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。     

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     

单侧唇腭裂中牙槽嵴裂的手术治疗

为16例单侧唇腭裂中的牙槽嵴裂患者,采用自体髂骨骨松质(13例)或羟基磷灰石(3例)充填,并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中12例随访1～5年,自体骨移植者有9例,全部发生骨连续,并有7     

单侧唇腭裂中牙槽嵴裂的手术治疗

为１６例单侧唇腭裂中的牙槽嵴裂患者，采用自体髂骨骨松质（１３例）或羟基磷灰石（３例）充填，并以上唇粘膜瓣和裂隙两侧粘骨膜瓣移转封闭裂隙的治疗方法。其中１２例随访１～５年，自体骨移植者有９例，全部发生骨连续，并有７例或从骨移植区长出。羟基磷灰石者３例无一例有牙萌出。认为缺损修补以自体骨移植为好，羟基磷灰石不宜用于未成年人。     

Neonatal computed tomographic maxillary explorations in children with unilateral cleft lip and palate

The aim was to examine the bony maxillary structures by computed tomographic measurements in newborns with unilateral cleft lip and palate before cheiloplasty. Analysis of maxillary bone was performed and size parameters were measured by computed-tomographic analysis in 12 infants with unilateral cleft lip and palate. We compared the bony maxillary length and the bony maxillary width between the cleft side and the healthy side. For eight patients, the bony maxillary length was different between the cleft side and the healthy side. For three patients, the bony maxillary width was different between the incisor alveolar structure in the cleft side and the healthy side. For six patients, the bony maxillary width was different between the canine alveolar structure in the cleft side and the healthy side. We noted an asymmetry without hypoplasy in bony maxillary structure in newborns before cheiloplasty. The data can serve as the starting point for a control and later evaluation on the efficiency of different therapeutic approaches of alveolar and maxillary development in children with cleft lip and palate.     

应用单侧岛状颊肌黏膜瓣和双反向双Z成形术修复宽大腭裂

目的应用单侧岛状颊肌黏膜瓣加双反向双Z成形术修复较宽大的腭裂,延长软腭,不做牙槽弓内侧松弛切口,腭部无骨性创面裸露和瘢痕形成,以减少或避免对上颌骨和牙槽弓生长发育的影响。方法应用改良的双反向双Z成形术延长软腭,裂缘蒂的口腔侧黏骨膜瓣翻转关闭鼻腔侧的裂隙,一侧岛状颊肌黏膜瓣修复腭部口腔侧创面,牙槽弓内侧不做松弛切口。结果应用该法共治疗36例,2例出现了腭瘘,其余伤口愈合良好,软腭延长显著,无组织瓣坏死、伤口感染、张口困难、面神经损伤等并发症发生。随访8例患者,均获得完善的腭咽闭合功能。结论一侧岛状颊肌黏膜瓣与双反向双Z成形术联合应用修复较宽大的腭裂,既延长了软腭,又避免了腭部骨性创面裸露、瘢痕形成而影响上颌骨和牙槽弓生长发育,是一项安全可靠的手术。     

Maxillary dental arch and occlusion in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair.

We wanted to find out if growth of the maxilla in 26 patients with unilateral cleft lip and palate (UCLP) was adversely affected by having the residual cleft of the hard palate repaired earlier than had been done previously in a 2-stage palatal closure protocol. The ages at repair of the hard palate of the present patients ranged from 38 to 89 months. Dental casts from ages about 3 years (before any repair of the hard palate), 5, 7, and 10 years of age were analysed. The results indicated that earlier repair of the cleft in the hard palate did not influence maxillary growth differently from the later repair.     

腭板HA复合人工骨植骨术对上颌骨生长发育的相关研究

目的研究腭板HA复合人工骨植骨术对患者上颌骨三维方向上生长发育的影响。方法腭板骨缺损的先天性Ⅱ度腭裂患者40例，随机分为对照组和植骨组，植骨组腭板骨缺损利用HA复合人工骨修复，所有患者年满16周岁时复诊，行X线头影测量及牙颌模型测量对比分析。结果植骨组与对照组在上颌骨长度及高度发育上差异均无统计学意义（P〉0．05）；植骨组与对照组在上颌骨后部宽度发育上差异有统计学意义（P〈0．05），植骨组上颌骨宽度明显大于对照组。结论腭板植骨术对上颌骨宽度的发育存在明显的促进作用，在提倡序列治疗的过程中应该考虑对硬腭骨缺损进行植骨修复。     

Factors that affect variability in impairment of maxillary growth in patients with cleft lip and palate treated using the same surgical protocol

