赣籍汉族婴儿唇鼻体表正常值测量研究

目的 探讨赣籍汉族婴儿唇鼻体表特征,为唇裂治疗及治疗后效果评估提供可参照的正常值范围。方法 采用人体测量学的面部基本测量指标及Farkas建立的系统化颌面部人体测量学直接测量法,随机抽取2012年6—8月在江西省儿童医院行健康体检的赣籍105名3 ~ 12月龄正常汉族婴儿,对其唇鼻体表进行测量,其中3 ~ 6月龄组49名（男29名,女20名）,7 ~ 12月龄组56名（男38名,女18名）,测量结果应用SPSS17.0软件包进行统计学分析。结果 获得赣籍3 ~ 6月龄及7 ~ 12月龄正常汉族男、女婴儿唇鼻体表形态的基本均值和标准差。3 ~ 6月龄组男婴鼻尖高度、唇弓内侧嵴、唇峰间距及鼻孔底宽均大于女婴（均P < 0.05）;7 ~ 12月龄组男婴上唇高、唇弓内侧嵴、唇峰间距、鼻孔底宽均大于女婴（均P < 0.05）。结论 赣籍汉族婴儿唇鼻部某些测量指标值存在性别差异,并随月龄和体重增长呈现有规律的变化,为婴幼儿唇裂合理的个体化治疗提供了可参照依据。     

正常人唇、鼻标志间距比值的测量研究

作者对所在地区３００例汉族正常人唇、鼻标志间距的比值，鼻翼鼻尖角和唇弓中央角进行了测量和计算。通过统计学处理，得出该地区汉族正常人上唇宽、唇峰口角距、唇峰人中距和鼻幅宽与下唇宽的比值、鼻小柱高与鼻孔最大径的比值、鼻翼鼻尖角和唇弓中央角７项测量值，为唇、鼻畸形的修复．特别是为双侧唇裂的修复和术后效果评价提供了参考数据。     

使用Cutting法一期修复双侧唇裂鼻畸形的临床研究

目的:应用Dr.Cutting C在微笑列车光盘中推广的手术方法,进行双侧唇裂与鼻畸形同期整复,并探讨其术后的美容效果.方法:2007年12月至2008年7月,收治先天性唇裂患儿18例,男8例,女10例,年龄5个月至2岁.双侧完全性唇裂伴双侧完全性腭裂9例;双侧不全性唇裂6例,无腭裂;混合性唇裂3例,均未行术前正畸.应用原长法的原则进行唇裂整复,术中解削171轮m肌;唇珠的形态由侧唇红唇肌肉完成;红唇缘原有自然形态完整保存;并从鼻中隔角做中隔黏膜切口作为手术入路,上提鼻翼软骨的内侧脚,同期初步矫正鼻畸形.结果:18例均随访10 d至3个月,双侧完全性唇裂患儿形成明显的鼻尖形态,双侧鼻孔对称,鼻小柱形态近正常;1例混合性唇裂患儿两侧鼻翼基脚稍不对称.结论:应用Cutting法进行双侧唇裂与鼻畸形同期整复时,改善鼻唇的形态,延长鼻小柱并保存充分的前唇血供,获得满意效果.     

双侧唇裂前唇双三角瓣缩小鼻底横径及功能整复术

双侧唇裂由于畸形严重，比单侧唇裂整复效果差，术后继发畸形比较复杂，常涉及到鼻、唇、牙槽甚至能和颌骨多方面。我院1990年～1996年采用前唇原长双三角瓣缩小鼻底横径以及异位口轮匝肌重建术式，修复双侧唇裂48例，其中男36例，女12例，年龄最大20岁，最／J'6个月，Ill"32例，重°16例。现报告如下。一、治疗方法定点以一侧为例：①前唇定点：在前唇上部鼻小柱根部定点"广，在前唇正中下缘相当于人中切迹处定点'℃"，在相当于后峰点位置上定点"3"，2-3距离相当于唇峰人中切迹距，一般等于下唇宽0．l0．02倍【'］，婴儿＜3。，成人运smm…     

