单侧完全性唇裂患儿一期鼻畸形整复的临床研究

目的:单侧完全性唇裂患儿初期唇裂整复同期鼻畸形整复术后鼻形态进行研究。方法:将21例单侧完全性唇裂患儿根据是否接受唇裂整复同期鼻畸形整复分为两组,测量其术后7d及术后12个月鼻外形各项指标,用SPSS18.0软件进行统计分析比较其对称性。结果:术中接受鼻畸形整复的12例患儿术后7d鼻外形各评价指标比较,差异均有统计学意义(P0.05),鼻部对称性优于未接受同期鼻畸形手术者;术后12个月接受初期鼻畸形整复的12例患儿除鼻翼基底倾斜度外其余各指标比较,差异均有统计学意义(P0.05),鼻部对称性仍优于未接受初期鼻畸形手术者。结论:初期唇裂整复同期鼻畸形整复手术是矫正唇裂鼻畸形最根本有效的方法之一。     

新生儿唇裂手术修复体会

唇裂是口腔颌面部最常见的先天性畸形,新生儿唇腭裂的患病率大约为1：1000,早期修复上唇的正常形态及正常的吮吸功能,避免上颌骨和牙齿的异常发育,减少牙列畸形,给患儿及家属心理安慰。但早到何时,学者观点不一,多数学者以出生后3～6月时手术修复,而国外有学者主张在3月前手术修复。早期手术有其难点,患儿全身状况不易控制,全麻危险性大,术后护理不易合作,唇组织少、解剖标志不明显等。笔者2006-2009年,对13例单侧唇裂新生患儿进行手术修复,取得满意的效果,现总结如下。     

新生儿唇裂修复临床分析

本组收集了出生后8至72小时的新生儿唇裂修复术43例,结果可见新生儿唇裂修复术后效果与3至18个月唇裂修复术后者无差异,表明了早期行唇裂修复术的优点和可行性。存在的技术问题和难点可以通过熟练而仔细的操作予以克服,即使有感染或部分裂开也至少相当于一个满意的唇粘连术,通过早期手术可尽早地恢复患儿的吸吮功能、促进上唇口轮匝肌的发育,阻止畸形的进一步发展,恢复了上唇的外形及功能,解除了家长的精神负担,为患儿的健康成长营造了良好氛围。     

单侧唇裂修复同期鼻畸形矫正术

目的 探讨在修复伴有鼻畸形的先天性唇裂时,同期一次性矫正鼻部畸形,以最大程度地减少唇裂术后继发性鼻畸形发生的手术方法.方法 采用Millard术式或Millard术式＋三角瓣插入法,同时利用唇裂手术切口入路恢复大翼软骨、鼻肌及鼻小柱的正常解剖位置以矫正鼻畸形.结果 共修复单侧唇裂108例,术后随访1个月至3年,效果满意.结论 所有单侧唇裂均伴发鼻畸形,在唇裂修复同期进行鼻畸形的矫正,可获得即刻的手术效果和较为满意的远期疗效,并可能减少再次手术及手术难度.     

唇裂硬腭一期修复对完全性腭裂手术及牙弓发育的影响

目的:观察单侧完全性唇腭裂患儿唇裂硬腭一期修复对腭裂修复手术及患儿牙弓发育的影响。方法:40例年龄为3～6月龄的单侧完全性唇腭裂患儿,随机分为两组。观察组:行唇裂及硬腭一期修复;对照组:仅行唇裂修复。然后两组患儿均在1岁半时行腭裂修复。两次手术时分别取两组患儿上牙颌模型,测量上腭裂隙的宽度变化并进行比较;腭裂修复术时,对比两组患儿出血量的多少以及所作松弛切口的差异性,对两组牙颌模型进行牙弓的长、宽测量并做比较。结果:通过对牙颌模型的测量,发现在腭裂手术时观察组腭裂隙缩窄更明显,较对照组有显著性差异,具有统计学意义(P0.05);腭裂手术时,观察组较对照组所作松弛切口更少,平均出血量也更少,均有显著性差异(P0.05);1岁半时,两组患儿牙弓发育无明显差异(P0.05)。结论:单侧完全性唇腭裂患儿唇裂及硬腭一期修复可使上腭裂隙缩窄更明显,腭裂修复时所作松弛切口更少,减少了术后上腭骨面裸露面积,减轻了对患儿上颌骨生长的抑制作用,有利于患儿恢复;早期犁骨瓣关闭硬腭短期内对牙弓发育无明显影响。     