No consensus exists about the causes of restriction of maxillary growth in patients with cleft lip and palate (CLP). The aim of this study was to try to identify causes of this impairment other than the influence of surgical technique and skill. We analysed a sample of 129 consecutively treated 5-year-old children with unilateral cleft lip and palate (UCLP), who were operated on by the same surgeon with the same protocol. Multiple cephalometric measurements of the sample showed a wide distribution of values for maxillary growth. We selected SNA as a value describing maxillary position. Variables investigated were: initial cast measurements; timing of lip and of gingivoalveoloplasty (GAP)/palatal surgery; and presence of permanent lateral incisors. The significance of differences was investigated with Pearson's correlation and analysis of variance (ANOVA). The factor most significantly linked with maxillary protrusion was the presence or absence of the permanent lateral incisor, even when peg laterals and supernumerary laterals were considered. Initial width of the palate measured on infant casts correlated with maxillary growth, but the timing of GAP did not. Although surgical skill and technique may be the most important factors responsible for impairment of maxillary growth, inherent tissue hypoplasia, possibly the lack of lateral incisors, seems to be the most important non-iatrogenic factor.     

骨缝牵引成骨修复腭裂的临床初步研究

目的 临床探索骨缝牵引成骨修复腭裂的新技术。方法 选择2～4岁的腭裂患儿。一期手术在全麻下安置腭裂牵引器，牵引腭骨向中线和向后移动；牵引期持续约4～5个月。裂隙合拢后进行二期手术，修复裂隙。用误差为0．2％的游标卡尺，测量牵引前和牵引后上颌牙弓宽度、裂隙宽度和硬腭长度。结果 临床应用8例。2例因牵引器在安置后l周内脱落而终止牵引。6例经不同时间的牵引后，裂隙缩小，裂隙两侧的组织显著延长。其中牵引时间最长为126d，最短为37d；裂隙宽度平均缩小6．5mm；硬腭长度平均延长4．8mm。结论 临床证实了骨缝牵引具有诱导腭部组织再生、关闭或缩小裂隙和延长硬腭的可能性。     

A comparative study of maxillary growth following rotation-advancement and triangular flap unilateral cleft lip repairs: an experimental study in rabbits

The present study was designed to investigate 2 features of maxillary growth following Millard rotation-advancement and Tennison triangular flap cleft lip repairs in rabbits with surgically created defects simulating unilateral cleft lip and cleft alveolus. Sixty purebred New Zealand rabbits were used in this experiment. The animals were divided into 4 groups: 2 control groups (unoperated and unrepaired) and 2 experimental groups (lip repair with rotation-advancement and lip repair with triangular flap). Nineteen metric cranial variables were measured directly from the cleaned skulls. Direct cephalometric measurements were taken in the following dimensions: maxillary length, width and height, posterior facial width, and nasal deflection. Significant differences were noted between Millard rotation-advancement group and Tennison triangular flap group in 2 of 6 measurements of maxillary length. Analysis of variance revealed significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in 3 of 6 measures of maxillary width. Analysis of variance revealed no significantly statistical differences between Millard rotation-advancement group and Tennison triangular flap group in maxillary height. Statistical differences were noted between Millard rotation-advancement group and Tennison triangular flap group in posterior facial width. There was no significantly statistical difference between Millard rotation-advancement group and Tennison triangular flap group for the nasal deflection measurements. The results of this study indicated that the features of maxillary growth were different between the 2 lip-repair techniques in rabbits with surgically created defects simulating unilateral cleft lip and alveolus.     

Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣在完全性腭裂修复中的应用

目的 探讨一种对上颌骨发育影响较小,且能有效降低腭瘘发生率的功能性腭裂修补术。方法 自2013年起,采用Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣修补38例腭裂患者。结果 所有患者均一期愈合,均无腭瘘发生。术后随访1~2年,患者语音清晰度满意。结论 Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣,可有效降低腭瘘的发生率,远期腭咽闭合良好,避免了裸露骨面对上颌骨生长发育的影响,是一种值得推荐的功能性腭裂修复术。     

不同术式的双侧牙槽嵴裂植骨术对唇、颊龈沟深度的影响

目的　研究不同术式的双侧牙槽突裂植骨术对唇、颊龈沟深度的影响。方法　对我科 1992年 4月至 2 0 0 2年 3月间采用 :①提袋手柄式瓣牙槽突裂修复术 ;②双颊瓣牙槽突裂修复术 ;③双颊瓣加鼻中隔犁骨凿断牙槽突裂修复的 4 2例牙槽突裂患者进行分析。结果　将术后唇颊龈沟变浅分为Ⅳ级 ,结果 4 2例中 ,0级 2 0例 ,占 4 7 6 % ;Ⅰ级 10例 ,占 2 3 8% ;Ⅱ级 10例 ,占 2 3 8% ;Ⅲ级2例 ,占 4 7%。采用提袋手柄式瓣和双颊瓣加犁骨凿断牙槽突裂修复术的 6例中 ,唇颊龈沟变浅 2 3者有 4例 ,唇颊龈沟消失者 2例 ,可见这两种术式均可使唇颊龈沟变浅。结论　三种术式均有使唇颊龈沟变浅之可能 ,术中应注意预防之     

Factors that affect variability in impairment of maxillary growth in patients with cleft lip and palate treated using the same surgical protocol

