唇腭裂术后鼻整形的辩证法

唇腭裂是最为常见的先天性颅面畸形。国际报道的新生儿发病率是。00794％。病因是多方面的，包括遗传、营养、致畸因子、环境因素等。临床表现多样，从单纯的唇裂，到唇部和腭部完全裂开。唇腭裂常常伴有特征性鼻部发育异常和半侧颜面发育不良。鼻部发育异常的原因可以是原发的，也可以是继发的。原发性源于内在的发育进程异常，继发性源于原有畸形的复发、瘢痕或手术后遗症。对于此类鼻畸形的治疗，需要用发展的、变化的和全面的辩证思维，以取得最佳的临床效果。     

复合型美容整形住院医师的综合培训

随着经济条件的逐步改善,人们对生活质量的追求亦提高到了一个更高的层次,美容已成为了一种时尚.目前,在美容整形行业中出现的一些新情况、新问题,主要表现在:受术者的年龄跨度增大;提出的要求增高;手术难度高.在美国,美容整形外科是外科领域的尖端学科之一,对从事整形外科及美容外科的医师,除要求具有扎实的医学知识外,还要有丰富的社会学、心理学知识.美国对整形外科医师的培养有着一整套严格的制度,值得我们借鉴[1-2].     

综合矫治单侧唇腭裂术后鼻畸形

目的 通过外科手术和自体骨移植综合矫治唇腭裂术后遗留的鼻畸形。方法 本手术通过自体骨移植垫高患侧鼻翼基部凹陷、凿断鼻骨使其耸立以抬高鼻背和自体鼻中隔软骨移植以增高鼻小柱和鼻尖,一次性完成鼻外形的综合矫治。结果 45例唇腭裂伴发鼻畸形综合修复,术后1～8年随访复查,效果满意。结论 综合矫治术通过一次手术能够使鼻畸形得到全面彻底的矫正。     

唇腭裂术前术后的护理体会

唇腭裂是一种先天性的唇部畸形,发生于刚出生的婴儿身上,病症严重,手术治疗起来也比较困难,给人影响非常之大.唇腭裂手术最常见问题是不对称,口或鼻的一侧与对侧不一致.唇腭裂手术的目的是闭合缺损,有的需做第二次手术,这样儿童就可以正常喂食和讲话.唇腭裂和所有的手术一样,也有风险和特殊的并发症,需引起注意.唇腭裂最好从小抓起,越早手术,恢复的情况越理想,毕竟在传统审美观的趋势下,唇腭裂容易使患者产生一种自卑心理.此外,唇腭裂也会造成一生的语言障碍,以及外貌上的影响.所以唇腭裂手术是一个十分越的选择.因此唇腭裂病人手术前后的护理,对提高手术的成功率起着重的作用.唇裂是颌面部最常见的一种先天性畸形,除常与腭裂并发症外,其中少数病人还有身体其他部分的畸形.唇裂可造成唇部外形缺陷和吸吮,咀嚼,吞咽,语言,表情等功能障碍.腭裂是口腔颌面部最常见的一种先天性畸形,可单独发生,也可与唇裂同时伴发.腭裂不仅有软组织畸形.腭裂病人的吸吮,进食,语言等生理功能障碍及面容比唇裂更为严重,对病人的生活,学习,工作均带来一定的影响.     

唇腭裂整形修复术的护理

1997年至2006年，我院治疗唇腭裂患者77例，均取得满意效果。现将护理体会总结如下。     

美容整形受术者术前生活质量及其与术后满意度的相关研究

目的：探讨美容整形受术者的术前生活质量及其与术后满意度的相关性。方法：选用＂生活质量综合评定问卷（GQOLI-74）＂对美容整形受术者进行术前生活质量调查,术后2个月随访受术者术后满意度,用SPSS16.0进行统计分析。结果：生活质量调查结果为：躯体功能维度（63.93±8.44）、心理功能维度（70.61±10.60）、社会功能维度（70.27±10.89）、物质生活维度（67.82±13.88）、生活质量总评（14.06±2.53）、总评分（297.31±24.83）;术后满意度方面,有16.2%的受术者术后非常满意,64.9%比较满意,18.9%不太满意,无非常不满意。术后满意度与生活质量综合评定问卷的第F26、46、57、69、72条目存在相关关系。结论：美容整形受术者术前生活质量较高,其与术后满意度有相关性。     