婴幼儿先天性唇裂早期修复同期行鼻畸形矫正初步报告

目的 探讨婴幼儿先天性唇裂早期修复,同期矫正鼻畸形,以避免唇裂术后继发鼻畸形而再次手术的可行性。方法,采用Millard I式或II式唇裂修复法修复唇裂,同期矫正鼻畸形,使移位的鼻翼软骨,鼻中隔软骨复位,以恢复正常的解剖关系,结果 1998－1999共矫治30例,年龄3个月至3岁,单侧唇裂24例,双侧唇裂6例,随诊最长18个月,效果良好。结论 唇裂患儿幼小时组织比较薄膜,畸形易于矫正,早期修复唇裂,同期矫正鼻畸形,使畸形的鼻翼软骨,鼻中隔恢复到正常的解剖学位置并在此位置 生长发育,鼻畸形可望明显改善。     

单侧唇裂手术前后唇鼻部外观变化的数据分析

目的获得单侧唇裂患儿术前唇鼻形态的数据资料,根据唇鼻畸形特征设计手术修复方案,通过术后临床观察,评价手术效果。方法单侧唇裂患儿85例,分为单侧完全性唇裂组、单侧不完全性唇裂组。术前、术后6个月分别测量裂隙两侧唇长、唇高、人中嵴高度、鼻底宽度和鼻小柱高度,采用配对t检验来比较各组患儿裂隙两侧测量值的差异。结果单侧唇裂患儿术前裂隙两侧唇鼻部各项参数均有统计学意义（P〈0．01）;短期术后随访表明,两组1岁以内患儿在健一患侧唇长和鼻底宽度方面具有统计学意义（P〈0．01）,裂隙侧唇长较健侧小,鼻底宽度较健侧大。完全性唇裂组患儿术后半年患侧鼻小柱高度小于健侧。1～2岁患儿在健一患侧唇长、唇高、人中嵴高度、鼻底宽度和鼻小柱高度方面差异无统计学意义。结论测量单侧唇裂患儿唇长、唇高、鼻底宽度、鼻小柱高度和人中嵴高度,对术前手术设计和术后对称性评估有很大的帮助。短期随访表明,1岁以内单侧唇裂患儿患侧唇长变短,鼻底增宽,在今后的唇裂修复中,需要通过改进手术方法来解决。     

唇粘技术在围生儿唇裂治疗中的应用

唇裂是面部最常见的先天性畸形之一 ,畸形儿的出生对其家庭无疑是沉重的精神负担。尽早对患儿进行唇粘连术 ,关闭裂隙 ,不但对患儿和家庭在生理和心理上有利 ,更为重要的是可减轻畸形的进一步发展 ,为再次的唇裂整复手术创造了较好的条件。一、临床资料共收集我科 1982年 6月至 2 0 0 0年 6月的患儿 4 2例 ,其条件符合 :⑴出生后 5 .5～ 72ｈ的唇裂或伴有腭裂的围生期新生儿 ;⑵接受过唇粘连术 ;⑶半年后复诊再行唇裂整复术。其中男婴 2 3例 ,女婴 19例 ;双侧唇裂 8例 ;单侧唇裂 34例 ;完全唇裂 2 8例 ,不全唇裂 14例。 2 8例完全唇裂均伴有…     

唇裂止血复位固定器用于唇裂术患儿的护理

唇裂是一种常见的先天性畸形。我院 1997年1月至 2 0 0 1年 12月参加国家慈善总会开展的“微笑列车”活动 ,对全省 5个地区近 4 0 0余例唇、腭裂患儿进行唇、腭裂修复术。其中采用自制唇裂止血复位固定器[1] (下称固定器 )治疗唇裂患儿 2 6 8例 ,效果满意。该固定器的使用使术中出血明显减少 ,手术时间明显缩短 ,术后恢复快 ,并发症少 ,缩短了住院时间。报告如下。1　临床资料　　一般资料 :2 6 8例中 ,男 15 2例、女 116例 ,年龄最大 12岁 ,最小 6个月 ,平均 9个月。双侧唇裂 5 0例 ,左侧 12 3例 ,右侧 95例。均用固定器辅助行唇裂修复术。…     

单侧唇裂鼻畸形的临床研究进展

唇裂是口腔颌面部常见的先天性畸形,其发病率约为新生儿的0.18%,唇裂Ⅰ期修复手术多在患儿出生后的3个月进行[1].唇裂可分为单侧(完全性或不完全性)唇裂、双侧(完全性、不完全性、混合性)唇裂、正中裂(极少见)和隐裂(常为单侧或双侧唇裂中的某一侧)[2].     

