单侧唇腭裂修复术对上颌骨及面部软组织发育的影响

目的:探讨单侧唇腭裂修复术对上颌骨及面部软组织发育的影响。方法:对不同年龄手术的单侧完全性唇腭裂患者进行了标准头颅侧位片测量,并与同年龄正常儿童的各项指标分别进行比较。结果:正常对照组与病例组在腭平面长度、腭腔深度、前上半面高、腭平面倾斜角和SNA角等5项测量值上有显著性差异;正常对照组在腭平面长度与后上半面高的比值、腭腔深度与后上半面高的比值这2项上大于病例组,两者间有显著性差异;在后面部高与前面部高的比值、下颌升支与前面部高的比值和前面部高与前颅底的比值这3项上,病例组大于对照组,两者间有显著性差异。结论:单侧完全性唇腭裂患者以上颌骨长度发育障碍为主,这主要是由于先天性发育畸形所致,与手术的早、晚无显著相关性。为了使腭裂患儿获得较好的发音功能,主张早期行腭裂修复术。关键词 单侧完全性唇腭裂 标准头颅侧位片 上颌骨 腭裂修复术     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

单侧完全性唇腭裂手术对上颌骨生长发育的影响

单侧完全性唇腭裂患者随着年龄的增长常伴有上颌骨生长发育障碍,此类患者的内在发育、唇裂手术及腭裂手术皆可能影响上颌骨的发育,哪种因素是影响上颌骨发育的主导因素尚没有定论,研究者常借助对牙弓的测量推断上颌骨的生长变化.本文就唇腭裂手术对单侧完全性唇腭裂患者上颌骨生长发育的影响作一综述.     

上颌骨前牵引器与正畸联合治疗单侧唇腭裂的评价

目的:对单侧完全性唇腭裂伴上颌骨发育不足的患者,进行面罩式上颌骨前牵引加正畸治疗,探讨其对颌骨发育的影响。方法:14例患者在治疗前、上颌前牵引后及正畸治疗后分别摄X线头颅侧位定位片,通过9个测量指标数据进行治疗前后的比较分析。数据资料用SPSS10.0软件作统计学处理,治疗前后比较用t检验,以确定上颌前牵引及正畸联合治疗对上下颌骨的影响。结果:本组患者经上颌骨前牵引器牵引加后期正畸治疗,获得满意的效果。切牙覆盖达2mm,咬合关系较稳定;侧面呈直面型。SNA角增加,有高度显著性差异,P<0.001。SNB及下颌平面角SN-MP无变化,P>0.05;颌凸角的差值有显著改变(P<0.001)。结论:单侧完全性唇腭裂伴上颌骨发育不足的患者进行整形加正畸治疗,能促进上颌骨的发育,下颌骨未见显著的变化;通过上颌前牙轴倾度增大,下颌前牙轴倾度变小以及舌代偿,上颌前牙前移,覆牙合覆盖改善。这些改变反应在侧貌上,表现为上颌突度增加,上唇变丰满,凹面形变直面形,上下颌协调。     

正畸治疗对恒牙晚期单侧完全性唇腭裂患者鼻部形态影响的研究

目的　研究恒牙晚期单侧完全性唇腭裂患者正畸治疗后的鼻部形态变化。方法　21例恒牙晚期单侧完全性唇腭裂患者在正畸治疗前、治疗后分别拍摄X线头颅侧位定位片,通过12个测量参数进行治疗前后的比较分析。数据资料用SPSS 13.0软件作统计学处理,治疗前后比较用t检验。结果　患者经上颌扩弓和正畸治疗后,鼻背长由（37.0±2.3）mm增加到（41.5±4.2）mm,P<0.05;鼻背深度1由（16.1±1.3）mm增加到（18.3±1.5）mm,P<0.05;鼻背深度2由(18.5±1.9)mm增加到(20.4±2.3)mm,P<0.05;鼻唇角由(66.9±5.6)°增大到(72.2±6.6)°,P<0.05;面型角由(-5.0±2.1)°变为(4.6±3.4)°,P<0.01。结论　恒牙晚期单侧完全性唇腭裂患者经过正畸治疗后,患者的鼻部长度及深度增加,鼻部形态改善,患者侧貌更加美观。     

未手术唇腭裂患者上颌骨的生长发育

唇腭裂患者早期手术治疗影响上颌骨生长发育，未手术唇腭裂患者的上颌骨生长发育存在一些规律性的变化。复习文献发现，上颌骨位置异常表现为前突，水平向生长轻微减少而垂直向生长基本正常。其变化存在种族差异。     

