婴儿期单侧完全性唇腭裂术前颌骨矫治器的应用

目的：为了提高唇裂修复的效果，在16例婴儿期完全性唇腭裂术前采用Latham颌骨矫治器，关闭婴儿单侧唇腭裂的牙槽嵴裂隙，为唇鼻整形奠定基础。方法：采用Latham颌骨矫治器方法，个体化制作矫制器，用骨内针固定矫治器。用螺旋式加力法将错位的各骨段移位到较为理想的排列位置。结果：经过2～4周矫治后可使患侧鼻翼基底部升高，两侧牙槽嵴裂隙显著缩小。结论：对婴儿期完全性唇腭裂术前颌骨裂隙的矫治，为初期的整形手术奠定了较好基础。     

单侧完全性唇腭裂患者的正畸治疗

目的总结单侧完全性唇腭裂患者正畸治疗过程与疗效。方法临床矫治15例单侧完全性唇腭裂患者,初诊年龄8～17岁,采用HX直丝弓矫治技术,部分配合活动矫治器进行矫治。结果矫治后牙列整齐,咬合良好,在患者有限的口腔解剖生理条件下达到最大程度的美观、稳定、健康和功能。结论正畸治疗是单侧唇腭裂患者序列治疗中的重要部分。     

国产隐形正畸矫治器Invis-OrthoDS系统的开发与研制

目的 :开发和研制具有我国知识产权的国产隐形矫治器Invis OrthoDS系统 ,并应用于口腔正畸临床 ,矫治各类常见的错畸形。材料和方法 :采用自行开发和研制的先进层析扫描技术 ,获得数字化正畸用牙颌模型的STL文件 ,开发研制了应用于Invis OrthoDS隐形矫治系统的牙颌畸形计算机辅助诊断与矫正过程计算机辅助设计的应用程序软件 ,可对建立的数字化三维牙颌模型进行三维旋转观察并进行各项牙齿、牙弓、基骨等项目的测量和分析 ,并自动输出模型的各项测量结果及诊断意见。结合临床治疗方案与设计 ,应用本软件系统实现可视化的三维矫正辅助过程 ,并将每个矫正阶段过程的模型母模通过激光快速成形设备进行输出 ,并最后在输出的母模上通过压膜成形器制作各个治疗阶段的系列透明隐形矫治器。结果 :开发和研制了应用于隐形矫正Invis OrthoDS的层析扫描、高精度激光快速成形的硬件设备和系统及相应的软件系统 ,并可实现三维可视化的错畸形矫治模拟过程 ,并制作出每个矫正阶段的系列透明隐形矫治器 ,该轿治器具有无托槽、美观、舒适、可随时摘戴、高效、卫生及患者复诊次数少等特点。本系统的精度可达到 0 .1mm ,其精度足以满足临床矫治的需要。结论 :首次开发和研制了具有我国知识产权的国产正畸隐形矫治器In     

完全性唇腭裂婴儿术前正畸治疗的临床研究

目的 观察术前鼻-牙槽突矫治器(PNAM)在完全性唇腭裂婴儿术前矫治中的作用.方法 采用术前鼻-牙槽突矫治器对45例非综合征性完全性唇腭裂患儿(平均年龄为18.33 d)进行唇裂术前正畸治疗,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度、鼻孔高度和牙槽骨裂隙宽度,并用SPSS 10.0软件进行统计分析.结果 经PN...     

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...     

国产无托槽隐形正畸矫治系统的开发与研制

目的:开发和研制国产无托槽隐形矫治系统,以最终应用于口腔正畸临床,矫治各类常见的错(牙合)畸形.方法:自行开发和研制了先进的层析扫描技术,获得数字化正畸用牙颌模型的STL文件,研制了应用于无托槽隐形矫治系统的牙颌畸形计算机辅助诊断与矫正过程计算机辅助设计的应用程序软件,可对建立的数字化三维牙(牙合)模型进行三维旋转观察并进行各项牙齿、牙弓、基骨等项目的测量和分析,并自动输出模型的各项测量结果及诊断意见.应用本软件系统可实现可视化的三维矫正辅助过程,通过激光快速成型设备进行输出母模,并通过压膜成形器制作各个治疗阶段的系列透明隐形矫治器.结果:开发和研制了无托槽隐形矫正技术的硬件设备系统及相应的软件系统,并可实现三维可视化的错(牙合)畸形矫治模拟过程,并制作出每个矫正阶段的系列透明隐形矫治器,该矫治器具有无托槽、美观、舒适、可随时摘戴、高效、卫生及患者复诊次数少等特点.结论:首次开发和研制了国产正畸无托槽隐形矫治系统,填补了我国在这方面的空白,是当今先进三维数字化技术在口腔正畸诊断与治疗中应用的最新成果.     

