唇腭裂病人成年后的综合美容

既使是近乎完美的唇腭裂早期治疗，随着人体面部器官的生长发育，仍有可能出现鼻部、唇部畸型，因此，唇腭裂后期治疗至关重要。通过对１６０２例早期及后期唇腭裂病人的治疗体会与总结，指出各类型唇腭裂病人成年后常见的各种面颌部畸形。阐述了适用于该类病人的手术前设计、治疗原则、治疗步骤及方法。针对唇腭裂病人成年后所出现的畸形往往是多方面的这一现象，结合口腔颌面外科、正畸修复科、整形美容外科等专科特点，提出了综合美容整形的设计思路及治疗要点     

颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫瓣移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面，或充填于腭部的口腔与鼻腔侧组织瓣之间，尤其是硬软腭交界处。颊脂垫不需用皮片覆盖，可以自行上皮化。结果共治疗腭裂６例，术后颊脂垫完全成活，无腭瘘形成，无颊间隙感染发生。２周后，颊脂垫自行上皮化。结论颊脂垫血供丰富，易于成活，可为Ⅱ期愈合的创面提供肉芽组织再生床，改善软硬组织血供，以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复     

颊脂垫瓣移转在腭裂修复中的应用

介绍颊脂垫瓣移转的应用原理及用以腭裂修复的实践。方法 将颊脂垫瓣移植于硬腭裂隙的口腔侧创面，或充填于腭部的口腔与鼻腔侧组织瓣之间，尤其是硬软腭交界处。颊脂垫不需用皮片覆盖，可以自行上皮化。结果 共治疗腭裂６例，术后颊脂垫完全成活，无腭瘘形成，无颊间隙感染发生。     

颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫辦移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面,或充填于腭部的口腔与鼻腔侧组织辦之间,尤其是硬软腭交界处。颊脂垫不需用皮片覆盖,可以自行上皮化。结果共治疗腭裂6例,术后颊脂垫完全成活,无腭瘘形成,无颊间隙感染发生。2周后,颊脂垫自行上皮化。结论颊脂垫血供丰富,易于成活,可为Ⅱ期愈合的创面提供肉芽组织再生床,改善软硬组织血供,以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复。     

Gastric heterotopia and cleft palate. Deformation sequence or syndromic association?

Gastric heterotopia is more frequently in small intestine, gall bladder, biliary tract, Meckel's diverticulum, colon and rectum, but it can be found in other locations. It is especially rare in oral cavity. We only find one case that concurs with cleft palate. We present the case of a neonate with gastric heterotopia and cleft palate in addition to other congenital malformations not related at first. We make a brief revision of literature, showing the pathogenesis of heterotopia and its possible association with the cleft palate.     

腭裂患儿中耳功能的评价

对５６例腭裂患儿和５０例正常儿童的中耳功能进行对比评价。年龄５～１４岁。均进行耳科常规及声阻抗检查，发现腭裂患儿中耳静态压力与声顺值，声镫骨肌反射引出率都低于正常儿童。其咽鼓管功能不良，调节中耳压力的能力差，通过吞咽来主动开放咽鼓管的功能受限，故腭裂患儿的合理治疗需要多科医生的共同配合。     

Food residues identified in the pharynx of a patient with a cleft palate

Solid food residues were identified in the pharynx of a 17-month-old infant with a cleft palate at the time of anesthesia induction, although nothing-by-mouth directions for more than four hours had been strictly followed. Preoperative airway management, e.g. gargling and nose blowing, is necessary in patients with a cleft palate even after an appropriate period of fasting because food residues may remain in the nose due to the anatomical abnormality.     

A combination of unusual abnormalities of the lachrymal apparatus and nostrils in a case of bilateral cleft with choanal atresia

An unusual congenital anomaly of a bilateral complete cleft of the primary palate, a complete cleft of the left secondary palate with abnormal nostrils without external openings and right choanal atresia is presented. The child also has a lachrymal fistula below the right lower eyelid and a coloboma of the same eyelid medially. Neither lachrymal system drained into the nose.     

Isolated cleft of the ala nasi: A report of seven cases

Craniofacial clefts other than cleft lip & palate are reported to be 1.4 to 4.9 per 100,000 live births. Of these, clefts of nose are usually associated with other clefts. Isolated cleft of Ala is rare, 0.7% of all clefts reported by Monasterio. In an analysis of photographic records of 3,500 consecutive patients with craniofacial clefts including cleft lip & palate registered with us between 1985- 2012 which were accessed through our data base, 13 patients with nasal clefts were identified, seven out of which had Isolated cleft of the Ala. All were treated by a rotation flap of the Ala with good results with the longest follow up of 14Yrs. The authors have emphasised the rarity of the condition and presented a simple surgical procedure for correction. In the opinion of the authors this very simple procedure which can be performed by the junior surgeon gives a good long term result in the management of cleft Ala.KEY WORDS: Cleft of ala, cleft of nose, coloboma of ala, Tessier 1 and 2 clefts     

Vomerine hamartoma in a cleft palate child

A case of a female child born at full term after normal vaginal delivery with bilateral secondary complete cleft palate and vomerine hamartoma mimicking intra-oral midline encephalocoele. Radiologically the tumour was confined to the vomer without intra-cranial extension. The lesion was occupying the oral cavity causing feeding problem. Surgical excision of the tumour at the age of six months and two flaps palatoplasty at the age of twelve months were performed. On histopathology the lesion turned out to be a lipomatous hamartoma of a benign nature. The child was followed for 9 years with no evidence of recurrence and a satisfactory speech. To our knowledge this is the first report of cleft palate with vomerine hamartoma in the English literature.     

