腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用

目的　探讨腭帆提肌重建联合咽后壁瓣术在先天性腭裂中的临床应用。方法　采用腭帆提肌重建联合咽后壁瓣术,共修补47例先天性腭裂患者,其中单侧完全性腭裂21例,不完全性腭裂26例。结果　所有患者均一期愈合,未出现腭瘘,随诊1~3年,语音清晰度满意。结论　腭帆提肌重建联合咽后壁瓣术较好地恢复了腭帆提肌正常的解剖结构和位置,获得了良好的腭咽闭合,并有效地降低了术后腭瘘的发生率,是一种值得推荐的功能性腭裂修复方法。     

腭帆提肌重建联合岛状颊黏膜肌瓣在先天性腭裂中的应用

目的:探讨一种对上颌骨发育影响较小且具有良好腭咽闭合功能的腭裂修补术的临床应用。方法:采用腭帆提肌重建联合岛状颊黏膜肌瓣术,共修补37例腭裂患者。结果:所有患者均一期愈合,随诊1～3年,语音清晰度满意,无腭瘘发生。结论:腭帆提肌重建联合岛状颊黏膜肌瓣术较好地恢复了腭帆提肌正常的解剖结构和位置,获得了良好的腭咽闭合,有效降低了腭瘘的发生率,是一种值得推荐的功能性腭裂修复术。     

腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用

目的：探讨腭帆提肌重建联合腭咽环扎术在腭裂修复中的应用效果。方法：应用腭帆提肌重建联合腭咽环扎术修复较宽大腭裂26例,观察其修复腭裂后的伤口愈合和语音恢复效果。结果：术后均一期愈合,无复裂和瘘发生。随访16例患者,其鼻漏气得到有效控制,语音清晰度状况优良。结论：腭帆提肌重建联合腭咽环扎修复术可较好的恢复腭部的形态和腭咽功能,具有方法简单、创伤小和效果好的特点。     

Sommerlad腭帆提肌重建术修复腭裂临床体会

腭裂修复的目的是修复腭部的解剖形态．改善腭部的生理功能．重建良好的腭咽闭合,为正常吸吮、吞咽和语音、听力等生理功能恢复创造条件。sommerlad腭帆提肌重建术能恢复腭帆提肌的正常解剖位置．有助于充分发挥其生理功能．获得良好的腭咽闭合．本研究对181例腭裂患者用Sommerlad腭帆提肌重建术进行修复．获得了满意效果,现报道如下．     

Sommerlad腭帆提肌重建术在不完全腭裂修复中的应用

目的：探讨一种具有良好腭咽功能、对上颌生长发育影响小的不完全性腭裂修复的新方法。方法：采用Sommerlad腭帆提肌重建术,对38例不完全性腭裂进行手术修复,术后应用语音分析、头颅侧位X线咽腔造影检查。结果：所有患者术后均一期愈合。28例（73．7％）没有做松弛切口,10例（26．3％）行两侧约5～10mm松弛切口。20例术后6个月复诊,其语音清晰度、高鼻音以及鼻漏气都得到明显改善。咽腔造影结果显示：17例达到完全腭咽闭合,3名软腭动度良好,发“i”时腭咽间隙在3mm以内。结论：Sommerlad腭帆提肌重建术可有效恢复腭帆提肌正常的解剖结构和位置,重建提腭吊带,获得良好的腭咽闭合;并可尽量不做松弛切口,避免了硬腭裸露骨面造成对上颁生长发育的影响,较好地解决了传统术式所遗留的问题,是一种值得推荐应用的功能性腭裂修复方法。     

Sommerlad腭帆提肌重建术修复腭裂的临床研究

目的探讨采用Sommerlad腭帆提肌重建术修复腭裂的效果。方法采用Sommerlad腭帆提肌重建术修复先天性腭裂11例,其中完全性腭裂3例,不完全性腭裂8例。患者朗读汉语普通话测试字表,对比手术前后的发音准确率。结果 11例患者手术顺利,术中出血少,均不需输血。术后伤口无感染,无裂开,手术成功。发音准确率由术前的20%提高到术后的60%。结论 Sommerlad腭帆提肌重建术修复腭裂是一种较好的功能性腭裂修复术,值得在临床推广。     

腭帆提肌运动神经支配的实验研究

现代腭裂功能性整复术,提倡后退腭帆提肌,重建腭帆提肌吊环。但术中的过度分离,可能会造成腭帆提肌运动神经损伤,从而影响术后的腭咽闭合功能。我们对该肌的动物神经来源及外周走行路径进行了实验研究,以期为临床腭裂整复术提供解剖学依据。1材料和方法:雄性健康家兔10只...     

