单侧完全性唇腭裂胎儿颌面部血供的应用解剖

目的为单侧完全性唇腭裂胎儿宫内手术修复提供解剖学基础。方法制作和观察21～32周正常和单侧完全性唇腭裂胎儿头颈部血管铸型标本,比较它们颌面部血供的来源及吻合情况。结果①正常胎儿颌面部血供主要来源于面动脉、颏下动脉、下唇动脉、上唇动脉、鼻翼下缘动脉、鼻翼动脉、鼻外侧动脉、鼻背动脉、眶下动脉及面横动脉等,这些动脉及其分支构筑颌面部组织丰富的血管网;②单侧完全性唇腭裂胎儿患侧上唇动脉沿裂缘向上至鼻翼基底部与鼻翼下缘动脉等相吻合,患侧部分腭骨缺损暴露的腭大动脉穿过骨残端与患侧鼻腔内的血管相吻合。结论对单侧完全性唇腭裂胎儿颌面部进行宫内修复手术,重点在鼻部和上唇部的血供,主要以上唇动脉、鼻翼下缘动脉和腭大动脉为主。     

正常与单侧唇裂口轮匝肌和上唇血管的应用解剖

目的:为婴儿单侧唇裂功能性修复提供解剖学基础。方法:４例正常成人新鲜头颈标本,在下颌下缘面动脉远心端内注入红色乳胶。５例正常婴儿、６例单侧唇(腭)裂婴儿标本,经福尔马林固定,从皮肤面和粘膜面解剖上唇口轮匝肌,在手术显微镜下观察口轮匝肌的形态及血管的分布。结果:口轮匝肌分深浅二层。深层肌肉呈水平方向,起自一侧口角的皮肤和粘膜,走向另一侧口角。浅层由上下两束肌纤维组成。单侧完全性唇裂标本显示患侧深层肌肉在裂隙处中断,止于红唇由厚转薄处。而浅层肌肉不仅中断,其附丽点亦发生错位,造成鼻小柱、鼻翼畸形。健侧深层肌肉在裂隙处中断,浅层肌纤维均附于鼻小柱基部,造成鼻小柱向健侧偏斜。正常上唇动脉起始部和走行都较恒定,本组未见解剖异常。唇裂标本显示,一侧动脉不能与对侧同名动脉吻合成弓,还造成异常走行。结论:对单侧完全性唇裂功能性修复,患侧皮下剥离要达到鼻翼外侧,把扭曲错位的浅层肌组织从鼻翼基部及鼻翼外侧的骨膜上进行分离,并按解剖形态进行复位。     

婴儿单侧唇裂鼻畸形一次整复的解剖学基础

目的：为单侧唇裂鼻畸形婴儿期一次整复提供解剖学基础。方法；对0－3岁正常儿童和唇裂患者的头部标本做显微解剖及铸形和透明标本。结果：正常儿童上唇剖动脉主要来源于上唇动脉，大多左右侧上唇动脉吻合成动脉弓，上唇动脉有分支分布下鼻端，分布于外鼻的动脉主要有鼻背动脉、鼻外侧动脉、鼻翼动脉和鼻翼下缘动脉，且形成非常丰富的吻合。单侧完全唇裂患者的上唇动脉沿唇红缘和裂缝走行，终止于鼻翼基部（患侧）和鼻小柱基部（健侧），外鼻的动脉来源及分布与正常儿童相同。结论：本文结果对成功地施行婴儿单侧唇裂鼻畸形一次整复的手术是很重要的。     

上下唇血液供应及其临床意义

目的：研究上下唇的血液供应,为新的组织瓣设计提供解剖学基础。方法：对10具从面动脉灌注红色乳胶的成年新鲜尸体标本的口周区域进行解剖研究,在2具尸体标本的面静脉内注入兰色乳胶。在3.5倍的手术放大镜下解剖显著血管。结果：上唇动脉发生浅隔支与深隔支,向上走行进入鼻中隔前下部参与克氏动脉丛的组成。观察到2种新的下唇动脉的分布情况。下唇动脉沿途发出唇颏支,与进入颏部的其它血管分支相互吻合。结论：上下唇血供丰富,可设计含浅、深隔支的上唇岛状组织瓣、含鼻隔支的岛状鼻中隔软骨粘膜瓣及含颏唇支的颏唇瓣;了解下唇动脉的解剖变异,对成功地施行一期下唇动脉岛状瓣手术是很重要的。     

