279例腭隐裂临床回顾分析

目的:总结腭隐裂患者的流行病学特征,分析患者的手术年龄、就诊原因及伴发其他疾病和(或)畸形情况.方法:通过查询在北京大学口腔医院2013年1月1日—2020年12月31日经同一医师治疗的279例连续腭隐裂患者的病历资料进行回顾分析,对手术年龄、就诊原因及伴发其他疾病和(或)畸形的百分比进行统计分析.结果:经统计,手术年...     

腭隐裂患者颅颌面生长发育的研究进展

腭隐裂是一种特殊类型的腭裂,无显性裂隙存在,但有软腭肌肉附着异常及不同程度的硬腭骨质缺损.由于仅10％的腭隐裂患者存在腭咽闭合不全及异常语音,很多患者易被漏诊,故对其研究较少.本文归纳总结了近年来国内外学者相关研究成果,对腭隐裂患者的颅颌面生长发育潜能、手术对其颅颌面生长发育影响以及与腭咽闭合功能的关系的研究进展作一综述.     

腭黏膜下裂伴先天性硬腭瘘1例报告

腭黏膜下裂伴先天性硬腭瘘临床罕见,迄今国内外文献报道仅10余例。作者报告1例病例,并结合相关文献,对该病的临床特点、诊断、发生率、发病机制及手术治疗进行讨论。本病发病机制不清,临床症状与腭黏膜下裂相似。手术除完整封闭瘘孔外,还应后退异常附丽的软腭肌,重建提肌吊带。术后随访1a,无复裂,腭咽功能改善良好。     

改良腭黏膜瓣整复软腭裂的临床观察

目的:探讨整复软腭裂的新术式,重建腭咽闭合的效果。方法:采用腭黏膜瓣后推术对25例软腭裂患者进行整复治疗,并对其进行随访,以了解术后腭咽闭合的情况。结果:所有患者术后腭部创口愈合良好,瘢痕不明显,软腭的活动度良好,且均有良好的腭咽闭合功能。结论:对先天性软腭裂的患者实施该术式整复,能较好地恢复腭咽闭合功能,是较为理想的手术整复方法之一。     

腭隐裂患者头颅侧位X线片测量分析

目的　应用回顾性研究的方法对 50例腭隐裂患者X线片测量并与健康对照组对比分析 ,观察软腭在形态学、运动能力以及腭帆提肌附着位置等方面的特点 ,进一步研究腭隐裂患者腭咽闭合不全的原因 ,为其诊断提供依据。方法　腭隐裂患者 50例 (年龄 4～ 51岁 ,平均年龄 1 1 9岁 ,男性 2 0例 ,女性 30例 ,男∶女 =1∶1 5)。对术前头颅侧位定位X线片共 1 0 0张 (每例静止及发“i”音各 1张 )进行测量分析。结果　腭隐裂组的软腭相对长度较对照组短 ,患者的腭帆提肌附着点相对位置比对照组靠前 ,发音时软腭抬高角度较小 ,以上 3项指标经统计学分析 ,差异有显著性 (P <0 0 5)。两组间硬腭相对长度和发音时软腭伸长量的比较差异无显著性 (P >0 0 5)。结论　通过测量所得指标(包括软腭相对长度、腭帆提肌附着位置及发音时软腭抬高角度 )是诊断腭隐裂的重要指标     

隐裂154例分析

笔者在门诊遇到确诊的隐裂１５４例,１８４个患牙,分析讨论如下。发病年龄２０～６３岁,以４０～４９岁年龄组发病率最高,占４８．１％,其次为５０～５９岁者。男性７２例、女性８２例,上颌１１９个,下颌６５个,上颌发病率明显高于下颌;第一磨牙１１９个（６４．７％）,第二磨牙４４个（２３．９％）,第三磨牙７个（３．８％）．第二前磨牙９个（４．９％）,第一前磨牙５个（２．７％）。磨牙明显高于前磨牙,第一磨牙发病率最高。隐裂发生的部位及裂向１８４个患牙中裂纹全部或部分与发育沟重迭的１７８个（９６．７％）,未与…     

先天性腭咽闭合功能不全与腭隐裂的X线比较研究

目的：比较先天性腭咽闭合功能不全（CVPI）与腭隐裂患者的腭咽部形态学特点和差别。方法：先天性腭咽闭合功能不全17人；腭隐裂12人；对照组20人分别拍摄静止和发a时的头颅侧位定位片，所测指标使用SPSS10．0统计软件分析比较。结果：CVPI患者和腭隐裂患者的静止咽腔深度，发声咽腔深度、软腭有较长度比、腭咽闭合率、软腭运动率与对照组有显著性差异，但二者之间无明显差异。结论：CVPI患者和腭隐裂患者的腭咽部形态基本相同。     

先天性腭隐裂发生腭瘘导致语音不清1例

本文报告1例患有先天性腭隐裂的成年女性,由于腭部炎症所致软硬腭交界处、软腭部2处穿孔(腭瘘)而导致语音不清患者,经外科手术转移黏骨瓣封闭前端硬腭部裂隙,行咽成形术后,关闭软腭部瘘孔同时缩小咽腔,得以恢复正常语音功能.     

