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双侧唇裂或(和)唇腭裂一期整复后,尽管修复了唇裂或唇腭裂,但仍有诸多畸形存在,如鼻尖低平、鼻小柱短小、双侧鼻孔不等大对称、鼻翼塌陷、鼻堤缺失;上唇过紧、人中     

唇腭裂手术麻醉

唇腭裂是口腔颌面部最常见的先天性畸形,不仅严重影响患儿的容貌美观,还直接影响其生长发育.为获得满意的治疗效果,唇腭裂修复手术通常在儿童期完成.但此期的儿童,尤其是新生儿、婴幼儿的各项生理结构和功能均有特殊之处,与成人差别甚大.在实施麻醉时,麻醉医师必须熟悉其与麻醉有关的解剖生理特点,选用适合的麻醉方法和监测手段,尽可能保持其生理内环境的稳态,以安全渡过手术麻醉期.本文就唇腭裂患儿上呼吸道的解剖生理特点和气管插管、麻醉前准备、麻醉实施及其管理、麻醉后恢复临床应用要点作一归纳总结,以期指导临床实践.     

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儿童时期行唇腭裂修复手术,因手术的创伤和术后出现的瘢痕挛缩往往造成后期不可避免的颌骨发育障碍,形成特有的牙颌面畸形,常表现为面中部的二维甚至三维方向的发育不足,上颌严重后缩,上牙弓狭窄,牙列拥挤,咬合关系紊乱,前牙或全牙列反,下颌真性或假性前突,严重影响患者的口腔功能及容貌美[1-3]。此畸形较一般牙颌面发育畸形更为严重和复杂,迄今尚无有效的预防措施,     

唇腭裂患者上颌骨牵引成骨术后口鼻腔共鸣的变化

目的:通过研究行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)的唇腭裂患者前后过度鼻音、过低鼻音的变化,并结合腭咽部结构功能变化、上颌骨前移幅度等因素,综合分析上颌骨RED对口鼻腔共鸣的影响。方法:1999年至2001年行RED治疗的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED手术前后语音测听、拍摄静止位及[i]位头颅定位片测量腭咽闭合功能,对检测结果行非参数检验。结果:RED术后患者过度鼻音程度显著加重。RED前61.9%患者存在过度鼻音,RED术后增至90.5%,所有患者均未出现过低鼻音。上颌骨前移幅度对患者术后过度鼻音加重程度有显著影响。患者腭咽闭合冠状收缩不全率(RVCR)和RED前的过度鼻音程度也直接影响术后的过度鼻音程度。结论:唇腭裂患者经RED前移上颌骨后,鼻腔共鸣增加,过度鼻音加重。     

Feeding infants with cleft lip, cleft palate, or cleft lip and palate

In assessing 143 infants with cleft lip and palate, we found feeding problems to vary with the patients' anatomic lesion. Effective feeding techniques were identified by first assessing the infant's ability to generate negative intraoral pressure and to move the tongue against the nipple and then by matching these deficits to appropriate feeding devices.     

Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review

A review of the literature pertaining to the incidence of cleft lip, cleft palate, and cleft lip and palate in different races is presented. The studies have been evaluated according to the method used to record the incidence rate. Half of the studies include in their base population livebirths, stillbirths, and abortions, or livebirths and stillbirths to record the incidence rate. In addition, in most of the studies, clefts with associated malformations and possible syndromes are included in the reported incidence. There is evidence, however, to suggest that the risk of developing clefts in stillbirths and abortions is three times as frequent as in livebirths and that clefts with associated malformations behave differently epidemiologically from clefts without associated malformations. It is suggested, therefore, that the incidence of cleft lip, cleft palate, and cleft lip and palate should be studied separately for each group, namely for livebirths, stillbirths, and abortions and should be reported separately for clefts without associated malformations, clefts with associated malformations, and syndromes. More research is needed to study the risk of developing clefts among the various groups that exhibit different epidemiologic behavior for each race.     

Transverse changes after surgical closure of complete cleft lip, alveolus and palate

Surgery for patients with unilateral (UCLP) and bilateral (BCLP) complete cleft lip, alveolus and palate has a considerable influence upon craniofacial growth. With respect to this, the cleft team at Hannover Medical School has attempted to reduce necessary surgical interventions to labioplasty, palatoplasty and veloplasty. Still, the effects of these operations influence maxillary growth to an extent which requires orthodontic treatment in all patients. This study focuses upon the transverse alterations of the alveolar arch and the deciduous dentition after lip and palate surgery. Dental casts prior to any surgical intervention and after labioplasty and complete palaotoplasty of the hard and soft palate were measured for transverse changes by using anatomical landmarks. The results indicate a significant occurrence of anterior relative to posterior arch width loss for both UCLP and BCLP patients. Orthodontic treatment should be planned and performed with respect to these findings in order to support craniofacial growth and prevent maxillary dental arch deficiency. Received: 2 November 1998 / Accepted: 15 February 1999     

Reoperations in cleft lip and cleft palate treatment

The surgical management of cleft lip and palate is a difficult and complex endeavor. Several surgical techniques for the treatment of this deformity have been described around the world; each one, when properly done by expert surgeons, renders good and predictable results most of the times. However, the fact that there are so many techniques means that there is no universal procedure that will always deliver great esthetic and functional results. This article discusses the causes of inadequate results in primary cleft lip and palate surgery and describes the various secondary surgical techniques to correct the same.     

Bronchopulmonary function in children with cleft lip and palate]

Microflora of the bronchoalveolar zone was studied in the bronchoalveolar lavage (BAL) of 65 patients with cleft lip and palate aged 3 to 25 years (54 children and 11 adults). BAL microflora a bronchoalveolar washout almost corresponded (met) to a microflora in children correlated with the disease severity. In patients with through hiatuses of the labium and palate BAL microflora was close to that of the nasopharynx and larynx.     

单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化

目的 探讨单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化.方法 对18例单侧完全性唇腭裂患儿先用上颌腭托矫治器(PNAM)术前正畸治疗后,再进行唇裂修补手术.采用模型测量方法,比较患儿初诊时、手术前1个月和手术后2个月时的上腭裂隙变化.结果 治疗后患儿唇部外形明显改善,腭部裂隙减小,患侧塌陷的鼻翼穹隆高度恢复.结...     

Obturators for cleft lip and cleft palate

Cleft Lip and palate are most common congenital anomalies of the faces. Infants born with cleft lip and palate always have feeding problem. They were referred to dentists for obturators. Obturators usually have definite retention, lead to easily dislodgement. The author suggested the method of fabricating more retentive obturator.     

腭裂术后复裂的原因分析及临床体会

目的：分析腭裂术后复裂的原因,探讨预防复裂的方法。方法：通过105例腭裂术后复裂的临床资料进行回顾性分析,找出导致复裂的原因。结果：腭裂术后复裂的原因是多方面的,有病人自身因素,有手术医师的技术操作,还有术前、术后的护理等因素。充分认识这些因素并加以预防,腭裂术后复裂是可以避免或减少的。结论：腭裂术后复裂的因素是多方面的,只要加以重视,复裂是可以避免或减少的。     

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.