鼻牙槽骨塑形对单侧完全性唇腭裂患儿术后鼻外形的影响

目的：探讨术前鼻牙槽骨塑形矫治对单侧完全性唇腭裂患儿术后长期鼻外形美观与对称性的影响。方法：84例患儿按改良式旋转推进唇裂修复术实施手术。其中，经过术前鼻牙槽骨塑形矫治42例，未经术前鼻牙槽骨塑形矫治42例。均采用术后4～5a照片打分方式进行鼻外形评定，而后分组进行比较。采用SPSS10．0软件包进行配对样本t检验。结果：经过术前鼻牙槽骨塑形矫治和未经术前鼻牙槽骨塑形矫治患儿，术后4～5a鼻外形的美观与对称性平均得分分别为66．62±14．25和66．31±15．08，两者之间无显著统计学差异（P〉0．05）。结论：单纯术前应用鼻牙槽骨塑形矫治纠正单侧完全性唇腭裂患儿鼻畸形，而未对单侧唇裂鼻畸形形成的解剖学机制进行有效干预，手术后良好的鼻外形无法长期维持。     

单侧完全性唇腭裂新生儿术前矫形治疗中上颌各骨段位移轨迹的研究

本研究采用骨内针固位矫治器对一例单侧完全性唇腭裂（ＵｎｉｌａｔｅｒａｌＣｏｍｐｌｅｔｅｄＣｌｅｆｔｏｆＬｉｐａｎｄＰａｌａｔｅ，简称ＵＣＣＬＰ）新生儿头颅新鲜样本进行临床快速矫治。在连续定位Ｘ线片上观测了上颌解剖特征及在矫形力作用下各骨段位移规律。结果表明上颌各骨段明显错位、矫形力使各骨段产生不同方向和量的位移，其位移方向恰与错位方向相反。提示此疗法在唇腭裂系列治疗中具有重要意义。     

完全性唇腭裂婴儿的术前矫形治疗

完全性唇腭裂婴儿的术前矫形治疗 ( presurgi-cal treatment) ,简称术前矫治 ,是指在外科修复术前对唇腭裂婴儿进行的一类矫形治疗 ,通过矫治器的作用 ,使上颌骨错位的骨段尽可能排列成对称的牙槽弓形态 ,减小牙槽突裂隙 ,为外科手术提供尽可能接近正常的骨性结构 ,以改善手术条件 ,简化一期手术 ,达到更好的颜面形态、口腔功能的修复。一、历史回顾二、几种主要的矫治器1 .以 Hotz矫治器为代表的 passive plate,即传统型的腭护板。( 1 )作用方式 :通过类似“人工腭顶”的矫治器 ,分离口鼻腔、隔绝舌对裂隙的作用。( 2 )矫治器结构 ;( 3)临…     

新生儿完全性唇腭裂术前鼻撑和正畸治疗的临床观察

目的 观察新生儿完全性唇腭裂术前鼻撑和正畸治疗的效果。方法对38例完全性唇腭裂，通过模型测量矫治前后牙槽裂距的改变，观察治疗效果；用鼻外形的评价标准对术后患儿进行初步评价。结果经过108—152天的治疗，26例单侧完全性唇腭裂齿槽左右裂隙较矫治前平均缩小5．3mm，前后裂距较矫治前平均缩小3．5mm；鼻外形评价的优良率为76％。12例双侧完全性唇腭裂齿槽左侧裂隙平均缩小4．7mm，右侧裂隙平均缩小4．2mm，左右裂距平均扩大1．6mm，前后裂距平均缩小5．1mm，前牙槽突宽度平均增大1．2mm；鼻外形评价的优良率为66％。结论对完全性唇腭裂患者在新生儿期做术前鼻撑和正畸治疗，患儿易适应，有利鼻发育，可减小手术的难度，提高整复效果。     

