单侧完全性唇腭裂新生儿上颌牙槽形态的三维测量分析

目的 研究非综合征型单侧完全性唇腭裂新生儿上颌牙槽的三维形态特征,并验证三维测量方法的可靠性及可重复性。方法 筛选60名单侧完全性唇腭裂新生儿,通过iTero口内扫描仪对其初始上颌石膏模型进行扫描,由同一研究员使用Mimics软件对上颌牙槽的25个测量项目进行共两次三维测量,对两次的测量结果进行Bland-Altman一致性检验;并依据上颌牙槽的形态将样本分为G1、G2、G3三组,通过两两比较研究不同分组上颌牙槽的形态差异。结果 所有测量值的结果均符合正态分布,且两次测量结果具有较好的一致性。单侧完全性唇腭裂新生儿健侧的前段牙槽长度以及前后段牙槽的旋转角均明显大于对侧的前后段牙槽;G1及G2组健侧前段牙槽长度明显长于G3组,G1组牙槽裂隙宽度、牙弓中段的裂隙宽度、尖牙水平的牙弓宽度和健侧前段牙槽的旋转角都明显小于G2、G3组。结论 本研究统计了非综合征型单侧完全性唇腭裂新生儿上颌牙槽的平均尺寸,前段牙槽的发育不足和健侧前段牙槽的外旋程度共同决定了单侧唇腭裂牙槽裂隙的严重程度。     

单侧完全性腭裂两阶段手术修复模式

唇腭裂序列治疗已成为基本共识,但其标准化跟规范化这一基本问题却仍然没有得到很好的解决。在欧洲开展的调查表明,截止到2001,共有194种不同的治疗模式或程序应用于单侧唇腭裂[1],这种现状一方面表明各种治疗方法在不断地发展,另一方面则说明目前仍没有一种得到普遍承认     

单侧完全性唇（腭）裂患者术后上唇特征的研究

目了：了解单侧完全性唇（腭）裂患者术后上唇的形态特征。方法：将单侧完全性唇裂组和唇腭裂组患者。以及正常对照组的正,侧位标准相片上的上唇白唇面积,上唇白唇高,上唇红唇高,口裂宽,以及鼻底凸度,上唇和下唇凸度进行测量分析。结果 单侧完全性唇裂和唇腭裂患者唇裂术后的上唇面积和上白同均明显,于正常对照组,唇裂患者的唇突指数,明显小于正常对照组和唇裂组。结论 单侧完全性唇（腭）裂患者术后唇高短于正常对照组,唇突指数可较好地反映唇（腭）＿裂患者上唇支持硬组织凹陷畸形的程度。     

单侧完全性唇腭裂快速腭扩展的三维可视化评价

目的：应用三维可视化技术分析唇腭裂患者快速腭扩展前后颅颌面硬组织结构的改变。方法：选择一例单侧完全性唇腭裂患者,螺旋CT扫描,应用Amira 3.11软件读取DICOM格式数据,生成STL格式的三维硬组织数字模型,通过Magic RP5.41读取该模型,将腭扩展前后得到的数字模型进行重叠。结果：通过对腭扩展前后模型重叠分析,发现腭扩展后额骨发生了轻微的后移,颧额缝、额颌缝、鼻额缝下方的颌骨以及牙齿、齿槽区都发生了一定程度的向外扩展,颧颞缝前方颧弓发生了轻微的上移。牙齿横向位移最大的区域在上颌尖牙区。结论：通过基于DICOM格式的三维实体几何模型重叠技术,可以对UCLP患者快速腭扩展前后颅颌面硬组织结构的改变进行可视化评价,快速腭扩展前后牙弓位移量呈前大后小的趋势。     

三维测量分析单侧完全性唇腭裂术后成年患者的上颌骨形态

目的:探讨单侧完全性唇腭裂术后成年患者的上颌骨形态特征.方法:应用螺旋CT采集30例单侧完全性唇腭裂术后成年患者上颌骨数据,应用SimPlant11.04软件对数据进行三维重建、定点,建立三维坐标系,验证标记点的可重复性,测量标记点到三维坐标平面的距离.应用SAS6.12软件包对数据进行统计学分析.结果:7个居中的标记点中,A、ANS显著偏向健侧(P＜0.01);14对患健侧标记点的非对称率(Q)显示,INM’与INM 、SNM’与SNM、SPr’与SPr在到矢状面S的距离存在明显不对称畸形,而其余多数点在三维方向上无不对称畸形;患者上颌骨与正常人的主要不同是在前后方向上存在发育不足,患侧上颌骨错位较健侧明显.结论:应用螺旋CT及SimPlant 11.04软件三维测量上颌骨形态的方法,能够精确测量各标记点到坐标的三维距离,可用于评估患者患、健侧上颌骨的畸形程度.     

