大龄腭裂患者同期腭裂修复与齿槽嵴裂植骨的临床观察

目的：探讨８岁以上单侧完全性腭裂患者同期腭裂修复与齿槽嵴裂植骨的可行性及植骨效果。方法：对３８例同期腭裂修复与齿槽嵴裂植骨的腭裂患者作回顾性研究。患者年龄８～２４岁,平均年龄为１４．８岁。分析手术时间、术中出血、术后恢复和创口愈合情况。术后随访１２月以上,对随访的Ｘ线片进行植骨效果的客观评价。结果：所有手术均顺利完成,平均手术时间比单纯改良兰氏腭裂修复手术多３７ｍｉｎ,没有明显增加术中出血量,患者     

Primary alveolar cleft bone grafting in unilateral cleft lip and palate: arch dimensions at age 8.

The purpose of this investigation is to determine whether primary alveolar cleft bone grafting in infants with unilateral cleft lip and palate (N = 17) leads to less favorable dental arch dimensions at age 8 when compared with other 8-year-old patients with unilateral cleft lip and palate who received no alveolar bone grafting procedures (N = 49). Dental casts were obtained for the primary grafted group, and arch lengths and widths were digitally recorded with a reflex microscope. These arch dimensions were then compared with the reported data for a nongrafted group and a noncleft group of 8-year-old children. The major findings were: 1) that the dental arches of both cleft groups generally demonstrated a significant diminution in length and width (P < 0.05) compared with the noncleft groups, and 2) that the patients who underwent primary alveolar cleft bone grafting showed no statistically significant difference for any arch dimension (P < 0.05) when compared with the nongrafted group lacking this additional surgical procedure.     

唇腭裂患者齿槽嵴裂植骨修复术后随访结果分析

目的分析影响齿槽嵴裂修复术后效果的因素。方法对同一术者所行齿槽嵴裂植骨术的唇腭裂患者５４例进行回顾性研究，所有患者均有术前及手术后３个月以上的完整资料。分析植骨区的Ｘ线组织影像的临床分级与手术年龄、裂类型及手术类型等的关系。结果①齿槽嵴裂的植入骨成活率为９４％，临床成功率为８９％；②齿槽嵴裂的植骨效果与患者的年龄有关，１８岁以上患者植骨的临床成功率明显低于其他年龄患者；③除腭瘘修补术外，齿槽嵴裂植骨术与其他唇腭裂手术同期完成者其临床成功率与单纯行齿槽嵴裂植骨术的临床成功率相似；④单纯伴发唇裂或不完全腭裂的齿槽嵴裂植骨效果优于完全性唇腭裂的齿槽嵴裂植骨效果。结论良好植骨床的形成和植骨区严密的缝合是保证齿槽嵴裂植骨成功的关键     

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。     

Visual, auditory, and tactile temporal processing in children with oral clefts

Neurocognitive disorders may compromise the outcome of surgical cleft lip palate repair and thus need to be identified. Processing of rapidly changing sequential information (temporal processing) is a fundamental neurocognitive capacity that may contribute to various communication functions and has been found impaired in several developmental disorders. The occurrence of temporal processing difficulties in the cleft population is not known, however. We investigated the relation between oral clefting and temporal estimations of simultaneity/nonsimultaneity in visual, auditory, and tactile modalities. Subjects were 10-year-old controls and children with oral clefts of various types [i.e., cleft lip (alveolar), cleft lip and palate, cleft palate, and cleft palate submucous]. The visual and tactile tasks but not so clearly the auditory task differentiated the groups. Further, paralleling previous findings, the patients with cleft lip and palate outperformed the others, whereas the cognitive temporal processing acuity of the cleft palate and cleft palate submucous children was worse.     

Maxillary and sella turcica morphology in newborns with cleft lip and palate.