唇腭正中裂伴蝶鞍部脑膜膨出1例

患者 ,女 ,10岁。因腭裂要求手术就诊。查体 :智力正常。内眦间距 38mm ,重度眶距过宽。上唇正中裂 ,仅限于唇红。腭正中裂隙 ,由悬雍垂至硬腭。鼻咽部可见一直径约1.5cm球形肿物 ,有搏动且与心率一致 ,膨大与缩小交替进行 ,质软 ,有波动感 ,透光试验 (+)。MRI示 :颅底蝶鞍区一长T1、T2信号影 ,穿通蝶鞍与蝶窦 ,边缘清晰光滑。诊断 :颅面裂 (①先天性唇正中裂Ⅰ ;②先天性腭裂Ⅱ ;③脑膜彭出 )。拟颅底修补术后行腭裂修补术 ,患者因经济原因放弃治疗。讨论 :颅面裂是一种罕见的先生性发育畸形。根据Tessier(1973)分类 ,此例患者属于Tessi…     

72例隐裂牙的诊断与综合治疗的临床疗效分析

目的 探讨和研究隐裂牙的诊断和综合治疗的临床效果。方法 72例74颗隐裂牙根据临床表现及检查结果,分别进行树脂充填,U型曲固定,根管治疗及全冠修复。结果 经综合治疗的隐裂牙随访2～3年,总有效率为90.54%。结论 对隐裂牙进行综合治疗、全冠修复是重要的治疗手段,对患牙长期留存率的提高有重要意义。     

Clinical grading system for submucous cleft palate

Submucous cleft palate is a structural abnormality of the palate. The clinical features vary, as does the functional impairment, which ranges from none to severe. Although there is a poor correlation between the presenting clinical signs and the severity of velopharyngeal insufficiency during speech, a clinical grading system could assist surgical management and allow more meaningful comparisons to be made between outcome studies. The grading system described is based on clinical examination alone and reflects the likely degree of structural abnormality of the musculature of the soft palate.     

Surgical indication of Furlow palatoplasty to treat submucous cleft palate

This study investigated the effects of Furlow palatoplasty on children with submucous cleft palate (SMCP) and identified surgical indications by comparing SMCP and control patients. Twenty-three SMCP children (average age 28.9 months) who were nonsyndromic and underwent surgery between April 2010 and December 2016 were included. Facial computed tomography (CT) was performed preoperatively and at least 1 year postoperatively after a language test. Facial CT measurements were taken for 140 children aged 0–6 years without deformities (control group). Later surgery was associated with more severe nasality. In the coronal view, the difference in the maxillary tuberosity before and after surgery was 3.8 mm (p < 0.05). The height and width of the palatal arch (HNP and WNP) were well maintained (p > 0.05), whereas the angle of the levator veli palatini muscle (ALM) increased (p < 0.05). The nasopharynx was close to normal postoperatively. The distance between the medial pterygoid plates, the HNP, and the WNP were larger in SMCP patients preoperatively (p < 0.05), but these differences disappeared after surgery (p > 0.05). The ALM in SMCP patients was narrower preoperatively, but became flatter postoperatively (p < 0.05), indicating the repositioning of the levator muscle, with improvement of the velopharyngeal function. Furlow palatoplasty is indicated if the HNP and WNP values are larger, and the ALM value is less, in patients with SMCP than in those without.     

Preoperative velopharyngeal closure ratio correlates with Furlow palatoplasty outcome among patients with nonsyndromic submucous cleft palate

This study aimed to explore the preoperative factors that are potentially associated with the outcome of Furlow palatoplasty in treating nonsyndromic submucous cleft palate (SMCP). In this study, we reviewed patients with nonsyndromic SMCP who received Furlow palatoplasty between 2008 and 2017 at our department. A comprehensive panel of preoperative variables was included for analyses including gender, age at operation, concurrence of cleft lip, preoperative hypernasality, nasal emission, velopharyngeal closure ratio (VCR), velopharyngeal closure pattern, velum and pharyngeal wall movement, presence of Passavant Ridge and articulation error. The improvement of velopharyngeal function was considered a good outcome. Both univariate and multivariate analyses were performed to screen the potential predictors of the postoperative velopharyngeal function. Multivariate regression analyses indicated preoperative VCR as the only factor that was significantly associated with surgical outcome (p = 0.025). The receiver operating characteristic curve and Youden index indicated that VCR>52.5% was the cutoff value for predicting preferable postoperative velopharyngeal function (OR, 0.240; 95% IC, 0.059–0.979; p = 0.047). In conclusion, Furlow palatoplasty was recommended for non-syndromic SMCP patient with preoperative VCR>52.5% as the primary surgical treatment.     