单侧完全性腭裂婴儿期牙槽骨形态的三维分析

目的 :探索单侧完全性腭裂婴儿期牙槽骨裂隙两侧牙槽骨段的三维方向位移规律及其原理。方法 :随机选取 3 0名单侧完全性腭裂婴儿期模型 ,设计标志点 ,测量各标志点三维坐标 ,分析牙弓宽度及长度、中线及牙槽骨裂隙两侧偏移幅度。选取 9名正常婴儿口腔模型作为对照。结果 :完全性腭裂组婴儿前牙弓和后牙弓宽度增加 ;中线向非裂隙侧偏移 ;裂隙侧牙槽骨前段向后向外向上移位 ;非裂隙侧牙槽骨前段向前向上移位。结论 :牙槽骨矫形需结合异位情况促使裂隙侧牙槽骨段向前向内向下移位 ,非裂隙侧牙槽骨段向后向下移位     

单侧完全性唇腭裂患者下颌骨对称性的三维分析

目的三维分析成年期前未行腭裂修复术的单侧完全性唇腭裂患者(UCLP)的下颌骨形态对称性。方法对9例5岁前完成唇裂修复术、成年前未行腭裂修复术的UCLP患者进行螺旋CT扫描、三维重建,选择7个下颌骨标志点进行定点测量,分析下颌骨的三维形态。结果成年前未行腭裂修复术UCLP患者下颌骨各个部位都存在一定程度的不对称,其中CoGo、Cor-Go、∠Co'-Co-Me裂侧大于健侧;其他各指标裂侧均小于健侧。但配对t检验提示裂侧与健侧测量值相比均无显著性差异(P﹥0.05)。结论成年前未行腭裂修复术的UCLP患者下颌骨无明显不对称。     

唇腭裂新生儿的腭裂数字化模型方法

目的:利用硅橡胶印模和结构光三维扫描技术制取唇腭裂新生儿出生后第2天的腭裂表面形态数字化模型.方法:采用特殊重体硅橡胶印模材料制取患儿腭裂印模,通过3DSS扫描仪对石膏模型进行三维数据采集,经逆向工程软件处理数据,建立腭裂的数字化模型.结果:结构光扫描系统采得的腭裂数字化模型形态清晰,在软件平台上可以自由编辑和测量.结论:利用结构光三维扫描技术可以获取理想的新生儿腭裂数字化模型,该模型具有快捷、能长期存储等特点.     

单侧完全性唇腭裂患者髁突及下颌升支对称性的锥形束CT研究

目的: 评价单侧完全性唇腭裂(UCLP)患者下颌骨髁突及升支垂直向对称性。方法: 取25例单侧完全性唇腭裂患者作为实验组,25例同年龄正常牙合人群作为对照组,两组均拍摄锥形束CT(CBCT)图像,对下颌髁突高度(CH)、升支高度(RH)及髁突与升支高度和(CH+RH)进行测量分析及不对称指数计算,所得数据使用SPSS17.0进行配对样本t检验和独立样本t检验。结果: 单侧完全性唇腭裂患者健侧与患侧下颌髁突高度、髁突与升支高度和具有统计学意义。单侧完全性唇腭裂组与对照组髁突与升支高度和不对称指数具有统计学意义。结论: 单侧完全性唇腭裂患者下颌骨髁突高度、髁突与升支高度和存在不对称畸形,患侧明显小于健侧,且髁突与升支高度和不对称指数与正常牙合人群比较存在差异。     