OBJECTIVE: The first aim was to examine maxillary developmental fields by analyzing bone size parameters within the maxillary bone complex in newborns with unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The second aim was to evaluate sella turcica morphology in unilateral cleft lip and unilateral cleft lip and palate. SUBJECTS AND METHODS: Axial and profile radiographs from 40 newborns (boy-girl, 1:1) in each group (20 unilateral cleft lip and 20 unilateral cleft lip and palate) were randomly selected among radiographs taken for optimizing treatment planning. Analysis of maxillary bone size was performed on axial radiographs and size parameters were measured. Furthermore, analysis of sella turcica morphology was performed on profile radiographs. The results were divided into groups with normal morphology and severe deviations in the morphology. RESULTS: The maxillary areas were significantly shorter and broader in unilateral cleft lip and palate than in unilateral cleft lip. A profound asymmetry in the maxillary areas was seen in unilateral cleft lip and palate, but not in unilateral cleft lip. In both cleft types, approximately half of the individuals had deviations in sella turcica morphology. The most severe deviations occurred in newborns with unilateral cleft lip and palate. CONCLUSIONS: In newborns with unilateral cleft lip and palate, the maxillary areas are significantly shorter, broader, and more asymmetric than in newborns with unilateral cleft lip. The present study showed that bone structures are a suitable parameter for characterizing the craniofacial developmental fields. Additionally, a high incidence of deviations in sella turcica morphology might indicate that this area is affected in individuals with clefts.     

用髂骨修复唇腭裂患者齿槽裂的临床研究

目的　评价用髂骨修复唇腭裂患者齿槽裂的临床效果。方法　对 10 2例唇腭裂患者的齿槽裂应用髂骨植骨修复 ,术后随访 6个月以上。对其植骨后的临床效果进行评价。结果　所有患者的手术均顺利完成 ,术后 6个月植骨结果为 :优 4 1例(4 0 .2 % ) ,良 4 6例 (4 5 .1% ) ,差 15例 (14 .7% ) ,临床成功率为 85 .3% ,其中以 8～ 11岁组的成功率最高 (93.1% )。结论　用髂骨修复唇腭裂患者齿槽裂是一种有效的治疗方法     

2447例唇腭裂患者的临床资料分析

目的　了解先天性唇腭裂的患病状况及特点 ,寻找与唇腭裂发生有关的影响因素 ,为唇腭裂的预防与治疗提供依据。方法　对 1989～ 1998,10年间在原华西医科大学口腔医院颌面外科手术治疗的 2 4 4 7病例进行回顾性临床统计学分析。结果　在本组病例中 ,唇裂 6 4 8(2 6 5 % )、唇腭裂 996 (40 7% )、单纯腭裂 80 3(32 8% )。唇裂伴或不伴腭裂中 ,男多于女 (2 .14∶1) ,单纯腭裂女多于男 (0 77∶1)。单侧唇腭裂明显多于双侧 ,两者之比为 4 84∶1,其中左侧者多于右侧者 ,两者之比为 2 14∶1。有遗传史的病例占病例总数的 7 4 % ,其中唇裂伴或不伴腭裂有遗传史者占唇裂伴或不伴腭裂患者的 8 2 % ,单纯腭裂有遗传史者占单纯腭裂患者的 6 5 %。母亲怀孕前 3月经历危险因素有 95 4例 ,占 39 0 % ,其中唇裂伴或不伴腭裂者 70 0例 ,占唇裂伴或不伴腭裂患者数的 4 2 6 % ,单纯腭裂2 5 4例 ,占单纯腭裂的 31 6 %。A型和O型血患者比例高于正常人群比例 ,而B型血者比例低于正常人群比例 ,单纯唇裂出生于 4～ 6月者人数小于其他季度 ,而单纯腭裂出生于 7～ 9月者人数少于其他季度 ;19例双生子中 ,均为其中之一发病 ,无同时发病者。唇腭裂伴发畸形者共 4 1例 ,占总病例数的 1 7%。结论　本资料提示唇腭裂的发生可?     

Anophthalmia, cleft lip/palate, absent vomer bone, nystagmus, and mental-motor retardation: a new syndrome or Fryns "anophthalmia-plus" syndrome?

OBJECTIVE: We report that a 4-year-old boy presented with right unilateral complete cleft lip and palate, right anophthalmos, left congenital nystagmus, absence of the vomer bone, mental-motor retardation, and normal lymphocyte karyotype (46, XY). METHODS: For reconstruction of the deformities, we performed cleft lip repair by Millard's rotation-advancement technique and planned cleft palate repair. CONCLUSIONS: This combination of cleft lip and palate, anophthalmos, congenital nystagmus, absent vomer bone, and mental-motor retardation has not, to our knowledge, previously been described. We suggest that this represents either another case of the rare Fryns "anophthalmia-plus" syndrome or a new syndrome.     