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目的    探讨外鼻体积的计算方法，为临床提供参考依据。方法    收集2008年7月至2009年7月山西医科大学第二临床医学院和太原市中心医院行头颅螺旋CT检查的患者103例，获取外鼻图像，经三维重建后测量外鼻的各项数据，并计算外鼻体积。结果    103名汉族正常测量者中，男、女除鼻孔上间距差异无统计学意义（P > 0.05） 外，鼻长、鼻高、鼻宽、鼻深、鼻孔长径、鼻翼基底宽、鼻唇角、鼻翼角、鼻尖角以及体积值差异均有统计学意义（ P < 0.01） ；其中男性鼻长、鼻高、鼻深、鼻孔长径、鼻尖角以及轮廓体积明显大于女性。结论    本研究中的外鼻体积计算方法简便易行，适合于临床推广；初步建立太原地区成年男女外鼻体积正常值数据库框架。     

两种改良Millard法修复单侧唇裂的临床对比效果观察

目的对比分析两种改良Millard法修复单侧完全性唇裂唇高的恢复情况,为临床单侧完全性唇裂的治疗提供依据。方法选取先天性单侧唇裂患儿50例,随机分为2组,每组25例。第一组采用石冰的个体化改进MillardⅡ术式,第二组采用不做8点的改良Millard术式。两组患儿分别在手术后即刻和术后6个月随访,测量每名患儿健、患侧唇高并计算其差值,再进行两组对比。结果两组患儿手术完成即刻唇高差异无统计学意义(P=0.816);6个月后随访,两组间健-患侧唇高的比较差异有统计学意义(P=0.01)。结论在修复单侧完全性唇裂初期手术时,石冰的个体化改进MillardⅡ术式,应用范围更广泛,唇高改善理想;不做8点的改良Millard术式避免了鼻底的横行疤痕,但患侧唇高下降不足。     

西安地区汉族青年颅面部比例的研究

目的 建立西安地区汉族青年正常He颌面部水平，垂直各的比例指数，为临床治疗提供参考依据。方法 采用Farkas建立的面部形态直接测量法，对100例（男，女各50名）西安地区身体健康，颅颌关节协调，牙齿排列整齐，I类He关系，正常覆盖，覆He，无牙病治疗史及外伤史的年满18岁的汉族高中生，进行颅面部软组织23项测量，建立36项水平，垂直向比例指数。测量结果经Spss10.0统计软件处理，并进行男女两组的t检验。结果 男，女之间面部高度的比例指数均存在显著差异，涉及眼，鼻的比例，男女之间存在较大差异，其中两眼内眦宽略小于鼻宽，略大于眼裂宽，鼻宽稍大于1／4面宽，约为4／5眼裂宽。结论 男，女之间面部比例不同，古典面部比例标准不适合西安地区汉族青年正常He颌面部比例。     

西安地区汉族青年正常(牙合)颅面部颏唇区垂直向比例指数

目的：寻求西安地区汉族青年正常（He)颅面部颏、唇区垂直向的比例关系。方法：采用Farkas建立的面部形态直接测量法，对100例(男、女各50名)西安地区身体健康、五官端正、颅颌面关系协调、牙齿排列整齐、Ⅰ类稽关系、正常超覆稽、无任何牙病及外伤史的年满18岁的汉族高中生，进行面下部软组织14项测量，形成15项垂直向比例指数。测量结果经SPSSl0.0统计软件处理，并进行男女两组的，检验。结果：男、女组间颏、唇区垂直向的比例指数无统计学差异。上唇红高度约占上唇的1／3；下唇的皮肤部分占整个下唇的1／3多。颏占下颌高度的60％多。结论：研究结果与Farkas等的结果相一致。     

计算机辅助的黑龙江省汉族正常成人软组织侧貌美学分析

目的 :利用计算机建立软组织X线头影测量分析系统 ;研究黑龙江省正常成人软组织侧貌形态。方法 :利用PentiumⅡ 2 6 6PC机 ,ScanmakerⅢ扫描仪等硬件 ,在Windows98操作系统下 ,利用Adobephotoshop等图像处理软件及VisualBasic语言开发了该系统 ,并对黑龙江省 10 7名 (男 5 0 ,女 5 7)汉族正常年青成人的软组织侧貌进行了分析。结果 :本地区正常年青成人的软组织侧貌男、女不同 ,男性在鼻、唇、颏三者前后向的关系较女性明显 ,女性则趋于直面型。结论 :该系统准确 ,可靠 ,以此建立的参考值可为正畸 ,正颌患者的临床诊断 ,评价面部形态提供依据。     

计算机辅助的黑龙江省汉族正常(牙合)成人软组织侧貌美学分析

目的:利用计算机建立软组织X线头影测量分析系统;研究黑龙江省正常(牙合)成人软组织侧貌形态.方法:利用PentiumⅡ266PC机,ScanmakerⅢ扫描仪等硬件,在Windows98操作系统下,利用Adobe photoshop等图像处理软件及Visual Basic语言开发了该系统,并对黑龙江省107名(男50,女57)汉族正常(牙合)年青成人的软组织侧貌进行了分析.结果:本地区正常(牙合)年青成人的软组织侧貌男、女不同,男性在鼻、唇、颏三者前后向的关系较女性明显,女性则趋于直面型.结论:该系统准确,可靠,以此建立的参考值可为正畸,正颌患者的临床诊断,评价面部形态提供依据.     