鼻内镜下泪囊鼻腔吻合术的解剖学基础

目的为提高内镜下泪囊鼻腔吻合术的有效率和减少并发症提供解剖学基础。方法 15具(30侧)头颈部标本经双侧颈总动脉灌注红色乳胶,在国产手术显微镜下进行解剖,1具保留骨骼的头颈部血管铸型标本。结果①外鼻的动脉:分布到外鼻的动脉非常丰富,主要有鼻背动脉、鼻外侧动脉、鼻翼动脉、鼻翼下缘动脉及上唇动脉的分支等,且在鼻端处它们之间形成非常丰富的吻合;②鼻中隔动脉:鼻中隔血供属多源性,主要来自鼻后中隔动脉上支、下支,筛前?筛后动脉,筛前、筛后动脉主要分布于鼻中隔上部;③鼻腔外侧壁的动脉:蝶腭动脉大多(90%)在蝶腭孔处已分为鼻后外侧动脉和鼻后中隔动脉,鼻后外侧动脉发出下鼻甲动脉和中鼻甲动脉;下鼻甲动脉沿途分支分布于下鼻甲及下鼻道,且有分支与中鼻甲动脉吻合。结论本文结果对鼻内镜下泪囊鼻腔吻合术具有参考价值。     

面动脉鼻中隔支的调查

了解鼻中隔动脉血管的来源、配布、管径和走行,对进一步开展鼻的显微整形外科具有重要的意义。供应鼻中隔的动脉主要有发自眼动脉的筛前和筛后动脉、上颌动脉的蝶腭动脉和腭降动脉以及发自面动脉主干和上唇动脉的鼻中隔支。这些血管在鼻中隔内形成广泛的毛细血管丛或网,在鼻中隔的前下部形成黎氏动脉血管丛。源于面动脉的鼻中隔支,国内曾有人报道,但在一般经典解剖学中描述都较简单。为了搜集国人资料和为临床提供解剖学依据,我们对50例（男30,女20）100侧成人尸体的面动脉鼻中隔支进行了比较详细的调查。     

胎儿手部血供的应用解剖

目的 为开展宫内胎儿先天性并指手术提供解剖学依据.方法 制作8例24～32周正常胎儿上肢血管铸型标本,观察手部的掌浅弓、掌深弓及指掌侧固有动脉的来源、分支及吻合情况.结果 胎儿手部的血供主要来源于掌浅弓和掌深弓,手指在指蹼处的血供主要来源于指掌侧总动脉、掌心动脉及掌背动脉.结论 胎儿手部的血供是非常丰富的,为制作胎儿先天性并指手术皮瓣提供良好的解剖学基础.     

面动脉鼻中隔支

了解鼻中隔动脉血管的来源、配布、管径和走行,对进一步开展鼻病的诊治和鼻的显微整形外科具有重要的意义。供应鼻中隔的动脉主要有发自眼动脉的筛前和筛后动脉、上颌动脉的蝶腭动脉和腭降动脉以及发自面动脉主干和上唇动脉的鼻中隔支。这些血管在鼻中隔内形成广泛的毛细血管丛或网,在鼻中隔的前下部形成黎氏动脉血管丛（90％的鼻出血发生于此）。源于面动脉的鼻中隔支,国内曾有人报道,但在一般经典解剖学中描述都较简单。为此,笔者对成人尸体的面动脉鼻中隔支进行了较详细的调查。     