The influence of simultaneous cleft lip and palate repair on facial growth in rabbits

This study was designed to test the influence of simultaneous cleft lip and palate repair on facial growth in rabbits. Three groups of rabbits were used. Group I consisted of control rabbits who had no surgery; Group II had surgically created, but unrepaired, clefts of the lip, alveolus, and palate; and Group III had surgically created clefts of the lip, alveolus, and palate followed by immediate simultaneous lip and palate repair. In Group III, the lip was repaired using the Millare technique and the palate using two-flap palatoplasty, leaving no bare bone exposed. All animals were sacrificed after twenty weeks. Results of the direct cephalometry of the skulls confirmed that simultaneous lip and palate repair results in inhibition of anterior-posterior and transverse maxillary growth. Some significant changes were also found in mandibular length and nasal deflection. All 15 rabbits with simultaneous cleft lip and palate repair developed anterior crossbites and functional shifts to the left or cleft side. Further analysis comparing the results of facial growth inhibition in this study with inhibition following lip repair only or palate repair only will be necessary to assess the severity of secondary maxillo-facial deformities resulting from lip and palate repair.     

Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate.

OBJECTIVE: To investigate prelinguistic vocalization sequences of 1-year-old children with and without cleft lip and palate. DESIGN: Prospective study. PARTICIPANTS: Thirty-eight children born with unilateral cleft lip and palate and 36 control children born without clefts. The cleft children had the lip, soft palate, and posterior part of the hard palate repaired at 4 months of age. The lip was closed ad modum Millard, the nose was corrected according to McComb, and the soft palate was closed with a posteriorly based vomer flap. METHODS: Data were obtained from a clinical visit during which the baby played with the mother. Video recordings were transcribed and analyzed concerning (1) the frequency of occurrence of vocalization sequences, (2) the frequency of occurrence of contoids and vocoids, (3) the contoids' place and manner of articulation, and (4) the percentage of children who entered the canonical babbling stage. RESULTS: No significant differences were observed between the cleft and control groups concerning frequency of occurrence of vocalization sequences, contoids, or vocoids. Structural differences between the groups seem to influence the contoid inventory, with a higher frequency of occurrence of nasal contoids and a smaller frequency of occurrence of alveolar contoids in the cleft group. Canonical babbling was achieved by most children in both groups, and no significant difference was found between the groups. CONCLUSIONS: Early closure of the soft palate seems to have a positive influence on the prelinguistic development of children with cleft palate.     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

Cephalometric and occlusal outcome in adults with unilateral cleft lip, palate, and alveolus after two different surgical techniques.

OBJECTIVE: To assess differences in the aesthetic and functional long-term results of one-stage and two-stage surgical and orthodontic treatment in patients with cleft lip, palate, and alveolus. DESIGN: Sixty adult patients who were operated on as children for unilateral cleft lip, palate, and alveolus were examined. In every patient the lip was closed using Tennison's technique. Thirty patients had soft and hard palate closure in two stages and 30 patients in a single stage. Lateral cephalometric and model analyses were conducted at a mean age of 18.4 years. RESULTS: In the model analysis, transverse narrowing was seen in all patients after two-stage operations and in three patients after one-stage operations. The deficit was more severe in the molar region in the two-stage group and nearly similar in the premolar and molar region in the one-stage group. A sagittal deficiency in the anterior maxilla was found in 26 patients after two-stage operations and in 16 patients after one-stage operations. In the lateral cephalometric analysis, the mean sella-nasion-point A angle in the one- and two-stage group was 78.2 degrees and 76.8 degrees, respectively. The ANB angle was normal in both groups. In both groups the inclination of the midface was low. There was a low posterior facial height. Minor scarring was seen in the single-stage group. CONCLUSION: A more severe impairment of growth of the maxilla in the sagittal and frontal plane was observed after two-stage operations on the cleft palate.     

Dental development of Chinese children with cleft lip and palate.

