使腭裂患儿在行腭裂修复术后具有正常的语言功能，又不影响面上颌骨发育。方法 笔者从1992－1998年收治20例1岁以内的Ⅲ度腭裂患儿，采用在患侧（单侧腭裂）或一侧（双侧腭裂）形成黏骨膜瓣的单侧手术早期修复腭裂。结果 术后未发现腭瘘，语言功能良好。近期随访观察未发生面上颌骨发育异常。结论 单侧手术对腭部的损伤较小、手术时间短、出血少，尤其适用于腭裂患儿的早期手术，对面上颌骨发育干扰小。早期手术利于患儿形成正常语言功能。     

单侧手术早期修复腭裂

目的　为了使腭裂患儿在行腭裂修复术后具有正常的语言功能 ,又不影响面上颌骨发育。方法　笔者从1992～ 1998年收治 2 0例 1岁以内的Ⅲ度腭裂患儿 ,采用在患侧 (单侧腭裂 )或一侧 (双侧腭裂 )形成黏骨膜瓣的单侧手术早期修复腭裂。结果　术后未发现腭瘘 ,语言功能良好。近期随访观察未发生面上颌骨发育异常。结论　单侧手术对腭部的损伤较小、手术时间短、出血少 ,尤其适用于腭裂患儿的早期手术 ,对面上颌骨发育干扰小。早期手术利于患儿形成正常语言功能。     

单侧瓣修复单侧完全性腭裂

腭裂是一种较常见的口腔颌面部畸形 ,修复的方法基于ｖｏｎＬａｎｇｅｎｂａｃｋ提出的术式 ,在长期的临床实践中 ,专家们又提出了很多手术方法并不断加以改进 ,以达到修复的目的。不论何种术式 ,都有创伤大、剥离范围广、手术时间长的特点 ,手术创伤又对颌骨的生长发育中心产生影响 ,术后瘢痕和肌张力的异常 ,可加重颅面形态的发育畸形。为了减少手术对颅面形态的影响 ,我们自 1 999年以来选择性地对 34例单侧完全性腭裂的患者 ,采用单侧瓣的方法进行修复 ,取得了满意的效果 ,现总结如下。一、临床资料本组 34例 ,男 2 3例 ,女 1 1例 ;年龄…     

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。     

下鼻甲黏骨膜瓣在腭裂修复中的应用

目的 探讨在裂隙宽大的腭裂修复术中闭合软硬腭交界处裂隙的鼻侧面，确保缝合伤口一期愈合的方法。方法 设计蒂在后的下鼻甲黏骨膜瓣，并将该瓣转移至裂隙软硬腭交界处的鼻侧面，有效地减少局部组织缝合张力、闭合裂隙。结果 用本法治疗21例患儿，术后伤果口均一期愈合，无腭瘘发生，软硬腭交界处无明显的瘢痕形成。结论 应用下鼻甲黏骨膜瓣修复软硬腭交界处裂隙的鼻侧面，减少宽大腭裂的组织缝合张力，是一种简单而有效的方法。     

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。     

改良的Millard手术修复单侧唇裂

常用的修复单侧唇裂的方法有旋转推进瓣法 (Ｍｉｌｌａｒｄ手术法 )和下三角瓣法 ,各有其特点。自 2 0 0 0年以来 ,我们试用Ｙ Ｖ镶嵌的改良Ｍｉｌｌａｒｄ手术方法修复单侧唇裂 19例 ,效果满意。1　临床资料本组 19例 ,男性 15例 ,女性 4例。年龄最大 36岁 ,最小10个月。Ⅱ度单侧唇裂 12例 ,Ⅲ度单侧唇裂 7例。2　手术方法按旋转推进瓣术式定点 1～ 7,点 8在鼻前庭的外上方。由 5 - 6作一横形切口 ,将切口下侧去除部分三角状组织形成一钝角 ,联接 3- 5 ,使 5 - 6、5 - 3的上方成为横Ｙ形切口。点 4、7、8成Ｖ形瓣。沿空点全层切开唇组织 ,…     