腭裂的外科解剖

腭裂手术的主要目的是封闭裂隙达到良好的腭咽闭合功能,目前有各种手术报导来达到这个目的。进行功能性腭裂修补术,必须了解腭的外科解剖和腭咽闭合功能的知识。与手术直接有关的腭部肌肉。神经血管叙述如下: 一、腭部的肌肉: 有提腭帆肌、张腭帆肌、腭舌肌、腭咽肌和悬雍垂肌等5对肌肉。但与腭裂成形术有关的肌肉是提腭帆肌和张腭帆肌,此两肌肉进入软腭行使不同的功能。提腭帆肌有专门关闭鼻咽腔的功能;而张腭帆肌则司理耳     

腭裂手术的新概念

一、手术年龄1 .5岁左右修复腭裂有利于正常语音功能 ,因为在学习语音以前 ,建立了正常的腭部解剖位。二、为什么早期腭裂修复术 ,采用兰氏法 ?早期腭裂手术有利于语音的发育 ,但手术过多干绕颌骨 ,无疑会造成日后颌骨发育障碍 ,兰氏手术未后退软腭 ,仅封闭裂隙 ,在腭部所遗留骨创面极小 ,从而手术对颌骨干扰小。三、腭帆提肌功能位的重建是获得软腭上提功能的关键腭咽闭合的机理是腭帆提肌构成的前半园向上后收缩及咽上缩肌构成的后半园向前收缩来达到腭咽闭合。一些患者 ,有足够的软腭长度 ,但腭帆提肌上提功能差 ,也无法达到腭咽闭合。因…     

折叠式双咽后壁组织瓣腭咽成形术

根据腭帆提肌的解剖特点，利用折叠式双咽后壁组织瓣，来补偿腭帆提肌的作用，使腭裂患者术后以获得良好的腭咽闭合，经过２６０例临床应用，发音恢复良好     

Magnetic resonance imaging of the levator veli palatini muscle before and after primary palatoplasty.

OBJECTIVE: To explore the application of magnetic resonance imaging (MRI) in the evaluation of patients with cleft palate before and after primary palatoplasty with particular attention focused on the levator veli palatini muscle. DESIGN: Prospective study using MRIs of subjects before and after primary cleft palate surgery. SETTING: Hospital and university based. PATIENTS: One female infant with normal anatomy. Three male and four female infants with cleft palate of varying severity. INTERVENTION: Furlow double-opposing Z-plasty and V-Y palatoplasty. MAIN OUTCOME MEASURES: Magnetic resonance images. RESULTS: It was found that the levator veli palatini muscle can be imaged before and after palatal surgery in infants using MRI. The muscle may have sufficient volume, proportionate to a normal infant or adult, in infants born with cleft palate. If retrodisplaced properly, the muscle is likely to be steeper (more vertical) from its origin at the base of the skull to its insertion into the velum following palatoplasty, thus providing a more favorable angle for elevating the velum. Following palatal surgery, the levator muscle mass may not be as cohesive across the velar midline, compared with normal musculature. CONCLUSION: MRI is a viable imaging modality for the evaluation of the anatomy of the levator veli palatini muscle before and after primary palatoplasty in infants born with cleft palate.     

The innervation of the soft palate muscles involved in cleft palate: a review of the literature

Objective

Surgical techniques to obtain adequate soft palate repair in cleft palate patients elaborate on the muscle repair; however, there is little available information regarding the innervation of muscles. Improved insights into the innervation of the musculature will likely allow improvements in the repair of the cleft palate and subsequently decrease the incidence of velopharyngeal insufficiency. We performed a literature review focusing on recent advances in the understanding of soft palate muscle innervation.

Material and methods

The Medline and Embase databases were searched for anatomical studies concerning the innervation of the soft palate.

Results

Our literature review highlights the lack of accurate information about the innervation of the levator veli palatini and palatopharyngeus muscles. It is probable that the lesser palatine nerve and the pharyngeal plexus dually innervate the levator veli palatini and palatopharyngeus muscles. Nerves of the superior-extravelar part of the levator veli palatini and palatopharyngeus muscles enter the muscle form the lateral side. Subsequently, the lesser palatine nerve enters from the lateral side of the inferior-velar part of the levator veli palatini muscle. This knowledge could aid surgeons during reconstruction of the cleft musculature. The innervation of the tensor veli palatini muscle by a small branch of the mandibular nerve was confirmed in all studies.

Conclusion

Both the levator veli palatini and palatopharyngeus muscles receive motor fibres from the accessory nerve (through the vagus nerve and the glossopharyngeal nerve) and also the lesser palatine nerve. A small branch of the mandibular nerve innervates the tensor veli palatini muscle.

Clinical relevance

Knowledge about these nerves could aid the cleft surgeon to perform a more careful dissection of the lateral side of the musculature.

     

The longitudinal fibromuscular component of the soft palate in the fifteen-week human fetus: musculus uvulae and palatine raphe.

The structural relationships of the longitudinal fibromuscular component of the soft palate (musculus uvulae and raphe) were studied using histologic sections from 19 early human fetal specimens. Musculus uvulae arises in association with the palatine aponeurosis near the beginning of the second quadrant of the velum, follows a sigmoid course, and terminates near the base of the uvula. In addition, an occasional muscular loop may arise from the bony palate, arch downwards, and then recur into the uvular muscle. A complex relationship exists between the raphe in the velum and several palatal muscles. With regard to musculus uvulae, small muscular bundles arise from the raphe to embrace the muscle near its crest. These branches may aid in contouring the dorsal surface of the velum in the region of the levator eminence to complement the surface of the posterior pharyngeal wall and thus enhance the efficiency of the velopharyngeal seal.     