单侧完全性唇腭裂患者鼻上颌复合体对称性的三维分析

目的 三维分析成年期前未行腭裂修复术的单侧完全性唇腭裂（UCLP）患者的鼻上颌复合体形态对称性.方法 对9例2.5岁前完成唇裂修复术、成年前未行腭裂修复术的UCLP患者进行螺旋CT扫描、三维重建,选择22个头颅标志点进行定点测量,分析鼻上颌复合体的三维形态.结果 成年前未行腭裂修复术UCLP患者裂侧NC-HP、PF-MSP距离分别为18.01mm、19.72mm,大于健侧13.35mm、17.31mm（P＜0.05）;裂侧NC-CP、U3-HP距离分别为59.64mm、39.55mm,小于健侧64.13mm、39.70mm（P＜0.05）,即裂侧鼻腔较健侧明显下凹和塌陷,裂侧后段硬腭宽度大于健侧,尖牙低位.正中结构存在偏移,鸡冠点、鼻中隔、上中切牙中点偏向裂侧,骨性前鼻棘点朝向健侧.结论 成年前未行腭裂修复术的UCLP患者颅面不对称主要集中在鼻腔和邻近裂隙的牙齿槽区,颅面上部和远离裂区的区域没有明显不对称.     

3-D shape analysis of palatal surface in patients with unilateral complete cleft lip and palate

Facial development of patients with unilateral complete cleft lip and palate (UCLP) is associated with many problems including deformity of the palate. The aim of this study was to evaluate palatal morphology and variability in patients with UCLP compared with Czech norms using methods of geometric morphometrics. The study was based on virtual dental cast analysis of 29 UCLP patients and 29 control individuals at the age of 15 years.The variability of palatal shape in UCLP patients was greater than that in nonclefted palates. Only 24% of clefted palates fell within the variability of controls. The palatal form of UCLP patients (range from 11.8 to 17.2 years) was not correlated with age.Compared with control palates, palates of UCLP patients were narrower, more anteriorly than posteriorly. Apart from the praemaxilla region, they were also shallower, and the difference increased posteriorly. The UCLP palate was characterised by the asymmetry of its vault. The maximum height of the palatal vault was anterior on the clefted side, whereas it was posterior on the nonclefted side. The slope of the UCLP palate was more inclined compared with the control group. The praemaxilla was therefore situated more inferiorly.     

Timing of palate repair affecting growth in complete unilateral cleft lip and palate

ObjectiveTo evaluate the facial morphology characteristics of patients with complete unilateral cleft lip and palate (UCCLPs) who had undergone cleft palate repair at different times.DesignThis study included 46 nonsyndromic UCCLPs and 38 age and sex matched non-cleft patients. 35 cephalometric measurements were used to evaluate the facial morphology. Student’s t-test, one-way ANOVA and rank sum tests were used for comparison. Significant difference was defined at 95% level.ResultsThe data showed that UCCLPs who had palatoplasty between 7 and 12 years had greater PMP-A, PMP-ANS, Ba-ANS, Ba-A, Ba-N-ANS than those operated on before 4 years of age, and UCCLPs who had palatoplasty at 4–12 years had smaller Y-axis angle than those operated on before 4 years of age.ConclusionsThe maxillary sagittal length increased gradually as von Langenbeck repair was delayed. UCCLPs who underwent palate repair using von Langenbeck technique at 4–12 years had a more protrusive maxilla and less clockwise rotated mandible than those repaired before 4 years. UCCLPs operated using the von Langenbeck technique at 4–12 years had better head-face morphology than those operated on before 4 years. There was no difference in facial morphology among UCCLPs with palate repair at 4–12 years.     

Mandibular morphology in complete unilateral cleft lip and palate.