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。     

Facial characterization of infants with cleft lip and palate using a three-dimensional capture technique.

OBJECTIVE: To characterize the soft tissue features of infants with unilateral cleft lip (UCL) and unilateral complete cleft lip and palate (UCLP) prior to primary surgery and compare with noncleft controls. DESIGN: Prospective controlled capture of the facial morphology of infants using a noninvasive three-dimensional stereophotogrammetry method. PARTICIPANTS: 23 children with presurgical cleft: 11 UCL (M = 6, F = 5); 12 UCLP (M = 9, F = 3), and 21 noncleft controls (M = 7, F = 14) were imaged at approximately 3 months of age (range 10 to 16 weeks). MAIN OUTCOME MEASURE: Accurate, repeatable quantification of facial soft tissues in infants with clefts prior to surgery. RESULTS: Significant differences (p <.05) were found between the UCLP group and UCL and control groups in anatomical and soft nose width, cleft-side alar wing length, and nasal tip horizontal displacement. Both cleft groups were significantly different from controls and from each other in cleft-side nostril dimensions, alar wing angulation, columella angle, and alar base to corner of mouth dimension; alar base width; and soft tissue defect in nose and the lip and philtrum length bordering the cleft. Significant differences between clefts and controls were identified in the nostril and philtrum on the noncleft side. CONCLUSIONS: The use of children with UCL as controls for UCLP studies is inappropriate. This technique overcame the limitations of direct measurement of infant faces to aid the surgeon in the planning and subsequent re-evaluation of surgical rationale.     

单侧唇裂红唇微结构成形

目的：提出单侧唇裂红唇微结构成形的设计原则和整复方法。材料：18例单侧孵裂患儿,年龄3-6个月,其中单侧完命唇裂6例,单侧不全唇裂12例。方法：18例单侧唇裂患儿在唇裂一期整复术时均按照红唇微结构成形的设计原则同期整复红唇。分别于术后即刻、术后1个月及术后6个月进行随访评估。评估方法包括主观视觉效果和干性黏膜高度恢复率。结果：远期红唇主观视觉效果评估,88．9％的患者为好的结果;远期干性黏膜高度恢复率为99．6％。结论：红唇微结构成形不仅可再造唇弓嵴的连续性。而且可恢复于性黏膜正常的高度及唇吻线,最理想地整复红唇结构形态。     

Cleft lip: our experience in repair

Abstract  

The ideally repaired cleft lip should provide a symmetrical cupid’s bow, philtrum and a minimal scar. The lip length, pout and symmetry of the alar base should be maintained to achieve the best result. The most popular method for cleft lip repair is rotation advancement technique introduced by Millard which improves the relationship of alar base of cleft side, produces harmonious symmetry of the nostril, the surgical scar is masked in the philtral crest and nostril floor. In addition, it uses and preserves the lip anatomy, returns lip tissue into its normal position, minimizes amount of tissue discard and reconstructs orbicularis oris muscle.     

Anthropometric study of the upper lip of 1500 healthy children in Chengdu, Western China

The aim of this study was to measure and analyse morphological data about the upper lips of healthy children in Chengdu, Western China. The characteristics and patterns of growth and development of the upper lip may be helpful in guiding the treatment of cleft lip. A total of 1500 healthy children aged between 2 and 12 were divided into 11 groups according to their age. Seven points on the upper lip were measured directly: the length from the alar base to the commissure, the length of the philtrum, the length from the tip of the Cupid's bow to the commissure, the width of one limb of the Cupid's bow, the length from the alar base to the central columella, the area of the unilateral upper lip, and the angle of the line of the alar base to the commissure and the line of the tip of the Cupid's bow to the commissure. Five aspects were significantly different among the groups: the length from the alar base to the commissure (p=0.04), the length from the tip of the Cupid's bow to the commissure (p=0.02), the width of the upper lip (p=0.02), the area adjacent to the lip (p=0.03), and the area of the unilateral upper lip (p=0.04). These data may be useful for reference to cleft lip repair.     