McNamara分析法评价改良鼻牙槽骨矫形术对单侧完全性唇腭裂患者替牙列期颌骨发育的影响

目的 初步探讨改良鼻牙槽矫形术对单侧完全性唇腭裂患者替牙列期颌骨发育的影响.方法 选择56名单侧完全性唇腭裂患者,依据其在唇腭裂修复手术前是否进行过改良鼻牙槽骨矫形术分为矫治组与对照组,矫治组26人,对照组30人.选用McNamara头影测量分析法评价改良鼻牙槽骨矫形治疗对于单侧完全性唇腭裂患者替牙列中期的颌骨发育的影...     

Naso Alveolar Molding in Early Management of Cleft Lip and Palate

Cleft lip and palate is a congenital anomaly occurring at birth. This article describes about the construction of feeding plate which is also used for naso alveolar molding (NAM). The main objective of this treatment is that this procedure minimizes the extent of surgery that should be done on newborns. Two infants with unilateral and bilateral cleft lip and palate are treated by making feeding plate and which is also used for NAM. Both the infants had favorable results, better in case of unilateral cleft lip patient; we hope that it will minimize the extent of surgery and the resultant scarring.     

Quantitative 3D maxillary arch evaluation of two different infant managements for unilateral cleft lip and palate.

OBJECTIVE: A two-institution retrospective study was undertaken to determine whether two different prepalatoplasty protocols quantitatively affect maxillary arch morphology in infants with complete unilateral cleft lip and palate (UCLP). DESIGN: Serial maxillary dental casts, obtained at regular intervals through the first 18 months of life from preintervention until palatoplasty were evaluated quantitatively using computer-assisted three-dimensional digitization and analysis for three populations: institution 1 (protocol 1), institution 2 (protocol 2), and unaffected individuals (neither cleft nor treatment). Sequential UCLP patients from institution 1 were matched for age and initial alveolar cleft width, sex and cleft side having been demonstrated to be nonsignificant, with UCLP patients from institution 2 and to unaffected individuals for age for the analysis. SETTING: Both treatment institutions are well-established regional interdisciplinary cleft centers. Institution 1 is located in a tertiary, academic children's hospital in a metropolis within a primarily agrarian region of the Midwest; institution 2 is a freestanding private clinic located in a small city within a primarily agrarian region of an eastern state; the unaffected population is a historic archive acquired in the 1930s. Data acquisition (model digitization) and computer processing were performed at institution 1. PATIENTS: Eighty-five casts of 28 infants from institution 1, 106 casts of 31 infants from institution 2, and 68 casts of 29 unaffected infants were analyzed. All infants had alginate impressions taken prior to intervention and at several additional 6-month intervals after that, consistent with each institution's treatment protocol. INTERVENTIONS: At institution 1, patients with UCLP underwent lip adhesion and placement of a passive alveolar molding plate at 7 weeks of age, definitive cheiloplasty at 7 months of age, and one-stage palatoplasty at 14 months of age. At institution 2, patients with UCLP underwent definitive cheiloplasty at 3 months of age, had no maxillary orthopedics, and had vomer flap hard palate repair at 12 months of age and soft palate repair at 18 months of age. MAIN OUTCOME MEASURES: The outcome measures included directly digitized (cleft segment and hemialveolar ridge lengths) and derived (alveolar base width, alveolar cleft gap, maxillary frenum-alveolar base perpendicular angle, and rates of change over time of digitized cleft segment and hemialveolar ridge lengths) features. The data were assessed by comparing simple linear regression lines and an unpaired, two-tailed t test. RESULTS: Prior to initiating therapy, there were no statistically significant differences between the two populations with clefts. However, both populations with clefts differed significantly from unaffected individuals (p < .001), with increased maxillary base widths and larger perpendicular/frenum angles. At the time of palatoplasty, the two populations with clefts had statistically significant differences between them in the maxillary base width (p < .01) and the cleft gap distance (p < .05). The base width of institution 1 did not differ significantly from that of widths of unaffected children, and that of institution 2 was significantly less, although the latter had already received first-stage palate repair. Alveolar segment growth rates were similar for the greater and lesser segments, respectively, and the left side hemialveolus of both groups. The growth rate for the noncleft side hemialveolus of institution 2 exceeded (p < .05) that of both institution 1 and unaffected patients. CONCLUSION: Two different regimens for the initial management of UCLP can significantly affect maxillary alveolar arch growth with respect to the treatment used and in comparison with unaffected controls.     