OBJECTIVE: The purpose of this study was to evaluate and compare mandibular morphology and spatial position in children with complete unilateral cleft lip and palate (UCLP) treated at two different cleft centers (Hannover and Brussels) following different surgical treatment protocols. PATIENTS: A total of 62 Caucasian children (40 boys, 22 girls) with nonsyndromic complete unilateral cleft lip and palate (UCLP) were evaluated by means of conventional cephalometric analysis at approximately the age of 10 years. Data of both cleft groups were compared with a control, noncleft group (n = 40) matched according to age and sex. INTERVENTIONS: The Hannover children with cleft (n = 36) underwent lip repair at a mean age of 5.83 +/- 1.16 months. The hard and soft palates were closed at a mean age of 29.08 +/- 4.68 and 32.25 +/- 4.29 months, respectively. The Brussels children with cleft (n = 26) were treated according to the Malek surgical protocol with soft palate repair at a mean age of 3.04 +/- 0.20 months and simultaneous lip and hard palate repair at a mean age of 6.15 +/- 0.68 months. RESULTS: Statistical analysis (analysis of variance with post hoc Tukey's test) showed a significant (p =.001) smaller mandibular ramus length (Co-Go) in the Brussels cleft group, compared with the control group. The Hannover-Brussels comparison data revealed that the S-N-B angle was significantly (p =.047) less in the Brussels cleft group. CONCLUSIONS: The influence of surgical procedures in patients with UCLP might not be restricted to the maxilla but could influence mandibular spatial position to the cranial base. Because of these positional changes of the mandible, both cleft groups showed facial balance.     

单侧完全性唇腭裂术后患者颅颌冠状面上的形态特征的研究

本文通过对33名恒牙列早期单侧完全性唇腭裂术后患者和同龄正常青少年的线正位片测量研究，结果表明：该时期术后患者上颌骨及上颌牙槽宽度明显小于正常组，鼻中隔底部偏非裂隙侧，男性面中份宽度及鼻部宽度亦明显发育受限。相关性研究发现面部各部分宽度生长发育呈明显正相关。     

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目的 探讨成年单侧完全性腭裂患者上颌骨发育情况。方法 选择2005年11月至2007年11月中国医科大学口腔医学院收治的16例未伴有唇裂的成年单侧完全性腭裂患者（腭裂组）,通过拍摄标准头颅定位X线片 ,测量相关头影指标,并同时与20名正常成人（正常组）的指标进行比较,评价其上颌骨在三维方向上的发育情况。结果 男性和女性研究群体中,上颌骨相对于颅底的位置关系以及上颌骨长度与颅底长度的比值、面中份的高度与全面高的比值、上颌宽距与上面宽的比值,腭裂组与正常组间差异均无统计学意义。结论 成年单侧完全性腭裂患者上颌骨的长度、高度和宽度的发育基本正常。     

Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients

OBJECTIVE: To examine lateral cephalometric radiographs of adult unoperated cleft lip and palate patients for the purpose of clarifying whether maxillary deficiencies observed in treated cleft patients result from intrinsic defects or surgical intervention early in life. MATERIALS AND METHODS: This retrospective study examined lateral cephalograms of 30 adult patients with nonsyndromic complete unilateral cleft lip and palate (CUCLP). The lateral cephalograms were traced and evaluated for size and position of the cranial base, maxilla, maxillary dentition, mandible, and mandibular dentition as well as for vertical relationships. Comparisons with 30 adult noncleft individuals were made. RESULTS: In unoperated adult cleft lip and palate patients, the cranial base angle was increased with the anterior cranial base reduced in length. The maxilla was found to be normal in size and somewhat prognathic in position. Both the maxillary and mandibular incisors were relatively upright. The mandible was smaller in size and posteriorly positioned. CONCLUSIONS: The potential for normal growth of the maxilla exists in patients with CUCLP. It is likely that disturbances of maxillary growth in surgically operated cleft patients are related primarily to the surgical intervention.     

Periodontal condition in adult patients with unilateral complete cleft lip and palate

The periodontal condition, as expressed by plaque accumulation, gingival bleeding, and pocket depth formation, was registered in relation to maxillary teeth in 50 subjects with systematically treated unilateral complete cleft lip and palate (UCLP). Their treatment had been completed at a mean age of 19.5 years when a fixed partial denture was inserted in the cleft area. The mean interval between completion of the treatment and the present investigation was 9.5 years. Generally, the periodontal condition in relation to abutment and nonabutment teeth seemed to be in accordance with that seen in the general population, implying that the condition was poorer in relation to abutments as compared with nonabutment control teeth. Indirect evidence indicated that this was caused by the adverse effects of prosthodontic treatment rather than by the anatomic deviations created by the repaired cleft.