带尺侧上副动脉尺神经转位的解剖及临床意义

目的为临床上带血管蒂的尺神经移植在健侧颈7移位治疗臂丛根性撕脱伤中的应用提供解剖学依据。方法取新鲜经动脉灌注红色乳胶的成人上肢标本22侧进行显微解剖,观察尺神经外部营养动脉的来源。另取患骨肿瘤而截肢新鲜成人上肢6侧作仅保留尺侧上副动脉的尺神经游离,采用动脉灌注墨汁和尺神经组织切片的方法,观察尺侧上副动脉对尺神经内部血供营养的范围。结果尺神经在腋部由胸外侧或腋动脉的分支供应,在内侧肌间隔后方由尺侧上副动脉供应,在尺神经沟由尺侧上副动脉与尺侧返动脉后支的吻合支供应,在前臂由尺侧返动脉和尺动脉的分支供应。尺侧上副动脉灌注墨汁后,尺神经腕部、手背支及腋部的神经束内微血管被墨汁充填。结论以尺侧上副动脉的起始处为血管蒂部旋转点,尺神经可提供平均为(46.5±2.6)cm的有血供的移植长度,可经胸前皮下隧道逆向转位与对侧颈7神经根吻合。以尺侧上副动脉为血供的尺神经移植的设计是合理的。     

颌面部血管的应用解剖

目的对人体颌面部血管进行巨微解剖及血管铸型,为临床皮瓣设计提供解剖学依据。方法①3例正常成人头颈部标本,经颈总动脉灌注红色乳胶,由浅入深逐层解剖,观测并记录颌面部血管的起始处外径、走行、分支、分布、吻合及伴行情况;②3例正常成人新鲜头颈部标本,加压注入红色过氯乙烯填充剂,经腐蚀后观察颌面部血管的来源、走行、分支、分布、吻合及伴行情况。结果颌面部的血供主要来源于面动脉、眼动脉、上颌动脉和颞浅动脉的分支。面动脉的分支主要供血面颊部、唇部、鼻部和颏区;眼动脉的分支主要供血眼球、眼球外肌、泪腺、鼻背和眼睑;上颌动脉的分支主要供血牙及牙龈、颊部、下颌关节、鼻腔、腭、咀嚼肌;颞浅动脉的分支主要供血腮腺、眼轮匝肌、上下睑外侧皮肤、颞部的软组织及面神经颧支、上颊支和颞支。结论颌面部动脉血管系统的解剖学资料,可为临床颌面部整形美容术提供了应用参考依据。     

Could we prevent unilateral cleft lip/palate in the future?

Surveillance studies have shown that cleft lip and palate is one of the commonest craniofacial anomalies, occurring in approximately 1 in 500 live births. Previous studies on craniofacial form in unilateral cleft lip/palate subjects have been carried out, but most attention has been focused on the deformity of the bony septum whereas the deformities of the nasal spine and cartilaginous component of the septum had received little attention. Our recent study was based on monitoring a very specific type of nasal septal deformity, type 6, and its relation to the unilateral cleft lip/palate disease. This type is very anteriorly located and refers to the cartilaginous part of the nasal septum and the inter-maxillary bone itself. Rhinoscopic view shows a typical, almost horizontal, unilateral groove at the nasal septum located very anteriorly. At the opposite septal side, but corresponding location, there is so called basal crest.The results of our study showed that the incidence of type 6 septal deformity was very high not only in unilateral cleft lip/palate children (80.6%) but also in their parents (58% in at least one of them). In contrast, in our previous study this type of septal deformity was seen in only 3.7% of non-unilateral cleft lip/palate children before puberty, rising to 7.4% in students and 9.4% in adults.In other words, perhaps we can expect the onset of unilateral cleft lip/palate in the offspring of parents who both have a type 6 septal deformity. Perhaps there is a gene responsible for the onset of both type 6 septal deformity and the cleft.If these clinical entities belong to the same gene, the cleft per se could perhaps disappear from the Earth in a near future owing to the gene therapy which will be able to eliminate it before the baby is born or even conceived.     

