小切口自体髂骨骨松质修复牙槽嵴裂及口鼻瘘的临床研究

目的：分析小切口自体髂骨骨松质修复牙槽嵴裂的手术方法及影响植骨成功的因素。方法：对同一术者所行牙槽嵴裂植骨术的唇腭裂患者22例进行临床研究，所有患者均有术前及术后6个月以上的完整资料。探讨植骨区X线影像的临床分级与手术年龄、手术类型、裂隙类型类型等的关系。结果：植入骨成活率95.8％，临床成功率为91.7％；（2）18岁以上年龄组、完全性唇腭裂组、双侧唇腭裂组患者植骨的临床成功率相对较低；（3）本组病例均采用小切口，以骨移植用圆筒形取骨器切取髂骨骨松质，局部创伤小，术后疼痛轻。结论：以骨移植用圆筒形取骨器通过小切口自体髂骨骨松质是进行牙槽嵴裂植骨的一种良好方法。（2）良好植骨床的形成和植骨区无张力的严密缝合是保证牙槽嵴裂植骨成功的关键；植骨时机是植骨成功是否的重要因素；（3）牙槽嵴裂的植骨效果与手术年龄、裂隙类型、裂侧类型等有关。     

Comparison between combined cortical and cancellous bone graft and cancellous bone graft in alveolar cleft: Retrospective study of complications during the first six months post-surgery

BackgroundIn patients with alveolar cleft, alveolar bone graft is usually performed before the permanent maxillary canine or incisor eruption and using cancellous bone harvested from the iliac crest. The authors sought to compare the early complication rate in patients who received cancellous bone graft alone and cortical bone graft in addition to cancellous bone to reconstruct the nasal floor.MethodsFor this observational, retrospective, monocentric study, patients with alveolar cleft who underwent autologous alveolar bone graft and gingivoperiosteoplasty at Montpellier Hospital were divided into two groups: group A, who had cortical and cancellous bone graft; and group B, who had only cancellous bone graft. Both groups were followed for 6 months after surgery, and complications were recorded.ResultsIn total, 319 grafts (group A, 163; group, 156) were performed from June 1999 to May 2016. The major complication rates were 8% and 5.8% in group A and B, respectively, and were not significantly different (p = 0.52). Similarly, the rates of minor complications and of donor site morbidity were not different between groups.ConclusionsThis preliminary study shows that adding a cortical bone graft for the nasal floor reconstruction does not increase the risk of complications in 6 months following the graft. Long-term benefits such as alveolar height and a piriform aperture symmetrisation will have to be analysed to study the contribution of the technique.     

Calvarial periosteal graft for second-stage cleft palate surgery: A preliminary report

ObjectiveThe objectives of cleft palate surgery are to achieve optimal outcomes regarding speech development, hearing, maxillary arch development and facial skull growth. Early two-stage cleft palate repair has been the most recent protocol of choice to achieve good maxillary arch growth without compromising speech development. Hard palate closure occurs within one year of soft palate surgery. However, in some cases the residual hard palate cleft width is larger than 15 mm at the age of two. As previously reported, integrated speech development starts around that age and it is a challenge since we know that early mobilization of the mucoperiosteum interferes with normal facial growth on the long-term. In children with large residual hard palate clefts at the age 2, we report the use of calvarial periosteal grafts to close the cleft.Material and methodsWith a retrospective 6-year study (2006–2012) we first analyzed the outcomes regarding impermeability of hard palate closure on 45 patients who at the age of two presented a residual cleft of the hard palate larger than 15 mm and benefited from a periosteal graft. We then studied the maxillary growth in these children. In order to compare long-term results, we included 14 patients (age range: 8–20) treated between 1994 & 2006. Two analyses were conducted, the first one on dental casts from birth to the age of 6 and the other one based on lateral cephalograms following Delaire's principles and TRIDIM software.ResultsAfter the systematic cephalometric analysis of 14 patients, we found no evidence of retrognathia or Class 3 dental malocclusion. In the population of 45 children who benefited from calvarial periosteal grafts the rate of palate fistula was 17% vs. 10% in the overall series.ConclusionDespite major advances in understanding cleft defects, the issues of timing and choice of the surgical procedure remain widely debated. In second-stage surgery for hard palate closure, using a calvarial periosteal graft could be the solution for large residual clefts without compromising adequate speech development by encouraging proper maxillary arch growth.     