黏膜下腭裂的腭咽闭合状态及语音表现分析

目的 通过分析黏膜下腭裂患者腭咽闭合模式、腭咽口各部分的收缩运动状况和语音表现,进一步探究黏膜下腭裂的病理特征规律。方法 回顾2008—2016年于四川大学华西口腔医院唇腭裂外科就诊的黏膜下腭裂患者的病历资料,分析其术前腭咽功能、辅音构音表现,采用鼻咽内镜观察腭咽闭合模式以及软腭、咽侧壁和咽后壁的运动情况。结果 共纳入353例黏膜下腭裂患者,其中术前腭咽闭合完全（VPC）者138例（39.09%）,腭咽闭合不全（VPI）者176例（49.86%）,边缘性腭咽闭合不全（MVPI）者39例（11.05%）; 268例患者接受了鼻咽内镜检查,167例（62.31%）为环状闭合,89例（33.21%）为冠状闭合,12例（4.48%）为矢状闭合;派氏嵴参与了45.51%（76/167）的环状闭合和13.48%（12/89）的冠状闭合。353例患者中137例（38.81%）构音正常,124例（35.13%）表现为辅音省略,51例（14.45%）有代偿性构音,36例（10.20%）有辅音弱化,25例（7.08%）有辅音替代,36例（10.20%）有2种以上的构音错误。结论 环状闭合是黏膜下腭裂患者最主要的腭咽闭合模式,压力辅音省略是最常见的构音障碍。随着腭咽闭合程度的降低,发生2种以上构音错误的患者明显增加。     

Submucous cleft palate: variations in bony defects of the hard palate

We have analysed bony defects of the hard palate in patients with submucous cleft palate to find out whether velopharyngeal insufficiency (VPI) is dependent on the extent of these defects. We evaluated the maxillofacial structures associated with cleft palate by 3-dimensional computed tomography (CT) in 23 children diagnosed with submucous cleft palate. Bony defects of the hard palate were divided into Type I, defined as absent posterior nasal spine (n = 12), Type II, V-shaped bony notch (moderate, n = 7), and Type III, as bony defect extending into the incisive foramen (severe, n = 4) defects, respectively. VPI was found in 10, 3, and 4 patients, respectively. Neither VPI nor the degree of bifid uvula was significantly associated with the types of bony defects.     

黏膜下腭裂的形态分类与腭咽功能分析

目的 通过观测黏膜下腭裂患者的多项指标,以了解黏膜下腭裂的解剖形态与腭咽功能,以期提高临床诊断和治疗的准确率。方法对2008-2014年就诊的276例黏膜下腭裂患者的资料进行回顾性研究,对其术前腭咽功能、腭部形态、是否伴发唇裂、就诊原因等因素进行分析,观察各指标与腭咽功能的相关关系。结果276例患者中,术前腭咽闭合完全（VPC）者96例（34.78%）,腭咽闭合不全（VPI）者151例（54.71%）,边缘性腭咽闭合不全（MVPI）者29例（10.51%）。单纯黏膜下腭裂者196例（71.01%）,伴发唇裂者80例（28.99%）,伴发唇裂者较单纯的黏膜下腭裂者有更高的术前VPC率。黏膜下腭裂有不同的形态,完全具备Calnan三联征者仅103例（37.32%）。结论不同类型黏膜下腭裂的构成比和腭咽闭合率不同,需综合考虑各个因素与腭咽功能间的可能关系,谨慎选择治疗方案。     

Genetic and environmental risk factors for submucous cleft palate

A multifactorial aetiology with genetic and environmental factors is assumed for orofacial clefts. Submucous cleft palate (SMCP), a subgroup of cleft palates with insufficient median fusion of the muscles of the soft palate hidden under the mucosa, has a prevalence of 1:1,250-1:5,000. We described the prevalence of risk factors among 103 German patients with the subtype SMCP and genotyped 24 single nucleotide polymorphisms (SNPs) from 12 candidate genes for orofacial clefts. Analysis of risk factors yielded a positive history for maternal cigarette smoking during pregnancy in 25.2% of the patients, and this was significantly more frequent than in the normal population. The group of patients differed in allele frequencies at SNP rs3917192 of the gene TGFB3 (nominal P = 0.053) and at SNP rs5752638 of the gene MN1 (nominal P = 0.075) compared with 279 control individuals. Our results indicate a potential role of maternal smoking during pregnancy for the formation of SMCP. The analysis of genetic variants hints at the contribution of TGFB3 and MN1 in the aetiology of SMCPs.