腭裂手术前后舌静止及动态的比较研究

目的　探讨舌的位置及动态对腭裂语音的影响。方法　应用标准头颅侧位Ｘ 线片及计算机图像扫描系统,对腭裂手术前后及正常人的舌静止及发／ａ：／ 时的位置及动态变化进行了比较研究。结果　静止时,术前组Ａ／Ｆ值小于术后及对照组（ Ｐ＜ ０ ．０１） ;术后组Ｃ／Ｈ值小于术前及对照组（ Ｐ＜０ ．０１） ;术后组Ｓ／Ｖ 值小于对照组（ Ｐ＜ ０．０１）。发／ａ：／ 时,术前组Ｄ／Ｆ、Ａ／Ｐ 及α／ｐ 均小于对照组,而Ｐ／Ｂ、Ｃ／Ｈ 大于对照组;术后组Ａ／Ｆ小于对照组（ Ｐ＜ ０ ．０５） ,Ｃ／Ｈ 大于对照组（Ｐ＜ ０．０１）;术前组Ｄ／Ｆ、Ａ／Ｐ、α／ｐ 小于术后组。结论　腭裂术前的舌位置及动态存在明显异常,术后虽可获得接近正常的一定变化,但仍存在某些异常,需经语音治疗,消除舌的不良因素,才能达到清晰发音     

腭裂手术前后舌静止及动态的比较研究

目的探讨舌的位置及动态对腭裂语音的影响。方法应用标准头颅侧位 X 线片及计算机图像扫描系统,对腭裂手术前后及正常人的舌静止及发/a:/时的位置及动态变化进行了比较研究。结果静止时,术前组 A/F 值小于术后及对照组(P<0.01);术后组 C/H 值小于术前及对照组(P<0.01);术后组 S/V 值小于对照组(P<0.01)。发/a:/时,术前组 D/F、A/P 及α/p 均小于对照组,而 P/B、C/H 大于对照组;术后组 A/F 小于对照组(P<0.05),C/H 大于对照组(P<0.01);术前组 D/F、A/P、α/p 小于术后组。结论腭裂术前的舌位置及动态存在明显异常,术后虽可获得接近正常的一定变化,但仍存在某些异常.需经语音治疗,消除舌的不良因素,才能达到清晰发音。     

腭裂手术前后舌静止及动态的比较研究

目的 探讨舌的位置及动态对腭裂语音的影响。方法 应用标准头颅侧位Ｘ线片及计算机图像扫描系统，对腭裂手术前后及正常人的舌静止及发／ａ：／时的位置及动态变化地比较研究。结果 静止时，术前组Ａ／Ｆ值小于术后及对照组（Ｐ〈０．０１）；术后组Ｃ／Ｈ值小于术前及对照组（Ｐ〈０．０１）；术后组Ｓ／Ｖ值小于对照组（Ｐ〈０．０１）。发／ａ：／时，术前组Ｄ／Ｆ、Ａ／Ｐ及ａ／ｐ均小于对照组，而Ｐ／Ｂ、Ｃ／Ｈ大于对照组；     

Furlow法加腭咽环扎治疗不完全腭裂及腭裂术后腭咽闭合不全

介绍在Ｆｕｒｌｏｗ法的基础上，加腭咽环扎的应用原理及腭裂修复实践。采用大腿阔筋膜，通过剥离子将阔筋膜引入咽侧壁及咽后壁隧道内，通过环扎进一步缩小咽腔。本组共治疗２０例，随访１０例患者，发音优７例，良２例，差１例（此患者术后时间短，不足２个月）。Ｆｕｒｌｏｗ法延长软腭，环扎进一步缩小咽腔，使通过常规的手术方法不能或难以修复的不完全腭裂得以修复。     

新辅助化疗与单纯手术治疗局部进展期胃癌及贲门癌的比较:欧洲癌症研究与治疗组织40954号随机对照试验

为研究新辅助化疗在胃癌综合治疗中的价值,Schuhmacher、Gretschel、Lordick等人进行了一项新辅助化疗联合手术与单纯手术治疗局部进展期近端胃癌及贲门癌(包括Ⅱ、Ⅲ型胃食管结合部癌)的随机对照试验。该项研究中新辅助化疗共2周期,48 d/周期;方案为d1、d15及d29顺铂50 mg/m2静脉滴注超过1 h并水化,续以四氢叶酸500 mg/m2静脉滴注超过     