完全性唇腭裂齿槽裂植骨与鼻畸形的整复

对不同手术方法整复　齿槽裂与鼻畸形的比较分析 ,为完善唇腭裂的序列治疗提供参考。方法　将2 2例单侧完全性唇腭裂按分期整复组与同期整复组进行观察。通过对口鼻瘘封闭、尖牙萌出、鼻唇部美观等三种临床指标测定 ,进行统计学分析。结果　分期整复组的综合分析指标数高于同期整复组 ,有显著性差异 (P<0 .0 5 )。结论　完全性唇腭裂鼻畸形的整复在完善的齿槽裂手术后进行 ,能够取得更好的临床治疗效果。     

Bio-Oss与引导骨再生胶原膜联合植入牙槽嵴裂的临床观察

目的 观察进入青春期唇腭裂的患者鼻畸形修复及牙槽嵴裂同期植入天然多孔骨无机材料(Bio-Oss)及可吸收双层生物胶原膜(Bio-Gide)的临床效果。方法 对30例同期行牙槽嵴裂植入天然多孔骨无机材料及可吸收双层生物胶原膜与鼻畸形修复进行研究，对术后随访的X线片进行效果客观评价。结果 随访6～12月，其中1例拆线后牙龈处伤口裂开，但无Bio-Oss颗粒脱出，经换药伤口愈合。其余效果满意。结论 对于错过植骨最佳时期进入青春期的患者，牙槽嵴裂植入天然多孔骨无机材料能够代替植入的松质骨，避免再开辟第二术区给患者造成痛苦，联合应用可吸收双层生物胶原膜，进一步保障了植入天然多孔骨无机材料的成功。     

牙槽嵴裂骨移植修复术后影响骨吸收因素的初步研究

目的对牙槽嵴裂骨移植修复的患者进行随访评价，对植入骨的成活率及影响骨吸收的因素做初步研究。方法随访108例牙槽嵴裂骨移植患者，运用多因素回归统计方法进行分析。结果植入骨成活率为88％，临床成功率为60％；影响骨吸收的主要因素是：感染、手术年龄、裂隙类型、功能刺激、手术操作等，其中感染因素仅占22％。结论提高牙槽嵴裂植骨修复效果的因素：①手术应在患者8～11岁进行；②术前应行正畸治疗；③手术操作技术应进一步完善；④建立必要的功能刺激；⑤积极控制伤口感染。     

牙槽突裂植骨术后鼻外形的改变

目的：通过比较单侧牙槽突裂植骨手术前后鼻外形的变化,评价牙槽突裂植骨术在鼻畸形矫治中的作用。方法：通过人体学测量25例单侧牙槽突裂患者术前、术后即刻及随访6个月的外鼻形态,主要测量指标为健、患侧鼻孔宽度和高度,鼻翼基底宽度及两侧鼻翼基底连线与内眦连线的夹角,应用SPSS18.0软件包,对测得的数据进行配对t检验。结果：25例患者行牙槽突裂植骨手术后患侧鼻孔宽度为（11.61±2.18）mm,大于术前的（10.28±1.83）mm;高度为（4.52±1.19）mm,小于术前的（5.81±1.18）mm;患侧鼻翼基底均高于术前,与术前相比有显著差异（P〈0.01）。随访6个月后,虽形态有向术前回复的倾向,与术前相比仍有显著差异（P〈0.01）。结论：牙槽突裂植骨术后鼻翼基底的变化是植骨成功与否的一个重要指标,适量的超充填可弥补术后骨质吸收,为以后的鼻畸形整复提供一个对称的基底。牙槽突裂植骨后,鼻孔宽度和高度均有变化,故不主张在牙槽突裂植骨同期或之前行鼻畸形整复术。     

Isolated keratinized gingiva incision in alveolar cleft bone grafts improves qualitative outcomes: A single surgeon's 23 year experience

BackgroundFew publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oronasal fistulae recurrence, wound healing and graft exposure and loss.MethodsAll the patients were operated on using the same technique by a single surgeon. A total of 148 clefts have been operated with this approach, involving 117 patients with complete cleft lip and palate with a follow-up between 12 and 240 months.ResultsThe most important finding in this study is the excellent wound healing observed in almost all patients. Only three patients (2%) suffered a dehiscence with oronasal fistulae recurrence and bone loss. Another patient lost the graft without fistula recurrence. Minor dehiscence with partial bone loss occurred in 4 patients (2.7%). These patients did not need surgical closure and only superficial exposed bone particles were lost without compromising the clinical outcome.ConclusionsOur modification presents a flap design that is easy to elevate and mobilize, without disturbing the buccal sulcus or the gingival inter-dental papillae.     