新生儿先天性单侧唇裂修复术的临床研究

目的：探讨新生儿单侧唇裂修复的临床治疗效果。方法：选足月健康正常体重单侧唇裂患儿，在出生后48h内行唇裂修复术。对手术效果随访，并与婴幼儿期唇裂修复结果进行比较。结果：新生儿期修复单侧唇裂，效果理想，经3个月至4年随访．唇修复形态的优良率为92．8％，与婴幼儿组相比唇形态优良率无明显差别，但出血少，费用低，住院时间短，家长普遍满意。结论：对先天性单侧唇裂新生儿进行早期修复是安全的，且效果令人满意。     

Ambulatory surgery for cleft lip repair

Standard of care for cleft lip repair has included preadmission testing, surgical correction, and postoperative hospital care. Driven not by managed care economics but to speed the safe home care of infants by parents, the authors have gained experience in ambulatory cleft lip repair. In this retrospective study the authors evaluated the outcome of patients who underwent ambulatory cleft lip repair compared with those patients who were hospitalized after surgery. From 1989 to 1998, 24 cleft lip repairs in 24 patients performed by the senior author were evaluated. Two groups were treated. Group 1 (N = 11) consisted of ambulatory unilateral cleft lip repairs and group 2 (N = 13) consisted of inpatient unilateral cleft lip repairs. Important surgical factors considered were technique of cleft lip repair, performance of ancillary procedures, type of local anesthetic administered, and intravenous steroid administration. Time to first postoperative feeding and complications, including bleeding, spontaneous or traumatic wound dehiscence, and infection, were considered important outcome parameters. There were no differences in surgical technique or use of antibiotics and postoperative analgesics between the two groups. None of the patients in group 1 underwent ancillary procedures. Four patients underwent soft palate repair and 3 patients underwent insertion of myringotomy tubes among group 2 patients. The use of a 1:1 mixture of 1% lidocaine and 0.5% bupivacaine with epinephrine vs. 1% lidocaine with epinephrine as a local anesthetic and intravenous steroid administration was greater in group 1 (92%) than in group 2 (33%) patients. The average time to the first postoperative feeding was more than 1 hour sooner in the ambulatory group (p < 0.05) compared with the hospitalized group (excluding the 4 patients who underwent soft palate repair). There were no complications among patients with ambulatory cleft lip repair, and there were two cases of minor wound separation in patients who received postoperative hospital care. Although many variables factor into the outcome after cleft lip repair, these data support the safety and continued practice of ambulatory cleft lip repair.     

转移粘膜肌瓣加深前庭沟术式在单侧唇裂修复中的应用

目的:探讨一种转移健侧粘膜肌瓣加深前庭沟减少皮肤切口的术式在单侧唇裂修复中的临床效果。方法:利用裂隙健侧粘膜肌瓣加深前颌部前庭沟,达到延长健侧唇高恢复唇珠外形的目的,解剖复位口轮匝肌,矫正鼻唇畸形,减少皮肤切口及瘢痕。结果:采用该术式修复单侧唇裂44例,经1~2年随诊,患者唇部皮肤瘢痕不明显,唇弓唇珠外形满意,鼻小柱偏斜鼻翼外侧脚移位得到矫正,前颌部前庭沟深度增加。结论:该手术设计在单侧唇裂修复中值得推广。     

A longitudinal comparison of the psychological impact on mothers of neonatal and 3 month repair of cleft lip.

PURPOSE: This study investigates whether the timing after birth of babies' cleft repairs influences the psychological status of mothers. METHODS: Mothers of infants born with a cleft lip completed psychological assessments and semistructured interviews at four time points: 2-3 weeks, 3 months and 6 months following the birth. In addition, a preoperative assessment and interview was completed within the first week of birth for those with infants undergoing neonatal repair and within the week before surgery for the 3 month repair group. RESULTS: There were no significant differences between mothers of infants with early (neonatal) and late (3 month) repairs on the emotional measures at any time point or preoperatively. Means of measures for anxiety and depressive symptoms and the Impact of Event Scale were within the normal range. Measures of interaction with the infant, perceived infant difficulty, bonding and parental competence failed to show any impact of timing of operation. Women's emotional status improved significantly over the 6 month period regardless of operation timing. Qualitative analysis of interview data indicated most mothers preferred their infant to receive neonatal repair. CONCLUSIONS: There was no evidence to support the idea that repair neonatally or at 3 months led to differential levels of anxiety or depressive symptoms or differences in attachment to the infant. Nevertheless mothers expressed a preference for and greater satisfaction with neonatal repair. In the absence of definitive evidence of differences in physical outcome, parental preferences should routinely be considered in deciding the timing of this procedure.     