唇腭裂1386例发病特点回顾性分析

目的：通过对唇腭裂患者临床资料进行回顾性统计分析,研究该病的发病特点,为唇腭裂的预防及治疗提供临床参考。方法：统计分析2007年1月～2010年1月手术治疗的1386例唇腭裂患者,分别从患者诊断、性别、年龄、出生地,唇腭裂裂型分布情况等方面进行回顾性调查。结果：本组病例中,单纯唇裂356例（25．69％）,唇裂合并腭裂580例（41．84％）,单纯腭裂450例（32．47％）;男809例,女577例,男：女=1．40：1;单侧唇裂伴或不伴腭裂明显多于双侧者,两者之比为5．67：1,其中左侧多于右侧（1．82：1）。结论：唇腭裂发病以唇裂合并腭裂居多,男性发病多于女性,在腭裂患者中女性发病高于男性;单侧发病多于双侧,左侧多于右侧。     

双牙列义齿修复唇腭裂患者咬合关系紊乱的临床疗效观察

目的：观察双牙列义齿对唇腭裂患者上下颌咬合关系紊乱、面部形态畸形、功能障碍的美容修复效果。方法：对18例唇腭裂、牙槽突裂患者采用上颌前牙双牙列义齿修复,观察修复后面容、咀嚼功能改善效果及患者满意度。结果：随访2年,18例患者对面部美观的改善、咀嚼功能及发音功能的恢复、修复的治疗费用均比较满意。结论：双牙列可摘义齿可以达到较好修复效果,是一种简单、经济,实用的修复方法。     

Cleft surgery in East timor: the first four years

BACKGROUND: Following the vote for independence in 1999, this team commenced the first coherent reconstructive surgical service in East Timor. The aim of this paper is to report the cleft lip and palate surgical experience during the 4 years since independence. METHODS: From June 2000, a record of all cleft surgical procedures carried out by our team in East Timor has been maintained. This has been reviewed to identify the clinical experience, procedures carried out and the outcomes of the cleft population in this, the poorest and newest, nation in Asia. RESULTS: From the 519 reconstructive surgical procedures carried out by this team in East Timor during the first 4 years, 267 were for cleft lip and palate deformity. Cleft lip and nose repairs were most commonly undertaken, although over the period of the study increasing numbers of cleft palate repairs were evident, reflecting the developing confidence in the service by the local population. CONCLUSION: The establishment of a regular, consistent cleft lip and palate surgical team in East Timor has not only seen the successful correction of a large number of untreated cleft patients, but has also contributed to a restoration of trust in the newly developing health system in East Timor.     

大龄腭裂患者咽后壁组织瓣咽成形术及其语音研究

目的：探讨针对大龄(8岁以上)腭裂患者的特点，同期行腭裂关闭术和咽后壁组织瓣转移术并研究其对语音的影响，以提高修复效果。方法：对24例大龄腭裂患者行腭裂裂隙关闭手术以及咽后壁组织瓣咽成形术治疗，术前术后用鼻咽纤维镜检测其腭咽闭合情况，评价患者鼻漏气及过重鼻音改善情况。结果：24例腭裂修复术后创口均达到Ⅰ期愈合，软腭后退良好，腭咽闭合改善明显，为发音创造了条件，语音也有不同程度改善。结论：大龄腭裂患者同时采用腭裂关闭术及咽成形术的方法修复，有利于改善软腭的形态和发音。     

Anatomical closure technique of the nasal floor for patients with complete unilateral cleft lip and palate

Abstract

We describe a new technique for the reconstruction of the nasal floor at the same time as cheiloplasty in patients with complete unilateral cleft lip and palate. We operated on patients aged between 3 and 36 months in public secondary and tertiary level institutions. None of these patients had had a previous operation for the correction of the cleft lip or palate. The operation required the design of two mucous flaps, one lateral and one medial to the defect, to reposition the tissues anatomically and repair the congenital deficiency. Three hundred and fifty-eight patients have been treated using this technique, most of whom (n = 233, 65%) were boys, and 288 (80%) presented with a right complete unilateral cleft. Postoperative evaluation showed that 22 patients (6%) had asymmetry of the nasal base equal to or less than 1 mm, 18 (5%) had nasovestibular fistulas, and 5 (1%) required revision. We conclude that this technique greatly reduces the number of asymmetrical nasal floors and the incidence of nasovestibular fistulas.     