Abstract

No consensus exists about the causes of restriction of maxillary growth in patients with cleft lip and palate (CLP). The aim of this study was to try to identify causes of this impairment other than the influence of surgical technique and skill. We analysed a sample of 129 consecutively treated 5-year-old children with unilateral cleft lip and palate (UCLP), who were operated on by the same surgeon with the same protocol. Multiple cephalometric measurements of the sample showed a wide distribution of values for maxillary growth. We selected SNA as a value describing maxillary position. Variables investigated were: initial cast measurements; timing of lip and of gingivoalveoloplasty (GAP)/palatal surgery; and presence of permanent lateral incisors. The significance of differences was investigated with Pearson's correlation and analysis of variance (ANOVA). The factor most significantly linked with maxillary protrusion was the presence or absence of the permanent lateral incisor, even when peg laterals and supernumerary laterals were considered. Initial width of the palate measured on infant casts correlated with maxillary growth, but the timing of GAP did not. Although surgical skill and technique may be the most important factors responsible for impairment of maxillary growth, inherent tissue hypoplasia, possibly the lack of lateral incisors, seems to be the most important non-iatrogenic factor.     

Bone Formation in Palatal Clefts Subsequent to Palato-Vomer Plasty:Influence on Transverse Maxillary Growth

Palatal bone biopsies from nine children 22 to 24 months of age, with complete unilateral cleft, showed that palato-vomer plasty results in uninterrupted osseous closure of the cleft in the hard palate. The newly formed bone had fused with the nasal septum, but no suture had developed corresponding to the fusion. The bone contributed to the vertical growth of the nasal and oral cavities, but in spite of an extremely active suture on the non-cleft side the osseous closure of the cleft seems to inhibit transverse maxillary growth. Periosteal biopsies from the same children obtained from the buccal aspect of the maxilla from the region of the second deciduous molar on both sides, showed reduced appositional growth activity on the cleft side. Periosteal biopsies from nine unoperated children aged 2 months with the same type of cleft showed equal appositional growth activity on both sides. It is recommended to avoid any surgical procedure resulting in osseous closure of the cleft in the hard palate until the sutural growth of the upper face has terminated.     

Postoperative Evaluation of Palatoplasty Using the Modified Kaplan Method

Purpose Bilateral buccal mucosal flaps were used for a pushback operation of the nasal mucosa as well as the oral mucosa.Methods Two flaps from the buccal mucosal areas were inserted into the nasal mucosal raw surface at the hard and soft palatal border to achieve nasal mucosal pushback. Forty-four children with cleft palates were retrospectively studied to investigate the velopharyngeal function, articulation, and craniofacial morphology following primary palatoplasty using the modified Kaplan method.Results 72.7% showed good velopharyngeal function. Articulation disorders were found in 26 of the 44 subjects (59.1%). A craniofacial morphological analysis revealed no major changes in the SNA (sella–nasion point A angle) and SNB (sella–nasion point B angle) and no cases of a marked loss of maxillary mandibular balance. In addition, no significant differences were observed in the maxillary length and width.Conclusion The results of these palatoplasties by the modified Kaplan method indicated that the use of bilateral buccal mucosal flaps for the pushback of the nasal mucosa was effective in preventing the contraction of the maxillary and mandibular corpal lengths.     

A modified Le Fort I osteotomy for maxillofacial deformity: a preliminary report.

A new technique of Le Fort I osteotomy using a wedge-shaped bony incision is described. After forward mobilisation of the osteotomised maxilla, the bone graft is held firmly in contact under some compression between the maxilla and the mobilised wedged portion to achieve greater stability. This is a very effective technique for those maxillary osteotomies which need bone graft stabilisation, such as in cleft lip and palate patients.     

Facial growth of adults with unoperated clefts

Studies of adult patients with unoperated complete unilateral cleft lip and palate indicate that there is normal potential for maxillary growth. The maxilla in the unoperated patient is normally positioned or protruded. The protrusion of maxilla in the unoperated adult cleft patient is limited to the non-cleft side, contributing to hemifacial maxillary prognathism. Surgical scar tissue is known to interfere with the growth of the midface. Palatal surgery has more significant influence on the growth of the mid-face than the lip surgery; therefore, it is important to reduce the effect of surgery by delaying the timing of palatal surgery or changing the location of the surgical scar from the sutural areas. Delaying palatal surgery until the maxillary growth is complete is desirable but could lead to poor speech development. Therefore, it is essential to perform the palatal surgery before speech development. The other variables that affect the midface are the development genetic make-up of the cleft child, the amount of tissue deficiency, timing of surgery, surgical technique, and the skill of the surgeon. Surgeries continue to have some inhibitory effect on maxillary growth, but it is essential to recognize and perform those surgical procedures that have the least effect on growth of the maxilla. This will help minimize extensive orthodontic treatment and eliminate major secondary orthognathic surgery for correction of the abnormal growth of the maxilla.