非综合征唇裂伴或不伴腭裂对口腔健康相关生活质量的影响

目的 探讨非综合征唇裂伴或不伴腭裂对口腔健康相关生活质量的影响。方法 回顾分析2017年1月—2019年6月山东省菏泽市立医院收治的非综合征唇裂伴或不伴腭裂90例患儿的临床资料,其中唇裂不伴腭裂52例（唇裂不伴腭裂组）,唇裂伴腭裂38例（唇裂伴腭裂组）;选择同期我院口腔科常规口腔检查、口腔健康的40例儿童作为对照组,所有入组者均进行口腔健康检查。应用问卷调查法评估口腔健康对日常生活的影响,采用SPSS 22.0软件包对口腔健康与日常生活质量的相关性进行Spearman相关分析。结果 唇裂不伴腭裂组与唇裂伴腭裂组在龋失补指数（DMFT）、功能牙数目（TH）、咬合牙对、龋齿牙数、LOA≥6 mm牙数间差异具有统计学意义（P<0.05）;唇裂不伴腭裂组与唇裂伴腭裂组的DMFT、TH、咬合牙对、龋齿牙数、LOA≥6 mm牙数均显著高于对照组（P<0.05）;唇裂伴腭裂组OIDP量表各条目得分、OIDP总分显著高于唇裂不伴腭裂组（P<0.05）;唇裂不伴腭裂组OIDP量表各条目得分、OIDP总分显著高于对照组（P<0.05）。采用Spearman法分析临床口腔健康指数与OIDP分数的相关关系,唇裂不伴腭裂组与唇裂伴腭裂组DMFT、MT与根龋牙数、LOA≥6 mm牙数与OIDP分数呈负相关;咬合牙对与OIDP分数呈正相关（P<0.05）。结论 非综合征唇裂伴或不伴腭裂的口腔健康对日常生活质量均有不同程度影响。     

Vestibuloplasty in patients with cleft lip and palate

After cleft lip repair the upper lip is sometimes attached at the premaxilla. The scar bands and contractures may occur deleterious effects on: the growth, the facial expression, the speech, problems during orthodontic treatment and in prosthetic dental care, regression of the attached gingiva, resorption of the transplanted bone and the aspect of the upper lip. In nine edentulous patients with cleft lip palate, in six patients with cleft lip palate and with a mutilated dentition and in ten younger patients with cleft lip palate the buccal sulcus was successfully restored. The importance of a free upper lip and adequate sulcus has been under-emphasized in treatment of the patient with cleft lip palate.     

Type of oral cleft and mothers' perceptions of care, health status, and outcomes for preadolescent children.

OBJECTIVE: To evaluate the outcomes of care for children by type of oral cleft. DESIGN: Data were collected through structured telephone interviews during 2003 in Iowa with mothers of 2- to 12-year-old children with oral clefts. Interviews with mothers of children with clubfoot and statewide data on Iowa children were used for comparison. PARTICIPANTS: Participants included mothers of children in Iowa born between 1990 and 2000 with nonsyndromic oral clefts. Children were identified by the statewide Iowa Registry for Congenital and Inherited Disorders. MAIN OUTCOME MEASURES: Rating of cleft care, severity of condition, health status, esthetic outcome, speech, and school performance were evaluated by type of oral cleft. RESULTS: Children with cleft lip and palate were most likely to have their clefts rated as very severe. Children with palatal involvement were reported to have a lower health status and were almost twice as likely to be identified as having a special health care need compared with either children with cleft lip or children statewide. Children with cleft lip had more esthetic concerns; children with palatal involvement had the most speech concerns. CONCLUSIONS: Although mothers generally believed their children had received high-quality care, ratings of the children's current health status and outcomes of care varied significantly by type of cleft (cleft lip, cleft palate, and cleft lip and palate). Differences observed in this population-based study support the proposition that cleft type should be considered when examining outcomes of care for children with oral clefts.     

重视麻醉在唇腭裂整复术中的作用

近20年来,随着各种慈善组织进入我国,开展唇腭裂整复术的医院逐渐增多,提高了国内唇腭裂整复的整体水平。但在普及过程中,也出现了一些问题,尤其是在麻醉方面。本文从唇腭裂患者和婴幼儿的特点及其唇腭裂治疗出发,阐述了麻醉医师在唇腭裂整复中的作用和地位,同时提出了"龟兔赛跑的新理念",强调了团队合作的重要性。作为国内最大的唇腭裂治疗中心之一,愿在此和国内同行一起分享对于唇腭裂治疗的经验,并希望能借此提高我国唇腭裂治疗的水平,使更多的唇腭裂患者能够得到专业唇腭裂和麻醉团队的治疗。     

Current data on the characterization of oral clefts in Brazil

This study aimed at investigating the current distribution of the several types of clefts among the patients receiving treatment at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC-USP), Bauru, Brazil, for the first time during the year 2000. A total of 803 unoperated patients with cleft lip and/or palate, with or without additional malformations, with no recognizable syndromes, who came to the HRAC-USP for enrollment for treatment during the year 2000. A predominance of complete cleft lip and palate, either unilateral or bilateral, was observed (37.1%), followed by isolated cleft palate (31.7%) and isolated cleft lip (28.4%). A discrete relationship between cleft palate and the female gender was noticed (53%), and males were more affected by the other types of clefts (around 60%). The findings revealed a predominance of complete clefts of the primary and secondary palate, the treatment of which is more complex, and whose frequency is greater in males.     