双侧腭裂整复术中凿断翼钩与否对上颌骨发育的影响

目的对比在双侧腭裂修复术中凿断翼钩与否,术后患者的上颌骨发育情况.方法选择在3岁以内做双侧腭裂修复手术,术中不凿断翼钩的患者16例,编入试验组.另再选择3岁以内做双侧腭裂修复手术,术中凿断翼钩的患者10例,编入对照组.两组的年龄范围9～12岁,术后追踪9～10年.拍摄每例患者的头颅侧位片,并作头影测量分析,对比两组患者的上颌骨发育情况.结果两组的上颌骨都有明显的矢状向发育不足,下颌骨发育基本正常.测量上颌骨发育的各项目（SNA、A-NP、PP-SN、ANS-FHp、Ptm-A等）的组间差别不明显,说明手术中有无凿断翼钩,对患者的上颌骨发育并无影响.结论在双侧腭裂修复手术中,有无凿断翼钩,对患者的上颌骨发育并无明显影响,但不凿断翼钩有利于保护腭帆张肌,同时也能减少手术创伤,简化手术过程.     

Three-dimensional computer reconstruction of the levator veli palatini muscle in situ using magnetic resonance imaging.

OBJECTIVE: Most studies have used two-dimensional (2D) data to image and study the velopharyngeal mechanism, oversimplifying the complexity of the system. Three-dimensional (3D) computer modeling and animation offers the advantage of viewing in all coordinate planes and gives the researcher the ability to apply external forces and chart resultant movement patterns. The objective of this project was to create a 3D model of the velopharyngeal mechanism, with primary focus on the levator veli palatini muscle, based on magnetic resonance imaging (MRI) data to demonstrate the velum at rest and during elevation. METHOD: Quantitative data, based on MRI analyses and consisting of levator muscle length, width, and orientation were modeled using the Maya software system. RESULTS: Using data derived from MRI analyses, an accurate and realistic computer reconstruction of the levator muscle in situ was possible. A video of the animation was created to demonstrate the anatomy from variable view points, layering of the velar muscles, and movement of the velopharyngeal mechanism during vowel production. CONCLUSION: Improvements in visualization of the levator veli palatini muscle through 3D computer graphics offer a promising future for the field of speech science in providing advancements in basic research. It will be valuable in applied research and clinical activities such as surgical management for individuals impacted by a cleft palate. It is a step forward in creating models of abnormal anatomy (i.e., cleft palate) and is a step closer to a virtual surgical planning tool.     

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目的探讨先天性腭裂患者的腭帆提肌肌纤维型组成和分布,借以了解先天性腭裂患者肌纤维特点。方法对2008年1月至2008年7月于青岛大学医学院附属医院口腔颌面外科就诊的先天性腭裂患者20名,取其腭帆提肌组织进行冰冻切片,采用肌球蛋白ATP酶组织化学染色法,对其进行肌纤维分型研究。结果先天性腭裂患者腭帆提肌经肌球蛋白ATP酶组织化学染色后可分出两种肌纤维型,其中Ⅰ型纤维占(26.4±3.1)%,Ⅱ型纤维占(73.6±6.3)%,两者比较差异具有统计学意义。结论先天性腭裂患者的腭帆提肌肌纤维以Ⅱ型纤维为主。     

Magnetic resonance imaging of the levator veli palatini muscle in speakers with repaired cleft palate.

OBJECTIVE: To obtain detailed anatomic and physiologic information on the levator veli palatini muscle from MRI in individuals with repaired cleft palate and to compare the results with those from normal subjects reported by Ettema et al. (2002). DESIGN: Prospective study. SETTING: University-based hospital. PARTICIPANTS: Four men (ages 22 to 43 years) with repaired cleft lip and palate. MAIN OUTCOME MEASURES: Four quantitative measurements of the levator veli palatini muscle from rest position and dynamic speech magnetic resonance images were obtained: the distance between the origins of the muscle, angle of origin of the muscle, muscle length, and muscle thickness. RESULTS: The length and thickness of the levator veli palatini muscle varied among the subjects and were different from measurements obtained from normal subjects in a previous study. The distance between origin points, length, and thickness of the levator veli palatini muscle were smaller than those of the normal subjects. There were systematic changes of the levator veli palatini muscle, depending upon vowel and consonant types. Levator veli palatini muscle angle of origin and length became progressively smaller from rest, nasal consonants, low vowels, high vowels, and fricative consonants. These changes are consistent with those of the normal subjects. CONCLUSIONS: This study contributes to a better understanding of cleft palate anatomy in comparison with normal anatomy of the levator veli palatini muscle. The use of MRI shows promise as an important tool in the diagnosis and eventual aid to treatment decisions for individuals born with cleft palate.