单侧唇裂继发畸形的美学修复

目的 探讨单侧唇裂继发畸形与I期手术方式选择的关系,以及进行唇裂继发畸形美学修复的策略.方法 选择单侧继发唇裂120例,根据I期采用的不同术式进行分组,对唇裂畸形进行观察和分析,采用个体化设计,进行美学修复.对采用Millard、Tennison、矩形瓣及上三角瓣法的单侧唇裂继发畸形修复后,观察上唇人中窝形念、瘢痕、唇峰形态的恢复.结果 显示原采用Millard方法、上三角瓣方法优于Tennison方法和矩形瓣方法.Ⅱ期修复术后效果满意.结论 单侧唇裂I期采用的手术方式对继发畸形的程度和修复有显著影响.     

改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果研究

目的:探究改良Millard术式对双侧完全性唇裂患儿鼻唇畸形的修复效果。方法:将42例双侧完全性唇裂患儿作为观察组,使用改良Millard术式进行治疗;同时收集同年龄段体检正常的42例儿童作为对照组。术后24个月,比较两组研究对象的唇高、唇长、鼻底宽度、鼻小柱高度及家属心理状态。结果:术后,观察组两侧唇高均降低、唇长增加、鼻底宽度缩短、鼻小柱高度增加,差异均具有统计学意义(P<0.05)。两组研究对象的唇长、鼻底宽度比较,均无统计学差异(P>0.05),但两组间唇高、鼻小柱高度比较具有统计学差异(P<0.05)。术后与术前比较,患儿家属的精神病性、躯体化、偏执、强迫症、恐怖、人际关系、敌对症、焦虑评分均降低,差异均具有统计学意义(P<0.05)。结论:改良Millard术式对双侧完全性唇裂患儿鼻唇畸形可有效复位、重建鼻唇部解剖亚单位,同时降低家属心理负担,值得临床推广应用。     

毛发游离移植治疗唇裂修复术后上唇瘢痕

目的应用毛发游离移植胡须再造,治疗唇裂修复术后遗留的上唇瘢痕。方法切取枕部头皮,分割成含单一毛囊的皮条,供区缝合,应用崔式植毛器移植到上唇瘢痕。结果临床应用4例,单侧唇裂3例,双侧唇裂1例,移植毛发生长良好,效果满意。结论毛发游移植治疗唇裂修复术后上唇瘢痕是一种切实可行的方法。     

Use of octyl-2-cyanoacrylate in cleft lip repair

Octyl-2-cyanoacrylate (Dermabond; Ethicon, Somerville, NJ) is a synthetic tissue adhesive recently approved for skin closure. This study was designed to assess its effectiveness for use in clefts lip repairs. Sixty-four patients with unilateral, bilateral, or midline cleft lip defects were repaired. The ages at repair ranged from 4 days to 19 months, with an average of 46.5 days. Follow-up ranged from 6 months to 3 years. No complications were found. Several advantages were observed: shorter operative time, formation of a protective barrier, simplified incision care, no need for suture removal, and improved scar outcome. This study supports octyl-2-cyanoacrylate as an alternative to skin sutures in primary cleft lip repair.     

New Technique for Correction of the Microform Cleft Lip Using Trans/Intraoral Approach

The traditional method of treating microform cleft lip with nose deformity uses upper lip external incision, finally leading to a small scar on the upper lip. Hereafter, we present a new method for the correction of microform cleft lip using trans/intraoral approach. The new surgical technique is characterized as (1) using trans/intraoral approach and no incisions on the skin of the upper lip, (2) reconstruction of the “cross” muscular structure using the abnormal muscular insertions at the base of nasal columella and the nasal alar to restore nose deformity, and (3) repair of the lip deformity using two small Z-plasties to get the aesthetic and functional outcome. Thirty patients with microform cleft lip were repaired with our technique, and good functional and aesthetic results of repaired noses and upper lips were obtained in most cases.     

轮廓线切口入路行唇裂术后畸形整复术

目的 探寻一种功能和外观满意，要后上唇不再遗留或减少手术瘢痕的唇裂术后畸形整复方法。方法 采用复唇沟、唇红缘等轮廓线切口入路，于皮下进行唇裂术后畸形功能性整复。结果 应用该法行手术15例，其中双侧唇裂术后畸形4例，单侧唇裂术后11例，经6个月至2年随访，功能、外观均达到满意的效果。结论 该法一改传统的唇裂术后畸形整复方法，彩和轮廓线切口入路，术后手术瘢痕不明显；皮下充分松解，使原手术瘢痕明显淡化、平整；口轮匝肌从其不正常的附着处分离，恢复肌肉正常走向和功能，重建口轮匝肌环；调整鼻翼软骨、重塑鼻翼软骨，使唇裂鼻恢复正常。从而使患者的诸多畸形在功能和外观上均获得满意的效果。