双侧唇腭裂牙槽突植骨长期疗效的研究

目的　探讨双侧唇腭裂病例牙槽突植骨的远期疗效。方法　 5 5例双侧完全性唇腭裂患者 ,双侧牙槽突植骨手术在GOS儿童医院 (GreatOrmondStreetHospitalforChildren)完成 ,植骨部位共110个。植骨材料选用髂骨松质骨 ,以植骨手术进行时尖牙的萌出情况将裂隙分为 2组。植骨前后拍摄上颌前部咬合片 ,手术后观察时间为 1至 10年。采用Bergland标准评价植骨部位的牙槽骨高度。结果　在尖牙萌出前植骨的成功率 (95 % )明显高于尖牙萌出后植骨者 (6 7% )。结论　影响唇腭裂患者牙槽突植骨成功的因素很多 ,植骨时机是植骨成功与否的重要因素     

Current methods for secondary alveolar bone grafting assessment in cleft lip and palate patients — A systematic review

Introduction

The development of 3D X-ray diagnostics has led to new methods for secondary alveolar bone grafting (SABG) assessment. The aim of this study was to collect and present literature from the years 2007–2018, and review on the current treatment outcome assessment methods for SABG.

Secondary alveolar bone grafting in cleft lip and palate: A comparative analysis of donor site morbidity in different age groups

Introduction

There is no consensus regarding the optimal timing for secondary alveolar bone grafting for clefts defects. We aimed to investigate the potential correlation between the age of patients during surgery, donor site symptoms, surgical time and hospitalization following this procedure.

Single-dose versus prolonged antibiotic prophylaxis for alveolar bone grafting in cleft patients

The increase in antimicrobial resistance requires a critical discussion of antibiotic applications. Postoperative antibiotic prophylaxis is still common for intraoral bone transplantation. However, no guidelines exist for alveolar bone grafting (ABG) in cleft patients. This study compared the infection rate between prolonged and single-dose prophylaxis for this procedure, with the null hypothesis of no difference between the two groups. In total, 109 ABG procedures in 94 cleft patients performed by two surgeons were included. Patients received either prolonged or single-dose antibiotic prophylaxis. The complication rate was compared between the groups. Fifty-nine patients (34 male, 25 female) received prolonged prophylaxis (group 1), while 35 (23 male, 12 female) had just a single dose (group 2). Median age at surgery differed between the two groups, but not significantly (P = 0.72). One relevant surgical site infection was observed among patients with postoperative antibiotic application, while no infections occurred in the single-dose prophylaxis group (1.7% vs. 0%); this difference was not statistically significant (P = 0.84). The duration of hospitalization was longer in group 1. The reduction of antibiotic prophylaxis to a single dose did not increase the infection rate. The results strongly encourage reducing antibiotic prophylaxis for ABG procedures in cleft patients.     

双侧完全性唇腭裂患者的同期腭裂修复与齿槽嵴裂植骨

目的　分析 8岁以上双侧完全性腭裂患者同期行腭裂修复与齿槽嵴裂植骨的可行性及植骨效果。方法　对 15例同期行腭裂修复与齿槽嵴裂植骨的双侧完全性唇腭裂患者作回顾性研究。分析手术时间、术中出血、术后恢复和创口愈合情况。对术后随访的X线片进行植骨效果的客观评价。结果　所有手术均顺利完成 ,平均手术时间延长 5 2分钟 ,没有明显增加术中出血量 ,患者术后恢复好 ,无创口感染和植入骨暴露 ,植骨的临床成功率为 83.3% ,其中以 8～ 11岁组的成功率最高 (93.8% )。结论　双侧完全性腭裂患者的同期腭裂修复和齿槽嵴裂植骨是安全和可行的 ;对于 8岁以上的腭裂未修复的双侧完全性唇腭裂患者 ,均应同期完成腭裂修复与齿槽嵴裂植骨 ;双侧齿槽嵴裂同期植骨的最佳手术时间与二期植骨相同 ,为尖牙萌出前 ,年龄在 8～ 11岁之间。     

The effect of maxillary advancement on articulation of alveolar consonants in cleft patients