Tennison法修复唇裂对上颌骨生长发育的影响

目的　为了客观评价 Tennison法修补唇裂对上颌骨生长发育的影响。方法　该研究采用 30只 (30天龄 )日本纯种长耳白兔 (幼兔 ) ,随机分成正常对照组 (10只 )、造裂组 (10只 )、Tennison法修补唇裂组 (10只 ) ,术后2 6周 (30周龄 ) ,处死动物 ,行头颅测量。结果　发现 Tennison法修补唇裂术后 ,上颌骨前后向生长发育较正常对照组和造裂组受限 ,同时上颌骨宽度、后牙弓宽度呈代偿性增加 ,鼻中隔向裂隙侧偏曲。结论　 Tennison法对上颌骨生长具有一定的抑制作用     

三维测量分析单侧完全性唇腭裂术后成年患者的上颌骨形态

目的:探讨单侧完全性唇腭裂术后成年患者的上颌骨形态特征.方法:应用螺旋CT采集30例单侧完全性唇腭裂术后成年患者上颌骨数据,应用SimPlant11.04软件对数据进行三维重建、定点,建立三维坐标系,验证标记点的可重复性,测量标记点到三维坐标平面的距离.应用SAS6.12软件包对数据进行统计学分析.结果:7个居中的标记点中,A、ANS显著偏向健侧(P＜0.01);14对患健侧标记点的非对称率(Q)显示,INM’与INM 、SNM’与SNM、SPr’与SPr在到矢状面S的距离存在明显不对称畸形,而其余多数点在三维方向上无不对称畸形;患者上颌骨与正常人的主要不同是在前后方向上存在发育不足,患侧上颌骨错位较健侧明显.结论:应用螺旋CT及SimPlant 11.04软件三维测量上颌骨形态的方法,能够精确测量各标记点到坐标的三维距离,可用于评估患者患、健侧上颌骨的畸形程度.     

唇腭裂患者颈椎异常的影像学表现

目的观察唇腭裂患者颈椎异常的影像学表现，统计颈椎异常在唇腭裂患者中的比例及分布情况。材料与方法实验组304名6岁以上唇腭裂患者（男191人，女113人），对照组6岁以上非唇腭裂223人（男132人，女91人），应用头颅侧位片观察颈椎异常的表现。结果颈椎异常的表现类型分为后弓发育缺陷和融合两大类，其中，后弓发育缺陷分为椎弓裂、发育不足和寰枢对位不良三个亚类，融合分为寰枕融合和椎体融合两个亚类。寰枢对位不良在以往的研究中未曾报道。实验组中，55人（18．1％）发现颈椎异常，对照组中19人（8．5％）发现颈椎异常，差异有显著性。结论颈椎异常的表现类型分为后弓发育缺陷和融合两大类，发现新的表现类型寰枢对位不良。颈椎异常在唇腭裂患者中的发生比例高于非唇腭裂人群，差异有显著性。     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

单侧完全性唇腭裂儿童患侧前牙发育研究

目的 分析单侧完全性唇腭裂儿童（ＵＣＬＰ）患侧尖牙发育特点。方法 ５３例８～１２岁ＵＣＬＰ患儿,采用Ｂｒｏｕｗｅｒｓ方法,测量并比较术前曲面断层中健侧及患侧恒上尖牙长度,并观察恒上切牙缺失和畸形情况。结果 ＵＣＬＰ患儿健、患侧恒上尖牙长度有显著性差异（Ｐ〈０．０１）;患侧侧切牙缺失３５．８％,患侧上中、侧切牙畸形４７．２％。结论 患者患侧恒上尖牙发育明显迟缓,并伴有不同程度患侧侧切牙缺失、中、侧切     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反(牙合)畸形的研究

Objective To investigate the effects of maxillary protraction on anterior crossbite in repaired pre-pubertal patients with complete unilateral cleft lip and palate(UCLP).Methods Prospective controlled clinical trial was carried out.Eighteen UCLP patients with anterior crossbite,aged 9.63±1.24 years,were the experimental subjects.Fourteen UCLP patients with similar malocclusion,aged 8.71±1.92 years,were selected as controls.All patients were before puberty according to the evaluation of the hand wrist radiograms.A Hyrax appliance and reverse headgear were applied.Lateral cephalometric radiographs were taken before and after the treatment.Computerized cephalometric analysis was carried out.Results After treatment in experimental group.the maxilla moved forward more significantly.The mandible rotated downward and backward.The intermaxillary relationship and soft tissue profile improved significantly.The rate of maxillary and mandibular Contribution was 1:1.7. ConelusionsMaxillary protraction could improve the imermaxillary relationship and soft tissue profile in UCLP patients with mild or moderate skeletal deformity before puberty.     