不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究

目的　研究Millard法（旋转推进法）和改良Tennison法（三角瓣法）治疗单侧完全性唇腭裂的疗效及对患者颌面形态的影响。 方法　根据治疗方法的不同，将本院收治的52例单侧完全性唇腭裂患者分为Millard治疗组和改良Tennison治疗组，每组26例。术后6个月，评价2组患者的临床疗效；并于手术治疗前后，采用照片测量法测量患儿的鼻部形态指标，包括Enw（内眦间距）、BAW（鼻部高度）、BADH（双侧鼻翼高度差）、CHW（口角间距）、CL（鼻小柱高度）、CW（鼻小柱宽度）、NBD（鼻背倾斜度）、CD（鼻小柱倾斜度），测量患儿的健侧和患侧唇高。 结果　治疗后，改良Tennison组的临床修复优良率为88.46%，高于Millard组（69.23%），P<0.05。改良Tennison组平均BAW、CL、CW均大于对照组，平均BADH、CD均小于对照组（P＜0.05），改良Tennison组健侧-患侧唇高差小于Millard组（P<0.05）。 结论　改良Tennison法治疗单侧完全性唇腭裂的整体疗效优于Millard法，能较好地保持鼻部和唇部形态的对称性，更好地控制患者颌面形态，维持颜面美观的形态学机制，值得临床推广应用。     

不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究

目的　研究Millard法（旋转推进法）和改良Tennison法（三角瓣法）治疗单侧完全性唇腭裂的疗效及对患者颌面形态的影响。 方法　根据治疗方法的不同，将本院收治的52例单侧完全性唇腭裂患者分为Millard治疗组和改良Tennison治疗组，每组26例。术后6个月，评价2组患者的临床疗效；并于手术治疗前后，采用照片测量法测量患儿的鼻部形态指标，包括Enw（内眦间距）、BAW（鼻部高度）、BADH（双侧鼻翼高度差）、CHW（口角间距）、CL（鼻小柱高度）、CW（鼻小柱宽度）、NBD（鼻背倾斜度）、CD（鼻小柱倾斜度），测量患儿的健侧和患侧唇高。 结果　治疗后，改良Tennison组的临床修复优良率为88.46%，高于Millard组（69.23%），P<0.05。改良Tennison组平均BAW、CL、CW均大于对照组，平均BADH、CD均小于对照组（P＜0.05），改良Tennison组健侧-患侧唇高差小于Millard组（P<0.05）。 结论　改良Tennison法治疗单侧完全性唇腭裂的整体疗效优于Millard法，能较好地保持鼻部和唇部形态的对称性，更好地控制患者颌面形态，维持颜面美观的形态学机制，值得临床推广应用。     

单侧唇裂所致唇鼻部解剖结构改变的初步观察

目的　探讨单侧唇裂鼻畸形的形态特点,为手术治疗提供理论依据。 方法　观察60例单侧唇裂鼻畸形患儿唇鼻部的结构改变特征,测量上唇面积、主要线距变化等。 结果　单侧唇裂患侧人中面积、侧唇面积、唇峰口角距及红唇嵴角均小于健侧（P＜0.05）,鼻尖鼻底距和鼻小柱偏斜度Ⅲ度明显大于Ⅱ度（P＜0.05）,Ⅲ度唇裂健侧唇裂隙缘唇峰点上移程度大于Ⅱ度,但差异无统计学意义（P＞0.05）。 结论　单侧唇裂唇鼻部在健侧与患侧、Ⅱ度裂与Ⅲ度裂间差异较大,在手术设计中应加以注意。     

Some anatomical and histological studies on the arterial supply of the nasal cavity of the buffalo in Egypt (Bos bubalis L.).

The nasal cavity of the buffalo received its blood supply from the sphenopalatine and the external ethmoidal arteries; the former vessel chiefly supplied the respiratory portion of the nasal mucosa, while the latter was distributed to the olfactory region. The greater palatine artery supplied a palatonasal branch in the most extreme oral part of the nasal floor. The nasal vestibule received bronches from both the maxillary labial and infraorbital arteries. The arteries are of the muscular type and presented in addition ot the usual structure of their walls, thin-walled and thick-walled types. Stalked polsters are encountered in the branches of the arterial vessels having walls of the normal thickness. The appearance of the longitudinally arranged smooth muscle fibers found in the intime of some of the subepithelial small arteries and arterioles is suggestive of their epitheloid structure.     