唇腭裂的分期护理

随着唇腭裂序列治疗的发展,其护理亦不断发展.目前对唇腭裂患者的护理内容已由单纯的临床护理转变为临床护理与心理护理和咨询相结合,其护理范围也不局限于医院和病房而扩大到院前期及患者出院后.本文根据唇腭裂患者治疗的不同阶段进行分期,并就其所处的不同时期、不同治疗模式情况下的针对性护理进行了总结.     

农村唇腭裂患者心理健康状况调查研究

目的:了解农村成年唇腭裂患者的心理健康状况,为改善患者的心理健康状况提供理论依据。方法:采用SCL-90症状自评量表对78名农村成年唇腭裂患者及50名农村正常成年人的心理健康状况进行评价。结果:农村成年唇腭裂患者SCL-90总分、阳性项目数及抑郁、焦虑和人际关系诸因子分高于对照组,差异有统计学意义。其中唇裂(CL)、腭裂(CP)、唇腭裂(CLP)三亚组患者之间的心理健康状况差异无统计学意义。唇裂组不同性别之间在SCL-90总分、阳性项目数及抑郁、焦虑诸因子分存在差异,差异有统计学意义。治疗满意度与患者的心理健康状况显著相关。结论:农村成年唇腭裂患者的心理健康状况较差,对唇腭裂患者临床治疗的同时,要重视社会、心理等因素。     

The distribution of clefts of the primary and secondary palates by sex, type, and location

The frequency and patterns of distribution of cleft lip, cleft lip and alveolus, cleft lip and palate, and isolated cleft palate, together with the possible association between sex, type of cleft, and affected side were studied from records of 278 individuals with clefts. These records were obtained from four cleft centers in the New York City area and constituted a racially mixed urban sample. The type of the cleft varied between sexes. Males had significantly higher rates of cleft lip and palate (p<0.0001), and females had higher rates of isolated cleft palate (p<0.0001). No sex differences were found for cleft lip or cleft lip and alveolus. Unilateral clefts of both the primary and secondary palates were found to occur over three times more frequently than bilateral clefts, and left side predominance was demonstrated.     

Antenatal transabdominal ultrasound detection of cleft lip and palate in Western Australia from 1996 to 2003.

OBJECTIVE: To determine the frequency of detection of cleft lip with or without cleft palate and isolated cleft palate from antenatal ultrasound examinations conducted on mothers of infants born with cleft lip and/or palate and isolated cleft palate in Western Australia from 1996 to 2003. DESIGN: Review of patient records and purpose-designed questionnaire sent to parents of children born with cleft lip and/or palate and isolated cleft palate. RESULTS: There were 308 infants born with cleft lip and/or palate and isolated cleft palate in the study period. Of the 293 parents, 218 responses were available for the study (70.7%), and 2.9 +/- 1.8 SD antenatal ultrasound scans were performed on 216 women. No such scans were performed on two women. Cleft lip and/or palate was detected in 22.2% of cases. There was no detection prior to 15 weeks gestational age in the 137 women screened. Between 15 and 19 weeks gestational age, 174 scans detected 30 cases. Between 20 and 29 weeks gestational age, 84 scans detected 11 cases. Between 30 and 40 weeks gestational age, 66 scans detected 7 cases. The detection rate for bilateral cleft lip and/or palate was 44.4% and for unilateral cleft lip and/or palate, 40.6%. Detection rate for isolated cleft lip was 33.3%. Antenatal ultrasound failed to detect any infants with an isolated cleft palate (n = 95). The rate of detection of cleft lip and/or palate increased through the study period. CONCLUSIONS: The rate of detection of cleft lip and/or palate in Western Australia is comparable to that for referral centers worldwide and is increasing. The rate of detection of the various types of cleft anomalies using antenatal ultrasound ranged from 0% to 44%.     

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 4: outcome comparisons, training, and conclusions.

OBJECTIVE: A critical appraisal of cleft care in the United Kingdom. DESIGN: Retrospective comparative study. SETTING: All National Health Service cleft centers in the United Kingdom. PATIENTS/PARTICIPANTS: Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. CONCLUSIONS: This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.     

Hybrid Maxillofacial Prosthesis: A Case Report

The role of a prosthodontist in the management of cleft lip & palate patients is pertinent involving restoration of mastication, facial harmony, dental harmony and phonation. This article presents the prosthodontic rehabilitation of a congenitally bilateral cleft lip and palate patient with a unique method which fulfilled the patient's needs, esthetics and psychological well being.     

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.     

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.     