Nasoalveolar molding and gingivoperiosteoplasty versus alveolar bone graft: an outcome analysis of costs in the treatment of unilateral cleft alveolus.

OBJECTIVE: The purpose of this study was to compare the financial impact of two treatment approaches to the unilateral cleft alveolus. The recently advocated nasoalveolar molding (NAM; and gingivoperiosteoplasty (GPP; at the time of lip repair were compared with the traditional approach of secondary alveolar bone graft. DESIGN: The records of all patients (n = 30) with unilateral cleft lip and alveolus treated by a single surgeon during 1985 through 1988 were examined retrospectively. The patients were divided into two groups: group 1 patients (n = 14) were treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition; group 2 patients (n = 16) were treated by NAM, GPP, lip repair, and primary nasal repair. Patients who required secondary alveolar bone graft after GPP were noted. The cost of treatment by each protocol was calculated in 1998 dollars. RESULTS: The average cost of treatment for a patient treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition was $22,744. Of the 16 patients treated by NAM, GPP, lip repair, and primary nasal repair, 10 required no further treatment of the unilateral cleft alveolus; six patients required secondary alveolar bone graft. The average per-patient treatment cost in this group was $19,745. The average cost savings of NAM and GPP, compared with alveolar bone graft is $2999. CONCLUSIONS: The treatment of unilateral cleft alveolus by nasoalveolar molding and gingivoperiosteoplasty results in substantial cost savings, compared with treatment by secondary alveolar bone graft.     

单侧唇腭裂鼻-牙槽骨塑形后同期唇-鼻-牙槽骨整复术

目的:探讨唇腭裂婴幼儿术前鼻-牙槽骨塑形后的同期唇-鼻-牙槽骨整复术的方法与技术,并进行初步疗效评价。方法:对31例单侧完全性唇腭裂婴幼儿进行术前鼻-牙槽骨塑形及同期唇-鼻-牙槽骨整复术。术前鼻-牙槽骨塑形主要包括关闭牙槽骨间隙、唇牵张及鼻矫形;早期同期唇-鼻-牙槽骨整复术,即牙龈-牙周膜-牙槽骨整形术和改良Mohler法单侧唇裂唇鼻畸形同期整复术。采用SPSS10.0统计软件包对所得数据进行t检验。结果:31例唇腭裂婴幼儿经2～3个月术前鼻-牙槽骨塑形,唇裂隙宽度显著变窄(P<0.01),裂隙两侧唇组织适度牵张;鼻小柱延长及鼻塌陷畸形显著改善(P<0.05);牙槽裂隙显著变窄(P<0.01)。术后2例失访,29例患者随访6～30个月,结果显示:上唇和鼻形态俱佳,鼻小柱端正,鼻尖形态改善,双鼻孔、鼻底堤状隆起对称;口腔前庭-鼻腔瘘封闭;27例患者牙槽突裂隙关闭,牙槽骨连续性及稳定性增强并在原牙槽裂隙处有牙萌出,其中13例牙槽嵴高度、宽度及厚度不足;2例仍有1～2mm的牙槽裂隙。结论:单侧完全性唇腭裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨,术前进行鼻-牙槽骨塑形和同期唇-鼻-牙槽骨整复术是值得采用的序列治疗方法。     

唇腭裂婴儿术前鼻牙槽骨塑形治疗后鼻孔、牙槽和腭部裂隙的变化

目的探讨鼻牙槽骨塑形器应用于完全性唇腭裂婴儿术前矫形的临床效果。方法通过对16例完全性唇腭裂婴儿进行术前鼻牙槽骨塑形矫治．记录治疗前后患侧鼻孔的宽度、高度,鼻小柱长度和上腭牙槽骨裂隙的变化,观察矫治效果。结果经过90～150d的治疗．9例双侧完全性唇腭裂婴儿和7例单侧完全性唇腭裂婴儿的鼻小柱长度和鼻孔宽度高度均有明显的改善．牙槽骨裂隙宽度和硬腭前部裂隙宽度均明显缩小。结论鼻牙槽塑形器能明显改善完全性唇腭裂婴儿的鼻翼和鼻小柱外观,减小牙槽骨和硬腭前部裂隙的宽度,有利于鼻部发育,减少手术难度,提高整复效果。     

Comparison between the palatal configurations in complete and incomplete unilateral cleft lip and palate infants under 18 months of age.