IntroductionMaxillary advancement may affect speech in cleft patients. The aim of this study was to evaluate the effect of maxillary advancement on Finnish alveolar consonants /s/, /l/, and /r/ in cleft patients.Materials and methodsFifty-nine Finnish-speaking nonsyndromic cleft patients, who had undergone Le Fort I or bimaxillary osteotomies, were evaluated retrospectively Production of the Finnish alveolar consonants /s/, /l/, and /r/ was assessed from pre- and postoperative standardized video recordings by two experienced speech pathologists. McNemar's test was used in the statistical analyses. Kappa statistics were calculated to assess reliability.ResultsThe patients included 35 females and 24 males with CP (n = 12), UCLP (n = 31), and BCLP (n = 16). There was a significant improvement in /s/ and /l/ sounds after maxillary advancement (p = 0.039 and p = 0.002, respectively). The preoperative mean percentage of /s/ errors was 34%; postoperatively it was 20%. /L/ was misarticulated preoperatively by 34% of the patients and postoperatively by 19%. /R/ was misarticulated preoperatively by 47% of the patients and postoperatively by 42%. The level of mild articulation errors rose from 25% to 31%, while severe articulation errors decreased from 37% to 25%. The reliabilities were good.ConclusionWhen planning orthognathic surgery in cleft patients with maxillary retrusion and articulation errors, advancement of the maxilla might be a means for improving articulation of /s/ and /l/.     

福建省唇腭裂流行病学研究

目的为了解福建省唇腭裂发病情况并分析致畸因素。方法对１９８６年１０月至１９９２年１２月６年内福建省２２所医院的出生缺陷监测资料进行唇腭裂发病情况的研究。结果在１３９８８２名新生儿中发现唇腭裂２０４例，福建省唇腭裂发病率为１．４６‰（１∶６８４），尚不属国内高发区。６年的年度发病率未见有明显的变化。２０４例唇腭裂中有２８例伴有其他系统畸形。结论本研究母亲年龄、孕次、产次对唇腭裂发生的影响作用不肯定；吸烟、接触有害物质及孕期用药等因素与唇腭裂发病率有重要关系。     

Clinical,volumetric and densitometric evaluation of tissue engineered constructs for secondary alveolar cleft reconstruction: A randomized clinical trial

The objective of this study was to assess the efficacy of tissue engineered (TE) constructs compared to the standard autogenous anterior iliac crest (AIC) bone graft in secondary maxillary alveolar cleft reconstruction.This clinical trial was registered on (clinical trials.gov); the trial registry number is: NCT03563495. Patients with unilateral alveolar clefts were allocated on the basis of simple randomization. Selected patients were randomly divided into two equal groups: the AIC group (control) received autogenous particulate bone graft from anterior iliac crest, whereas the TE group received tissue engineered construct. Assessment included the newly formed bone volume and density at the grafted cleft sites, which were measured immediately, 6 and 12 months postoperatively on axial computed tomograms.The study population included 10 patients; each group comprised 5 patients. There was no statistically significant difference between the 2 groups regarding the mean volume of the newly formed bone (p = 0.91 at 6 months, p = 0.994 at 1 year) and the mean density of the newly formed bone (p = 0.364 at 6 months, p = 0.073 at 1 year). However, there was a significant increase of TE graft density from 6 months to 1 year (p = 0.048).Within the limitations of the study it seems that the tissue engineered construct (collagen/osteogenically differentiated bone marrow−derived mesenchymal stem cells) might be an alternative to autogenous bone for unilateral secondary alveolar cleftgrafting.     

唇腭裂患者齿槽嵴裂植骨修复术后随访结果分析

目的分析影响齿槽嵴裂修复术后效果的因素。方法对同一术者所行齿槽嵴裂植骨术的唇腭裂患者５４例进行回顾性研究，所有患者均有术前及手术后３个月以上的完整资料。分析植骨区的Ｘ线组织影像的临床分级与手术年龄、裂类型及手术类型等的关系。结果①齿槽嵴裂的植入骨成活率为９４％，临床成功率为８９％；②齿槽嵴裂的植骨效果与患者的年龄有关，１８岁以上患者植骨的临床成功率明显低于其他年龄患者；③除腭瘘修补术外，齿槽嵴裂植骨术与其他唇腭裂手术同期完成者其临床成功率与单纯行齿槽嵴裂植骨术的临床成功率相似；④单纯伴发唇裂或不完全腭裂的齿槽嵴裂植骨效果优于完全性唇腭裂的齿槽嵴裂植骨效果。结论良好植骨床的形成和植骨区严密的缝合是保证齿槽嵴裂植骨成功的关键