美容整形的新趋势

人们生活水平的稳步上升和美容整形外科的高速发展，使两者之间的距离越来越近。随着科学技术的日益提高，美容整形外科中的不少观念和习惯也在不断更新。首先，受术者的平均年龄正从中老年逐渐向中青年转移发展；其次，由以往人体表面的皮肤软组织美容逐渐向深层次的骨支架等硬组织美容整形发展；由单一部位的局部美容向整体的多部位的综合美容整形发展。这些新趋势的发展同时又促进和要求每一个美容整形工作者有更进一步地、全方位的提高。１美容整形对象的年轻化社会的快速发展必然伴随着激烈的竞争，要想赢得一席之地就需要全方位的发展…     

医疗美容整形受术者的心理探讨

疾病除给患者带来身体上的痛苦外,还会带来精神上的压力,在美容整形求术者身上的表现尤为明显.作为一种选择性手术,从他们要求手术到术后对手术效果的态度,常常会表现出一些不同寻常的心理状态[1].     

手的整形美容

手是人类进化的产物,是创造世界文明的特殊劳动工具,也是人的"第二张脸".因此,手的修复不但要恢复其功能和外形,还要有美容的效果.经过半个多世纪的发展,在老一辈手外科和整形外科专家的努力探索下,我国手外科从无到有逐渐发展壮大,并在皮瓣外科、断指再植、足趾游离移植、周围神经损伤的修复方面取得了举世公认的成就[1].     

5459例唇腭裂患者临床资料分析

目的：对20年来唇腭裂的治疗及唇腭裂患者的构成情况进行回顾。方法：对5459例唇腭裂患者病历资料分类整理，进行统计学分析。结果：唇腭裂各类型性别比例差异有显著性意义，唇腭裂患者的首次手术年龄差异有显著性意义，其主要修复方式随年代的变化而不同。结论：唇腭裂患者中男性明显多于女性。自1980年以来，唇腭裂患者的首次手术年龄呈逐渐下降趋势，主要手术方法也有很大的变化。     

A revised classification of the cleft lip and palate

BACKGROUND:

Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis.

OBJECTIVES:

To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate.

METHODS:

The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors’ revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA).

RESULTS:

A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients.

DISCUSSION:

The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency.

CONCLUSION:

The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.     

Report of a hemohiliac's cleft lip and palate repair — ten year follow-up

Summary The association of cleft lip and palate with hemophilia is rare. Recent advances in hematology have made it possible for hemophiliacs to have surgery without problems, using prior administration of anti-hemophilic globulin. The case reported was a hemophilia B patient with unilateral cleft lip and palate. When primary cheiloplasty was carried out at four months of age, there were serious bleeding problems during and after the operation. Palatoplasty was performed at age two and repair of secondary deformity of the cleft lip at age eight. On both occasions a prothrombin complex was administered, and no problem was experienced in either procedure. A ten year follow-up is presented.     

先天性唇、腭裂对患儿呼吸系统顺应性的影响

目的 探讨先天性辰、腭裂对患儿呼吸系统顺应性（ＣＴ）的影响。方法 唇裂或腭裂病儿２４０例（观察组）,非唇腭裂病儿６０例（对照组）均为择期手术患,按年龄段：１～１２月、１～３岁、４～７岁、８～１２岁,各分为５个亚组。全麻诱导气管内插管后,行机械通气,保持ＰＥＴＣＯ２４～４．６ｋＰａ,用Ｄａｔｅｘ Ｕｌｔｉｍａ监测仪测定ＣＴ。结果 与非唇裂同一年龄组ＣＴ值相比,唇裂各年龄组、腭裂１～１２月及１～３岁组     

Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip

Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports.     