Development of the lip and palate in staged human embryos and early fetuses

Cleft lip and palate are the most common congenital malformations in humans. Using 43 staged human embryos and early fetuses ranging from the 4th to 12th week of development, we investigated the development of the lip and palate in order to provide the basic developmental concepts required for managing these anomalies. The lower lip appeared as bilateral mandibular arches at Carnegie stage 11, and these were completely merged at stage 15. The components of the upper lip, medial nasal prominence and maxillary process, appeared at stage 16, and completely merged at stage 20. The median palatine process appeared at stage 16, and the lateral palatine process, at stage 17. The palatine processes and the nasal septum started to fuse abruptly at stage 23, and from external observation seemed to be fused at the 9th week. However, complete fusion did not take place until the 12th week of development. The tongue was prominent at stage 16, showed differentiation of the muscular tissue at stage 21, and was located superior to the lateral palatine process before stage 23. These results may be used in understanding the different mechanisms present in the formation of various congenital anomalies in this region.     

Blood supply of the human levator and tensor veli palatini muscles

In spite of its clinical importance in cleft palate, there are few detailed accounts of the blood supply of the soft palate and palatal muscles. A series of dissections was carried out to investigate the supply of the levator and tensor veli palatini muscles. Ten adult cadavers and 12 fetuses were used, all of which had been previously injected with a variety of media to outline the vascular tree. Conventional dissection was performed on the cadavers, and microsurgical instruments and a dissection microscope were utilized for fetal dissections. In 70% of dissections the m. levator veli palatini had a dual arterial supply, from the ascending palatine and ascending pharyngeal arteries. In the remainining cases the muscle was supplied by a single artery, either the ascending palatine or ascending pharyngeal. In 79% of dissections the tensor muscle had a dual supply from the accessory meningeal artery along with either the ascending palatine, ascending pharyngeal, or, in one case, the lesser palatine arteries. The results suggest that in careful surgical closure of the cleft soft palate the normal dual arterial supply would protect the tensor and levator muscles from vascular damage. In the minority of patients where only a single vessel supplies the levator, a radical intrapalatal dissection may jeopardize its vascularity.     

实时三维超声产前诊断胎儿典型面裂畸形的临床意义

目的探讨实时三维超声产前诊断胎儿面裂畸形的临床意义,寻求提高胎儿唇腭裂诊断准确性的有效方法。方法应用实时三维超声产前对面裂畸形;唇腭裂胎儿和正常胎儿唇腭部位的二维进行对照。结果 10例正常胎儿面部显示率100%,上牙槽突显示率100%,硬腭显示率70%(7/10)。10例唇腭裂胎儿包括7例单纯唇裂,2例上唇裂合并硬腭裂和1例唇裂合并软腭裂。实时三维诊断了所有7例单纯唇裂,诊断率100%;诊断了单侧唇裂合并腭裂1例,有1例单侧唇裂合并腭裂仅诊断了唇裂而漏诊了腭裂,诊断率70%(7/10),另外1例唇裂合并软腭裂仅诊断了唇裂而漏诊了软腭裂。结论实时三维超声产前诊断对胎儿唇裂,尤其是唇裂合并牙槽突及硬腭裂的诊断具有较大的应用价值,但是对胎儿未合并牙槽突裂的软腭裂及部分硬腭裂做出诊断,仍具有很大的难度。     

武汉地区167例先天性唇腭裂临床分析

目的探讨先天性唇腭裂的临床流行病学特征,了解先天性唇腭裂的发病情况,为先天性唇腭裂的深入研究提供数据。方法对我院2008年1月至2013年6月在我院引产及分娩的先天性唇腭裂畸形儿病例进行回顾性分析,并进行统计学处理。结果单纯唇裂、唇裂合并腭裂性别、单双侧比较差异有统计学意义。唇腭裂左右侧比较无统计学意义。唇腭裂城乡分布无统计学意义。唇腭裂家族发病亲缘关系、三种类型比较,差异均无统计学意义。唇腭裂伴发畸形性别比较无统计学意义。结论唇裂合并腭裂最常见。唇腭裂各类型中除单纯腭裂外男性多于女性,单侧多于双侧。唇腭裂家族发病情况与亲缘关系的远近无关。唇腭裂伴发畸形无性别差异。