OBJECTIVE: To compare the dental development and rate of tooth development between children with and without cleft lip and palate. Patients: Age- and gender-matched pairs (231 in all) of southern Chinese children ages 3 to 12 years, with and without cleft lip and palate. METHODS: Dental histories and radiographs were studied. From these, dental development was determined. RESULTS: Of 2946 tooth pairs in the children with cleft lip and palate, 252 (8.6%) were found to be asymmetric, significantly (p < .001) more than the 63 of 3179 (2.0%) tooth pairs observed in the children without cleft lip and palate. The teeth with the highest frequency of asymmetry were the maxillary lateral incisors (38.1%). Differences in dental development on the cleft versus noncleft sides of children with unilateral cleft lip and palate were significant for both maxillary and mandibular teeth (p < .001 and p = .039, respectively). The mean delay in tooth formation of the children with cleft lip and palate was 4.4 months relative to the children without cleft lip and palate. The majority of the teeth in the cleft lip and palate group were delayed by one developmental stage. This happened in 40.0% of the maxillary teeth and 30.1% of the mandibular teeth. The delay in tooth formation increased as the number of missing teeth increased in the children with cleft lip and palate, although not significantly. CONCLUSIONS: This group of southern Chinese children with cleft lip and palate demonstrated a higher prevalence of asymmetric and delayed dental development than did their counterparts who did not have cleft lip and palate.     

Human prenatal nasal bone lengths: normal standards and length values in fetuses with cleft lip and cleft palate.

OBJECTIVE: The aim of this study was to present prenatal autopsy standards for nasal bone length in normal fetuses, as well as to compare nasal bone lengths in human fetuses with cleft lip and palate with those standards. MATERIAL AND METHODS: The material consisted of human fetuses investigated in connection with diagnosed and legally approved abortions and spontaneous abortions; 40 were normal and 26 had cleft lip and palate (7 isolated cleft lip, 12 isolated cleft palate, and 7 combined cleft lip and palate). Menstrual ages (MA) ranged from 12 to 25 weeks, crown-rump length (CRL) from 55 to 210 mm and foot length (FL) from 7 to 44 mm. All fetuses were radiographed in lateral projection, and, using these images, the nasal bone lengths were measured with a digital caliper. Regression analyses were performed. RESULTS: Standards for normal nasal bone length at different ages are expressed as menstrual age, crown-rump length, or foot length. Comparisons with normal standards showed that the isolated cleft lip group had a significantly smaller nasal bone length than the normal fetuses had. Fetuses with isolated cleft palate and fetuses with combined cleft lip and palate showed no significant deviation from normal standards. CONCLUSION: Normal nasal bone standards can contribute to information on deviations in nasal bone length for aborted fetuses with known and unknown genotypes. The differences in nasal bone lengths in fetuses with different lip and palate clefting can contribute to understanding the pathogenesis of cleft lip and palate.     

Caries experience and oral health behavior in Chinese children with cleft lip and/or palate.

PURPOSE: The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children. METHODS: A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency consumption of specific drinks and, children's toothbrushing frequency. RESULTS: One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries. CONCLUSIONS: The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: a. whether the child had been bottle-fed and; b. the educational attainment level of the mother.     

湖北地区唇腭裂患者的ABO血型研究

目的 :研究湖北地区唇腭裂的发生与ABO血型有无相关性。方法 :统计湖北地区唇腭裂患者的A、B、O、AB血型的百分比 ,与湖北正常人群的A、B、O、AB血型的百分比相比较。分别统计A、B、AB、O血型患者中唇裂 ,腭裂 ,唇腭裂发病人数 ,并进行统计学处理。结果 :唇腭裂患者中A型血所占比例较正常人群低 (P 0 .0 5 ) ,O型血所占比例较正常人群高 (P 0 .0 5 ) ,B型及AB型血在唇腭裂患者与正常人群中无显著性差别。唇裂、腭裂、唇腭裂的发生与A、B、O、AB血型无明显相关性。结论 :湖北地区A型血胎儿不易患唇腭裂 ,O型血胎儿易患唇腭裂。唇腭裂的发生与血型无关     

Abstracts from other journals

The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children. A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency of consumption of specific drinks, and children's toothbrushing frequency. One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries. The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: (a) whether the child had been bottle-fed and; (b) the educational attainment level of the mother.     

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。     

Distinctive cortical articulatory representation in cleft lip and palate: a preliminary functional magnetic resonance imaging study.

OBJECTIVE: To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate. DESIGN: We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level-dependent functional magnetic resonance imaging. SUBJECTS: Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers. RESULTS: Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient. CONCLUSIONS: The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.