OBJECTIVE: The purpose of this study was to examine the three-dimensional characteristics of the palatal configurations in incomplete unilateral cleft lip and palate (UCLP) patients and to determine whether there are differences in the effect of early orthopedic treatment between complete and incomplete UCLP patients. DESIGN: Eight infants with incomplete UCLP and 12 infants with complete UCLP, selected at random, wore Hotz plates, and 8 other infants with complete UCLP did not. Palatal impressions were taken of these patients immediately after birth and at 1, 2, 3, 4 (just before cheiloplasty), 6, and 18 months of age (just before palatoplasty). Using our measuring system, the palatal casts were measured and compared three-dimensionally. RESULTS AND CONCLUSIONS: The palate of the incomplete UCLP patients measured immediately after birth, compared with complete UCLP, showed: (1) smaller posterior arch width; (2) sagittal arch length did not differ; (3) incisal point was located more mesially; (4) the gap between the alveolar arch forms of the major and minor segments was smaller; and (5) the curvature of the palatal surface forward the nasal cavity in the minor segment was less. At 18 months of age, the following characteristics could be observed: (1) the difference observed at birth in the posterior arch width between the incomplete and complete UCLP infants vanished; (2) a significant difference in the location of the incisal point was observed only between the incomplete UCLP infants and the complete UCLP infants with a Hotz plate; and (3) the curvature was less in the incomplete UCLP infants than in the complete UCLP infants. Furthermore, the morphological change of the palatal surface was less in the incomplete UCLP infants than in the complete UCLP infants. This suggested that any influence of the Hotz appliance might be less in incomplete UCLP than in complete UCLP.     

Presurgical presentation of columellar features, nostril anatomy, and alveolar alignment in bilateral cleft lip and palate after infant orthopedics with and without nasoalveolar molding

Objectives : (1) To evaluate quantitative differences in presurgical presentations of alveolar alignment and nostril anatomy of infants with BCLP treated with nasoalveolar molding (NAM) from those treated with maxillary infant orthopedics only (IO) and (2) to detect interrelationships between presurgical nasoalveolar anatomy, age at lip surgery, age of commencing, and durations of alveolar and nasal molding. Methods : A retrospective analysis was conducted on nasal-alveolar measurements and presurgical treatment records of infants with BCLP who received lip repair by a single surgeon in a tertiary-care, referral teaching hospital consecutively from 2000 to 2009 after undergoing NAM (n = 29; 51 nostrils) or IO (n = 17; 32 nostrils). Paired t tests analyzed nostril and alveolar symmetry in each group. Intergroup comparisons were made by linear mixed-model regression analyses. Pearson's correlation tests were conducted to detect significant interrelationships within groups. Results : Significant between-group differences were noted in alveolar irregularity (NAM: 3.58 ± 1.02?mm; IO: 7.31 ± 1.28?mm; p < .01), columellar length (NAM: 2.88 ± 0.27?mm; IO: 1.48 ± 0.34?mm; p < .001), columellar width (NAM: 6.10 ± 0.21?mm; IO: 6.88 ± 0.26?mm; p < .01), columellar length/width ratio (NAM: 0.48 ± 0.05; IO: 0.20 ± 0.07; p < .05), and columellar angle (NAM: 0.98 ± 1.1°; IO: 3.69 ± 1.37°; p < .05). Differences in age of commencing presurgical orthopedics, lip surgery, and treatment durations were not significant. Better-aligned alveolar segments in the NAM group did not statistically correlate with nostril dimensions. Alveolar irregularity and nostril height in the IO group strongly correlated. Conclusions : Infants who received NAM had longer columellae and better-aligned alveolar segments than those who received only IO. Other nostril dimensions were not significantly different.