单侧完全性唇腭裂术后患儿颜面非对称性变化的研究

本研究采用莫尔等高条纹分析法检测一组混合牙列期单侧完全性唇腭裂（ＵＣＬＰ）术后患儿颜面主要结构的非对称笥,并与正常儿童进行对比分析。结果显示ＵＣＬＰ术后患儿面中份,特别是鼻及口唇部位发生明显的不对称性畸形,说明唇腭列修补术后继发牙颌面畸形是三方面的异常,该研究结构提示对唇腭裂患者进行序列治疗对预防和减轻这种术后畸形有十分重要的意义。     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反[牙合]畸形的研究

目的探讨前方牵引治疗单侧完全性唇腭裂（UCLP）患者术后前牙反[牙合]畸形的效果。方法进行前瞻性临床研究设计,UCLP术后骨性前牙反[牙合]患者治疗组18例,年龄9．63±1．24岁,观察对照组14例,平均8．71±1．92岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗或观察前后拍摄头颅侧位片并测量,进行成组设计和配对设计t检验。结果UCLP治疗组前方牵引后,上颌骨前移;下颌后移合并后下旋转;上下颌间关系和面型改善明显,上颌与下颌改变的比值为1：1．7。对照组上下颌不调、前牙反覆盖、凹面型加重。结论UCLP术后轻中度骨性前牙反[牙合]畸形,前方牵引能够促进上颌骨向前,改善上下颌骨关系和软组织面型,应该早期矫形治疗。     

Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the mandible demonstrated a minimal counter-clockwise rotation of the body (mandibular plane = −0.2 ± 3.2°) and ramus (−0.6 ± 4.3°). Maxillary DO in CLP had no significant effect on the shape or rotation of the mandible. The maxillary advancement remained stable after 1 year.     

Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate

Objectives:This study evaluated the long-term stability of maxillary protraction (MP) in patients with complete unilateral cleft lip and palate (UCLP) and identified factors influencing relapse and long-term outcomes.Materials and Methods:Twenty-three adolescents with UCLP who underwent MP therapy were recalled when craniofacial growth was close to completion. Subjects exhibiting reverse/positive overjets were assigned to unstable/stable groups. Lateral cephalometric measurements were made before treatment (T0), after active treatment (T1), and at the end of the growth spurt (T2).Results:About 63% of the subjects exhibited positive overjets during follow-up. The unstable group demonstrated higher B–x and Co–Gn distances than the stable group (both P < .05) at T0. More short-term (T0–T1) sagittal advancement of point A (A–y) was evident in the unstable group than in the stable group (P < .05), but no long-term difference was apparent between the two groups (P = .481). During the posttreatment period (T1–T2), the SNA angle and maxillary incisor protrusion (U1–SN angle) were considerably lower in the unstable group than in the stable group (both P < .05). Overall, the unstable group exhibited a lower increase in the vertical extent of point A (A–x) than the stable group from T0 to T2 (P < .05).Conclusions:In the long term, MP affords favorable maxillary advancement in patients with UCLP. A mandibular excess at T0 and vertical maxillary hypoplasia may contribute to the long-term relapse of a reverse overjet.     

Biomechanical evaluation of sagittal maxillary internal distraction osteogenesis in unilateral cleft lip and palate patient and noncleft patients: A three-dimensional finite element analysis

Objective:To compare the pattern and amount of stress and displacement during maxillary sagittal distraction osteogenesis (DO) between a patient with unilateral cleft lip and palate (UCLP) and a noncleft patient.Materials and Methods:Three-dimensional finite element models for both skulls were constructed. Displacements of the surface landmarks and stress distributions in the circummaxillary sutures were analyzed after an anterior displacement of 6 mm was loaded to the elements where the inferior plates of the distractor were assumed to be fixed and were below the Le Fort I osteotomy line.Results:In sagittal plane, more forward movement was found on the noncleft side in the UCLP model (−6.401 mm on cleft side and −6.651 mm on noncleft side for the central incisor region). However, similar amounts of forward movement were seen in the control model. In the vertical plane, a clockwise rotation occurred in the UCLP model, whereas a counterclockwise rotation was seen in the control model. The mathematical UCLP model also showed higher stress values on the sutura nasomaxillaris, frontonasalis, and zygomatiomaxillaris on the cleft side than on the normal side.Conclusions:Not only did the sagittal distraction forces produce advancement forces at the intermaxillary sutures, but more stress was also present on the sutura nasomaxillaris, sutura frontonasalis, and sutura zygomaticomaxillaris on the cleft side than on the noncleft side.     

Impacted maxillary canine in unilateral cleft lip and palate: A literature review

Background

The incidence of canine impaction in unilateral cleft lip and palate (UCLP) is increasing and in most cases is a part of a syndrome. The provision of different treatment modalities in these patients is a challenging and daunting task.