New orthodontic and orthopaedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting

At the age of mixed dentition, a downward or laterally displaced premaxilla with a wide alveolar cleft in patients with bilateral cleft lip and palate remains a dilemma both for orthodontists and surgeons. These premaxillary deformities not only make the alveolar bone grafting difficult but also aesthetically and functionally unacceptable. The purpose of the present article is to introduce three new orthodontic and orthopaedic techniques for solving these premaxillary deformities and facilitating alveolar bone graft through a non‐surgical approach. These techniques are the premaxillary orthopaedic intrusion for correcting a downward displaced premaxilla, the premaxillary orthopaedic repositioning for correcting a laterally displaced premaxilla, and maxillary orthopaedic protraction by alternate rapid maxillary expansions and constrictions for minimizing a wide alveolar cleft. They were evaluated clinically and cephalometrically for their treatment effects. The results revealed that the premaxillary and cleft deformities were corrected in a short period of time and therefore the alveolar bone grafting could be carried out without difficulty in all of the patients who received the treatment. The treatment effects were mostly orthopaedic and partly orthodontic. No growth disturbance on the maxilla was observed throughout the treatment. These new orthodontic and orthopaedic techniques are very effective for solving the difficult‐to‐treat premaxillary deformities and facilitating the alveolar bone grafting in the patients with bilateral cleft.      

两瓣后推加咽后瓣成形术修复腭裂80例临床回顾分析

目的:观察两瓣后推 咽后瓣成形术修复腭裂的治疗效果。方法:对80例腭裂患者行两瓣后推 咽后瓣成形术,术后观察腭咽闭合情况,并进行语音机能评定。结果:本组腭裂修复术后,患侧软腭的长度较术前明显延长,平均延长16.7mm±3.5mm(P<0.01),术后语音有不同程度的改善。结论:两瓣后推 咽后瓣成形术是一种有效地腭裂修复手术方式。     

腭裂手术治疗现状和进展

先天性腭裂是口腔颌面部发育畸形中最为常见的疾病之一,腭裂修复手术仍是目前治疗该疾病的唯一有效方法。为了使患者获得良好的语音功能,形成了众多修复手术方法,本文将对近年来腭裂手术治疗现状和进展进行综述。     

干细胞在唇腭裂患者牙槽突裂中应用的研究进展

干细胞具有自我更新能力及多向分化潜能,已被广泛应用于多个领域。相对于唇腭裂患者牙槽突裂的常规手术治疗方法,干细胞具有来源广泛、取材方便、免疫原性低等优点,整形外科医生已逐渐关注唇腭裂患者牙槽突裂干细胞治疗的研究。该文对胚胎干细胞、人间充质干细胞、颌面部来源干细胞在唇腭裂患者牙槽突裂中应用的研究进展进行了综述。     

Tongue posture in cleft palate patients with a pharyngeal flap.

Position of the tongue was studied in lateral cineradiographic pictures of 15 patients with cleft palate and velopharyngeal incompetence, and from ten unaffected reference subjects. The patients were examined before and after pharyngoplasty. Before operation there was no difference in the degree of tongue/velum contact between the patients and the reference subjects, but after the operation, contact was lost in 13 of the 15 patients because the tongue was lowered and the velum raised by the pharyngeal flap. This contradicts the previous theory that the position of the tongue should be expected to be higher to maintain the posterior oral seal. The tongue was in a more posterior position in the patients than in the reference subjects both before and after operation. After operation the tip of the tongue retracted into the anterior oral cavity. The posterior and downward change in position of the tongue may account for part of the posterior and downward growth pattern of the lower third of the face which occurs in children after pharyngoplasty. A loss of tongue-lip balance around the premaxilla may be one of the factors that causes the maxillary retrusion that has been reported after pharyngoplasty in patients with cleft palates.