单侧单瓣法与两瓣法在腭裂手术治疗中的对比研究

目的：通过比较单侧单瓣法与两瓣法两种术式,分析总结何种术式更适用于腭裂的治疗。方法：50例腭裂患者25例采用单侧单瓣法（单侧完全性15例,不完全性10例）,25例采用两瓣法（单侧完全性16例,不完全性9例）施行手术,多方面分析比较。结果：单侧单瓣法在术中平均失血量,手术平均操作时间,术后3日内平均体温,术后平均用药天数等方面较两瓣法有显著性差异,具有统计学意义（P〈0.05）。腭咽闭合功能改善情况使用吹水泡试验和现代汉语语音清晰度字表测定两种方法进行评价,统计学分析均无明显差异（P〉0.05）。结论：单侧单瓣法是一种值得在临床上开展的具有可行性的腭裂手术治疗术式。     

颊肌黏膜瓣修复裂隙较宽的完全性腭裂

腭裂修复术的主要目的是通过关闭口鼻腔之间的裂隙，恢复腭部、鼻咽部的解剖结构和生理功能，能够正常吞咽并获得良好的语言功能。自1999年至2002年，我们应用颊肌黏瓣（单侧或双侧）修复裂隙较宽的完全性腭裂10例，现报道如下。     

Risk factors leading to mucoperiosteal flap necrosis after primary palatoplasty in patents with cleft palate

Background: Few studies have been published reporting risk factors for flap necrosis after primary palatoplasty in patients with cleft palate. This complication is rare, and the event is a disaster for both the patient and the surgeon. This study was performed to explore the associations between different risk factors and the development of flap necrosis after primary palatoplasty in patients with cleft palate.

Methods: This is a case-control study. A 20 years retrospective analysis (1994–2015) of patients with nonsyndromic cleft palate was identified from medical records and screening day registries). Demographical and risk factor data were collected using a patient´s report, including information about age at surgery, gender, cleft palate type, and degree of severity. Odds ratios and 95% confident intervals were derived from logistic regression analysis.

Results: All cases with diagnoses of flap necrosis after primary palatoplasty were included in the study (48 patients) and 156 controls were considered. In multivariate analysis, female sex, age (older than 15 years), cleft type (bilateral and incomplete), and severe cleft palate index were associated with significantly increased risk for flap necrosis.

Conclusions: The findings suggest that female sex, older age, cleft type (bilateral and incomplete), and severe cleft palatal index may be associated with the development of flap necrosis after primary palatoplasty in patients with cleft palate.     

应用岛状颊肌粘膜瓣修复腭裂初步报告

目的：介绍应用岛状颊肌粘膜瓣修复腭裂的临床实践。方法：应用裂缘葶粘骨膜瓣闭合硬腭裂隙的鼻腔侧、软腭后推、软腭鼻侧粘膜Z成形术延长、腭帆提肌吊带重建,再以蒂在后的血管神经蒂岛状颊肌粘膜瓣修复软腭后推后在腭部遗留的横行创面和硬腭裂隙的口腔侧创面。结果：1997年以来共治疗12例,术后岛状颊肌粘膜瓣完全成活,软腭延长显著,无腭瘘形成,无血肿、感染、肋腺导管和面神经损伤及开口功能障碍等并发症发生。结论：岛状颊肌粘膜瓣血运好,易成活;术后早期不需配戴牙垫,不影响恒磨牙的萌出,不干扰咬合,无埯断蒂,不破坏翼下颌皱襞形态和结构,供区易于缝合,感觉功能好。     

Tongue flap repair of cleft palate fistulae

In a series of 20 patients with palatal fistulae that were judged beyond closure with local tissue alone, the fistulae were successfully closed with tongue flaps in 17 patients (85%), 6 of whom required an additional minor procedure. The social stigma of fluid leaking from the nose was corrected in all patients and, in the older age group, several patients no longer had to wear obturators. Speech was improved in 9 patients due to a reduction in hypernasality and in 8 patients, articulation was noticeably improved. The anteriorly-based tongue flap has proved to be a reliable way of closing the difficult fistula where symptoms are sufficient to justify the attempt. The procedure was used successfully in all three children under 2 1/2 years on whom it was used.     