单侧唇裂继发畸形修复中口轮匝肌的重建

目的介绍口轮匝肌复位重建在单侧唇裂继发畸形修复中的效果。方法对采用直线缝合法修复的唇裂患者，在行继发畸形修复中，选Millard旋转推进法设计皮肤切口，切开皮肤，将裂隙的健、患两侧的口轮匝肌进行解剖，在健侧，分离口轮匝肌达正常侧人中嵴处；在裂隙侧，将口轮匝肌从皮肤下解剖达10mm；在口腔裂隙的健侧从鼻棘，裂隙侧从鼻翼基部，将口轮匝肌从黏膜下分离出来。使用透明的尼龙线缝合肌肉。将裂隙健、患侧分离的口轮匝肌每侧水平分成4束，互相交叉缝合，然后缝合皮肤。结果术后患侧鼻孔大小、对称性、鼻小柱长度、鼻小柱的位置、患侧人中嵴、患侧唇峰、唇珠、人中凹、鼻尖的高度、突度的变化，术后均近似正常，近期效果满意。结论利用口轮匝肌的重建来修复单侧唇裂继发畸形，以恢复正常上唇正中解剖结构及对称的鼻孔大小，是一种有用的方法。     

Early postoperative complications in primary cleft lip and palate surgery

We studied the occurrence of early complications of cleft lip and palate surgery by the retrospective study of 132 consecutive cases (160 procedures) operated between three and six months of age. Three children presented with major complications within the immediate postoperative period. All were treated successfully. A local complication directly related to the operation occurred in 7.5% of the cases within the first six postoperative days. In 17%, a general complication not directly related to the operation was observed. The majority of these general complications were cross infections during the hospital stay. These observations led us to reduce the hospital stay to one day for cleft lip and five days for cleft palate and cleft lip and palate operations without compromise to safety but with a reduction of the morbidity and hence the treatment costs and of the child-family disturbance.     

米库氯铵与顺苯磺酸阿曲库铵在婴幼儿唇腭裂手术中的应用比较

目的观察和比较米库氯铵和顺苯磺酸阿曲库铵用于婴幼儿唇腭裂手术中的肌松效应和安全性。方法 2012年9月至2013年9月择期行唇腭裂手术治疗的患儿60例,年龄6个月至3岁,随机分为两组,每组30例。两组均给予咪达唑仑0.1mg/kg、丙泊酚2mg/kg、瑞芬太尼1μg/kg及米库氯铵0.2mg/kg(M组)或顺苯磺酸阿曲库铵0.15mg/kg(C组)行麻醉诱导后气管插管。采用TOF-Guard加速度肌松监测仪连续监测尺神经四个成串刺激(TOF)。观察并记录肌松起效时间、临床作用时间和恢复指数,进行插管评级并观察不良反应情况。结果两组的插管条件评级差异无统计学意义。M组肌松起效时间、肌松临床作用时间以及恢复指数明显短于C组(P0.05);M组不良反应发生率明显低于C组(P0.05)。结论米库氯铵用于婴幼儿唇腭裂手术时起效快、肌松效应时间短,恢复较快。     

牙槽裂植骨同期鼻中隔骨支架植入鼻整形术

目的　研究在牙槽裂植骨修复的同时 ,利用自体髂骨皮质板块 ,修复单侧唇腭裂鼻畸形。方法　 10岁以后的单侧完全性唇腭裂患者 ,采用自体髂骨松质骨移植修复牙槽裂 ,同时采取髂骨内侧骨皮质修整后植入两侧鼻翼软骨内侧脚之间 ,形成鼻中隔前下部的骨性基础支架 ,将分离复位的鼻翼软骨内侧脚提升 ,使软骨穹窿顶超过骨性支架的上缘约 3mm ,将软骨缝合固定于骨性支架。结果　本组 2 4例患者均一期痊愈出院 ,患侧鼻翼基部凹陷、鼻小柱偏斜、鼻尖低平等畸形得到良好的矫正。结论　牙槽裂植骨与鼻畸形整复同期进行互不干扰。鼻中隔前骨性支架对鼻的外形结构有良好的支持作用 ,可以有效地矫正唇腭裂鼻畸形 ;与牙槽裂植骨同期进行 ,取材方便 ,减少了手术及麻醉的次数。