婴儿期单侧完全性唇腭裂术前正畸治疗的临床研究

目的探讨上颌-鼻软骨整形矫治器在婴儿期单侧完全性唇腭裂术前正畸中的应用与疗效。方法2003年1月~2004年3月,对100例出生后10 d~3个月内单侧完全性唇腭裂婴儿进行上颌-鼻软骨整形矫治器矫治。其中男60例,女40例,健康状况良好。根据矫治起始时间的不同分为观察组(10 d~1个月内)及对照组(1~3个月)各50例,对比两组婴儿正畸治疗前后上唇裂隙、上前牙槽突裂隙关闭程度及唇腭裂联合整复术后3个月鼻翼外观满意度,评价疗效。结果婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度观察组为5.0±1.6 mm、4.1±2.7 mm,6.9±2.6 mm、6.4±2.9 mm;与对照组7.5±3.1 mm、8.3±3.0 mm,12.5±4.0 mm、10.8±2.6 mm比较,差异均有统计学意义(P<0.05)。两组婴儿正畸前后上唇裂隙、上前牙槽突裂隙宽度自身比较,差异无统计学意义。两组患儿术后鼻翼外观满意度观察组86.3%与对照组62.4%比较,差异有统计学意义(P<0.05)。结论尽早对单侧完全性唇腭裂患儿实施上颌-鼻软骨整形矫治器矫治,可明显改善上颌形态及鼻畸形程度,减小牙槽突裂隙,并有效减小上唇张力,为婴儿期唇腭裂联合手术创造有利条件。     

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.     

Standardisation of cleft care--a technique for creating a three-dimensional model of the cleft lip, palate and nose.

The Royal College of Surgeons Cleft Steering Group and the Craniofacial Society of Great Britain and Ireland have recommended that, for patients with a cleft of the lip and/or palate, a model is made of the deformity before primary surgery. This provides a record for audit and can be used to compare the results of treatment. There is no standardisation in the way in which a model of the cleft deformity is made, which makes inter-unit comparison difficult. In this paper, we describe our technique for making a composite model of the cleft palate, lip and nose. This method is adaptable and quick to perform, and the models are easy to store.     

腭裂患儿中耳功能的评价

对56例腭裂患儿和50例正常儿童的中耳功能进行对比评价。年龄5～14岁。均进行耳科常规及声阻抗检查,发现腭裂患儿中耳静态压力与声顺值,声镫骨肌反射引出率都低于正常儿童。其咽鼓管功能不良,调节中耳压力的能力差,通过吞咽来主动开放咽鼓管的功能受限,故腭裂患儿的合理治疗需要多科医生的共同配合。     

改良腭咽松弛切口修复低龄婴幼儿不完全性腭裂

目的：寻找和开辟一条不影响颌骨发育而早期修复婴幼儿不完全腭裂、恢复腭咽功能的新途径。方法：笔者从2000—2003年选择性地对1-1.5岁的不完全腭裂患儿，采用改良腭咽松弛切口施行腭裂修复术18例，手术均在气管插管全身麻醉情况下进行。结果：术中出血少，无手术意外及腭瘘等并发症。结论：改良腭咽松弛切口修复婴儿期不完全性腭裂，对腭部的损伤较小、手术时间短、出血少，是一种不影响颌骨发育，早期修复腭裂、恢复腭咽功能、简便易行、易于推广使用的理想修复方法，早期手术利于患儿形成正常语言功能。     

Oral clefts in the Sultanate of Oman

This is a retrospective study of the epidemiology of congenital clefts of the lip and palate in babies of Omani nationals born in the Sultanate of Oman between 1989 and 1995. Babies of non-Omani immigrants were excluded from the study. The data were collected from two sources. The first was the Centralized Plastic Surgery Service of Khoula Hospital at Muscat, the capital city of Oman between 1989 and 1995, which registers all oral cleft cases in the country. These data revealed the overall incidence of oral clefts (OC) to be 1.5 per 1000 live births, with incidences of 0.62 per 1000 for combined lip and palate (CLP) cleft, 0.34 per 1000 for cleft lip (CL), and 0.54 per 1000 for isolated cleft palate (CP). The second data source was national delivery records from maternity sections of all hospitals in the country from 1989 to 1995, which include oral clefts as congenital anomalies identified at birth. These statistics were similar to those from the first source for CL/CLP but underestimated the number of isolated cleft palates (CP). The histories of patients attending the Plastic Surgery Clinic of Khoula Hospital during the last year of the study period could be examined in detail. A study of the 177 OC cases registered in 1995 alone revealed associated congenital anomalies in 38.4%. A higher inbreeding coefficient of 0.0294 was noted among oral cleft cases than in the general population, which was calculated at 0.0198. Familial clefts accounted for 23% of all cases. Greater parental age and birth order were found to be associated with increased risk of oral cleft. High temperatures during the tropical desert summers in Oman (when temperatures reach 48°C) do not seem related to the incidence of oral clefts.     