应用颊肌黏膜瓣修复腭部缺损

目的 探讨应用颊肌黏膜瓣修复腭部缺损的方法 及效果.方法 修复腭裂时,设计蒂在后的颊肌黏膜瓣,通过翼下颌缝黏膜下隧道修复软硬腭口腔面缺损;腭部肿瘤切除后缺损时,则将该瓣直接转移修复;修补腭裂术后瘘孔时,以蒂在前的颊肌黏膜瓣,通过齿槽裂隙缺损直接覆盖修复.切取最大颊肌黏膜岛状瓣6.0 cm×3.5 cm(成人),供区松解直接闭合.结果 临床应用14例,除1例腭裂术后护理不当软腭有部分复裂,1例远端表皮轻度糜烂外,余12例组织瓣均完全成活.结论 该瓣能Ⅰ期修复腭部肿瘤切除后缺损,功能形态良好,且术后可尽早接受放射治疗,提高了远期疗效;同时对宽大腭裂或腭裂术后并发较大腭前瘘孔,也是一种新的修复术式,且为牙槽嵴裂修复预留软组织床.     

下鼻甲粘骨膜瓣在完全性唇裂鼻底修复中的应用体会

目的:探讨裂隙较宽的完全性唇裂整复术中鼻底修复的方法改进。方法:设计蒂在下的下鼻甲粘骨膜瓣,唇部切口按长庚法设计,制作下鼻甲粘骨膜瓣,患侧颊粘膜瓣及健侧唇"C"粘膜肌瓣共同修复完全裂开的鼻底。结果:127例完全性唇裂患者中,98例为单侧,29例为双侧,术后创口均甲级愈合,鼻底封闭良好,鼻外形矫正到位,左右基本对称。讨论:下鼻甲粘骨膜瓣制作简单,损伤小,能促使裂侧鼻翼外角自由内收,术后无异常并发症,是完全性唇裂鼻底良好修复的一种有效方法。     

The double transposition flap for closure of the extremely wide hard palate cleft

Repair of the extremely wide hard palate cleft can be done effectively with a double transposition flap. All cases referred for closure of cleft palates from 1997 to 2005 were considered for this study. Of these, 6 were classified as extremely wide cleft palates thought not to be treatable with standard closure techniques. A double transposition flap was used in each case. All patients tolerated the procedure well; no flap failure or dehiscence was noted; and none has required secondary repair. All patients tolerated an appropriate diet following flap repair. Two patients who were gastrostomy tube dependent preoperatively no longer required gastrosotomy tubes postoperatively.     

Eyelid reconstruction using a hard palate mucoperiosteal graft combined with a V-Y subcutaneously pedicled flap.

Full-thickness eyelid defects after tumour ablation require the reconstruction of two layers, the anterior and posterior lamellae. Eyelids were successfully reconstructed after removal of malignant tumours in four patients using a hard palate mucoperiosteal graft combined with a curved V-Y subcutaneously pedicled flap. Although there have been some reports of hard palate mucosal grafts for reconstruction of the posterior lamella, the graft is not sufficiently rigid to support the reconstructed eyelid without the aid of supporting materials such as cartilage grafts. The hard palate mucoperiosteal graft seems to be rigid enough to support the reconstructed eyelid without the use of cartilage or other supporting materials. The subcutaneously pedicled V-Y advancement flap is useful for reconstruction of the anterior lamella in partial eyelid defects. We used it with a modified curved design to allow easy advancement and to make postoperative scars inconspicuous.