唇粘连术与Millard Ⅱ式联合修复单侧完全性唇裂疗效分析

目的:分析唇粘连术与Millard Ⅱ式手术联合矫正单侧完全性唇裂的优点与手术要点.方法:2003年3月至2009年9月对42例单侧完全性唇裂接受过唇粘连术患者采用MillardⅡ式手术矫正.结果:所有患者术后切口愈合良好,随访3～6个月,患侧鼻小柱延长,两侧鼻孔对称,人中嵴对称,唇弓形态好,无瘢痕增生.结论:唇粘连术...     

66例双侧唇裂功能性整复的临床疗效观察

目的 探讨改良Mulliken法功能性修复双侧唇裂的临床效果。方法 选取66例双侧唇裂患者,应用改良Mulliken法进行唇裂整复,术中在前唇设计窄的“领带”型人中结构;解剖复位侧唇口轮匝肌,重建口轮匝肌环;利用侧唇唇红组织重建唇珠。同期初步矫正鼻畸形,延长鼻小柱。结果 术后经0.5~2 a随访,所有患者无“三等份上唇”不良外观,超过80%（54/66）的患者上唇唇弓形态恢复自然,左右对称,人中宽度与正常相似。唇红丰满,唇珠大小适度,无口哨畸形,动静态外形良好。鼻底宽度正常、鼻孔形态对称,鼻小柱高度较术前延长,鼻尖形态基本满意。结论 利用改良Mulliken法功能性修复双侧唇裂,能有效纠正鼻唇畸形,临床效果良好,值得推广使用。     

唇腭裂患儿高级听觉中枢的MRI形态学研究

目的:通过对2岁以下唇腭裂患儿采用磁共振成像(MRI)的形态学研究方法,调查低龄唇腭裂患儿高级听觉中枢可能的结构异常。方法:选取6月～2岁唇腭裂患儿18例及年龄相匹配的正常对照组婴儿18例,分别在1.5T磁共振成像仪上扫描采集脑结构数据,运用FreeSurfer软件重建脑结构并对各部分进行测量,对2组数据采用多元协方差分析方法,进行组间比较。结果:唇腭裂组患儿的左侧大脑灰质、左侧丘脑和左侧颞上平面(听觉皮层所在区域)的体积显著小于正常对照组,左侧颞上平面的厚度也显著低于正常对照组。右侧大脑半球、右侧丘脑及脑干的体积与正常对照组无显著性差异。结论:唇腭裂患儿的高级听觉中枢可能有异于正常儿童。这种异常也许构成了其中枢性听觉处理障碍(APD)的神经生物学基础。     

Modification of the repair of a unilateral cleft lip

The ideally repaired cleft lip should provide a symmetrical Cupid's bow, philtrum, and minimal scar. In the appearance of the upper lip, the philtrum plays a key role. The most popular method for unilateral cleft lip repair is the rotation advancement technique introduced by Millard. This technique requires the rotation of the non-cleft-side flap in a unilateral cleft lip. As the vertical discrepancy between the peaks of Cupid's bow is increased, the scarring becomes more evident. Also, where it crosses the philtral column in the oblique extension of the upper lip, it becomes apparent for the eye to notice. Thus, many surgeons have tried to modify this technique to improve the symmetry of the philtral columns. Therefore, I developed my technique, called the E (reversed) M (sided) skin extension (EMSEN) repair, including 2 perpendicular incisions in rotation flap and 2 equilateral flaps in advancement flap and muscle repositioning. We carried out the EMSEN technique to 20 consecutive (9 boys and 11 girls) patients with unilateral cleft. The mean age at repair was 10.1 years (range, 3 months to 18 years). The postoperative outcomes were assessed with the subjective and objective scar assessment test. The mean follow-up time was 24.5 months. No early complication involving hematoma, infection, wound dehiscence, or partial or total flap loss was encountered. Three plastic surgeon committee members (randomized selected) reviewed the analysis of the color, texture, width, and thickness of the scar. It was found that most members of the plastic surgeon committee and patients or parents were very good and very happy, respectively. We eradicated some shortcomings in Millard's technique with this technique. E (reversed) M (sided) skin extension repair lengthens the vertical lip using the E-M flaps, resulting in a nonlinear incision such as W-plasty scar on the philtral ridge and forming symmetrical Cupid's bow, superior to Millard repair.