Popliteal pterygium syndrome: orofacial and general features

This report describes the case of a 13-year-old Indian boy with popliteal pterygium syndrome. The popliteal pterygium syndrome is an extremely rare hereditary disorder thought to occur with an incidence of approximately 1 in 300000 live births. It is a congenital malformation syndrome affecting the face, limbs, and genitalia with highly characteristic features, including popliteal webbing, cleft palate (with or without cleft lip), lower lip pits, syndactyly, and genital and nail anomalies. This patient was referred to our department because of complaints of pain in the mouth and poor oral health. The orofacial findings included cleft lip, cleft palate, lower lip pits, a few missing teeth, and severely decayed teeth. In this syndrome, the orodental problems are overshadowed by the major syndromic manifestations but nevertheless need appropriate management. These patients have special dental needs and early diagnosis of the affected children is therefore important in order to initiate preventive dental care and carry out appropriate dental treatment at the optimal time.     

唇腭裂患儿家长的心理分析

的　评价唇腭裂患儿家长心理状态,探讨唇腭裂患儿家长负性心理状态与唇腭裂类型的关系,及改善 唇腭裂患儿家长负性心理的有效途径。方法　筛选非综合征性唇腭裂患儿家长100名作为试验组,另选择34名正 常儿童家长作为对照组。试验组按照患儿唇腭裂类型分为3个亚组:单纯性唇裂组(CL组)、单纯性腭裂组(CP组) 和唇腭裂组(CLP组)。选用生活事件量表和焦虑自评量表对试验组和对照组家长的心理状态进行定性和定量分 析。结果　试验组生活事件总刺激量、负性事件刺激量均高于对照组(P<0·05),3个亚组间生活事件总刺激量和 负性事件刺激量也有统计学差异(P<0·05),CLP组最高,CP组最低。焦虑自评量表调查结果显示,试验组焦虑自 评总分值与对照组无统计学差异(P>0·05)。结论　唇腭裂患儿家长普遍处于一种负性心理状态,少数表现出躯 体症状,唇腭裂患儿的畸形类型不同,家长的负性心理状态也不同,唇裂畸形比腭裂畸形对家长心理的影响更重, 说明唇腭裂患儿家长更在乎患儿的容貌畸形。     

For your health VINAR cares

The incidence of cleft lip and/or palate (CLP) in Kirov region is 1:1078 newborns. More than half of the patients (52%) have both cleft lip and palate thus requiring more complex and time consuming treatment. Multidisciplinary approach to CLP patients rehabilitation used in tertiary care center is described in the study.     

Dental treatment need and dental general anesthetics among preschool‐age children with cleft lip and palate in northern Finland

Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental treatment among cleft lip and palate patients in northern Finland, as well as their need for dental treatment under general anesthesia. The records of 183 cleft lip and palate patients, treated in Oulu University Hospital from 1997 to 2013, were reviewed. Data on dental caries were analyzed in association with cleft type, considering also the presence of syndromes. The frequency of dental general anesthetic (DGA) use, and of treatments, were also analyzed. Dental treatment need was most frequently observed, in this rather limited study population, in patients with the most severe deformities, namely bilateral cleft lip and palate, of whom 60% had caries. Among the study population, 11.5% (n = 21) had a syndrome. Of those, 57.1% had dental caries at the age of 3 or 6 yr, and only four could be treated without a DGA. Dental treatment under general anesthesia was performed in 14.8% of cleft patients without a syndrome, but in 38.1% of those with a syndrome. General anaesthesia is required for the provision of dental care more often in cleft (17.5%) than in non‐cleft (0.2%) patients, and especially for those with a syndrome.     

腭裂中耳功能异常的综合评估及治疗方案的优化探讨

目的 探讨腭裂伴中耳功能异常的综合评估策略,优化诊治程序,进一步提高腭裂的综合治疗效果。方法 对腭裂患者中耳功能异常的469侧患耳进行声导抗测试,对中耳积液与鼓室图、鼓室压及听力的关系进行统计分析。对其中62例唇腭裂患儿的124侧患耳鼓室图变化进行为期1年的动态监测。结果 鼓室图为B、C、异型者积液率分别为50.3%（97/193）、34.8%（8/23）和20.9%（53/253）。异型积液患耳的鼓室压与无积液患耳的鼓室压之间差异无统计学意义（P>0.05）。B型且有积液的患耳听力损失高于无积液患耳（P=0.001）,异型鼓室图患耳积液与听力损失不相关（P>0.05）。唇腭裂患者在唇裂修复术至腭裂整复术期间,其中耳各型鼓室图构成比无差异（P>0.05）。结论 各型异常鼓室图积液率不同。鼓室压低于-150 dapa的异常鼓室图患耳应穿刺排查。B型鼓室图且有积液的患耳很可能影响听力,应在腭裂整复术中同期行鼓膜切开置管术;异型鼓室图患耳,即使有积液,也可暂保守治疗,暂不置管,但需密切随访。选择在腭裂整复术时置管并不会延误治疗时机。