Prevalence of dental anomalies, ectopic eruption and associated oral malformations in subjects with Treacher Collins syndrome.

OBJECTIVE: To examine the prevalence of dental anomalies in the deciduous and permanent teeth, ectopic eruption of permanent first molars, and associated oral malformations in individuals with Treacher Collins syndrome. STUDY DESIGN: Clinical and radiographic examination of 15 patients with Treacher Collins syndrome, from the Hospital for Rehabilitation of Craniofacial Anomalies of the University of S?o Paulo, not submitted to orthodontic or orthognathic treatment. RESULTS: Dental anomalies were present in 60% of the sample, with 1-8 anomalies per individual. Hypoplastic dental anomalies were the most common, followed by heterotopic and hyperplastic dental alterations. The most frequent anomalies were tooth agenesis (33.3%), mainly affecting the mandibular second premolars, and enamel opacities (20% of patients). Ectopic eruption of the maxillary first molars was found in 13.3% of subjects. Associated oral malformations, primarily isolated cleft palate, followed by complete cleft lip and palate and macrostomia, were observed in 66.7% of patients. CONCLUSIONS: Presence of cleft palate associated with the syndrome is in agreement with the literature. The high prevalence of dental anomalies suggests a possible etiologic relationship, not described in the literature so far, between such alterations and the Treacher Collins syndrome. Further investigations on larger samples are required to confirm these results.     

单侧不完全性唇裂鼻畸形婴儿术前应用鼻模的临床研究

目的:观察单侧不完全性唇裂鼻畸形婴儿术前应用鼻模的临床效果。方法:给15例出生在6～60天的单侧不完全性唇裂鼻畸形婴儿佩戴合适的鼻模41～113天,定期复诊加垫片,给予鼻前庭持续、温和的支撑力,评估治疗前后患儿照片的鼻孔高度、宽度及鼻小柱偏斜度。结果:15例患儿鼻前庭外形均得到明显改善,鼻小柱偏斜度减少,患侧鼻孔宽度变窄、高度抬高,扁平的鼻翼呈拱形隆起。结论:单侧不完全性唇裂鼻畸形患儿在婴儿早期佩戴鼻模对鼻前庭外形的改善有非常明显的作用,为手术创造了良好的条件,为唇腭裂的序列治疗提供了有效的补充。     

Levator palati and palatal dimples: their anatomy, relationship and clinical significance

To achieve the best results in cleft palate repair it is necessary to be aware of the normal anatomy. In a series of cadaver dissections, the levator palati muscle was found to occupy the intermediate 40% of the length of the soft palate. This normal distribution should be the aim at cleft palate repair. Observation of the oral surface of the palate during production of the sound "Ah" reveals palatal dimpling. This has been observed in many normal and cleft palate subjects. The dimpling has been reproduced in cadavers by levator palati traction and been found on dissection and serial histological section to correspond to the levator insertion.     

Speech Outcome after Cleft Palate Surgery with the G teborg Regimen Including Delayed Hard Palate Closure

The regimen for treatment of children with cleft lip and palate in Göteborg, Sweden, until 1996 included early soft palate repair at 6-8 months of age and delayed closure of the hard palate at about 8 years of age to improve maxillary growth. The aims of this report were to describe the treatment concept and to present speech data of 59 children treated by this method. The speech of 38 children with unilateral and 21 with bilateral cleft lip and palate was evaluated perceptually from standardised tape recordings of repeated sentences and spontaneous speech at five ages from 3 to 16 years of age. All patients were not evaluated at each age level. The results showed a low prevalence of hypernasality after hard palate closure and pharyngeal flap surgery in only five children (8%), indicating a primary velopharyngeal insufficiency in less than 10% of the children. Only three children with bilateral clefts had glottal articulation when at pre-school age and no child with a unilateral cleft did. These results were interpreted as an indication of velopharyngeal competence (VPC) in most of the children. In addition, the speech problem found in these children consisted of retracted oral articulation of alveo-dental pressure plosives, which is almost always an indicator of VPC. However, we do consider that retracted oral articulation is a problem and to improve our results further we have decided to modify the technique for soft palate closure slightly and place the vomer flap further anteriorly to encourage narrowing of the cleft in the hard palate, and to close the hard palate at 3 years of age.