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.     

先天性腭裂患者术中凿断翼钩对语音及中耳功能的影响

目的：研究在腭裂修复术中，凿断翼钩对腭裂患者中耳及语音的影响。方法：复习133例腭裂手术患者的临床资料，所有患者均排除全身多发畸形及腭心面综合征；手术采用von Langenbeck方法90例，Veau两瓣法43例；术中凿断翼钩的67例，未凿断翼钩的66例。术后在颅颜中心和耳鼻喉科定期复查，进行语音评估和检查中耳有无感染、有无听力障碍。采用Statistica4．0进行统计学分析。结果：翼钩凿断的患者中．最早在11个月后出现中耳炎．最晚在76个月出现中耳炎，平均13．4个月；未凿断翼钩的患者中，最早在12个月出现中耳炎，最晚在120个月出现中耳炎，平均13．9个月。两者无显著差异（P〉0．05）。凿断翼钩有完整评估资料的44例患者中，平均随访51．7个月．其中腭咽闭合（VPC）36例，临界（M）5例，腭咽闭合不全（VPI）3例，分别占81．8％、11．4％和6．8％；未凿断翼钩的44例中，平均随访53．5个月，VPC32例，M8例，VPI4例，分别占77．3％、14．8和7．9％。两者无显著差异（P〉O．05）。结论：翼钩在腭裂手术中的凿断与否，与腭裂患者在术后出现中耳感染之间无显著相关性，与术后出现腭咽闭合不全的几率也无必然的联系。     

腭裂修复术中凿断翼钩对腭咽闭合功能影响的研究

本文应用Ｘ线检查方法,对８３例单侧腭裂术后患者进行了术中凿断翼钩是否影响患者术后腭咽闭合功能的研究。结果表明：（１）腭裂术中凿断翼钩后,患者鼻咽腔的横向收缩力明显减小;软腭抬高角度也有减小的趋势。（２）两大瓣术中凿断翼钩可使闭合条件明显提高,说明该手术方法如凿断翼钩有延长软腭的作用。     

腭裂的功能性修复术与伴发鼻畸形的整体修复术

1　腭裂的功能性修复术腭裂修复术的施行已经历了一个多世纪 ,手术目的是重建腭部解剖形态与恢复功能 ,手术方法是修补裂隙 ,后退软腭与缩小咽腔 ,企图获得腭咽闭合 ,目前一般应用的术式尚存在有不足之处 ,作者进行了针对性改进 :( 1 )改变了常规手术的翼钩凿断为不凿断 ,不改变腭帆张肌的位置 ,也不作腭大孔与翼钩之间的软腭部剥离 ,也就是可避免损伤腭中、小神经。( 2 )取消了在截开的翼内板与翼外板之间填塞碘仿凡士林纱条作为减少组织张力的措施 ,而是应用了羟基磷灰石块状体作为永久性植入 ,可保证咽腔获得可靠性缩小 ,取得更有保障的…     

腭裂整复手术的基本理论与临床

一、腭咽闭合的生理基础腭帆提肌的解剖生理腭帆张肌与凿断翼钩的问题咽上缩肌与咽腔解剖派氏垫 ( Passavant ridge)的评价腭咽闭合过程中的生理代偿功能二、腭裂的修复手术1 .手术时间的选择——婴幼儿语言发育时期为一岁左右国际上序列治疗的时间 ,对腭裂修复术为 1 2 -1 8个月早期手术的优点 :1恢复语言功能2避免中耳感染 (十聋九哑 )3有利于软腭的生长发育早期手术的缺点 :手术创伤和腭部裸露的骨面形成的瘢痕 ,影响上颌骨发育导致牙颌畸形故有两期手术的治疗方式 ,兼顾上述优缺点早期——修复软腭手术期——修复硬腭2 .手术方法及其特…     

功能性腭裂修复术的初步报告

本文报告16例功能性腭裂修复术,介绍了手术方法,即保持腭部的解剖,仅作翼内板与翼外板的板间截开,不作翼钩的凿断,不松解腭帆张肌,不作腭小孔部位的分离,避免损伤支配软腭的腭小神经,将翼内板与软腭作整块分离,在其间隙安置一块2×1.5×0.5cm~3的羟基磷灰石块状体,由于有固体物支撑故能长时间的保持咽腔缩小,以改善腭咽闭合功能。该法改变了以往在松驰切口中填塞碘仿凡士林纱条,而作关闭性缝合,以确保羟基磷灰石块状体的种植成功,并在腭部打包缝合以固定硬腭区,保护腭部的手术创面。该手术注重保持腭部的正常解剖生理功能,确保腭咽闭合的形成,同时改变腭裂修复术创面的延期愈合的缺点。     

单瓣旋转推进腭裂修复术的临床作用

临床资料 1.分别选择单侧Ⅱ°、Ⅲ°,双侧Ⅲ°腭裂各2例,均为唇裂术后患者,其中2例裂隙宽大. 2.手术方法 2.1 按两瓣法常规作松弛切口,凿断翼钩,适当游离腭前神经血管束,掀起黏骨膜瓣(图1).     

腭裂患儿咽鼓管功能障碍与中耳疾病的研究

目的 :探讨不同年龄组腭裂患儿咽鼓管功能障碍与中耳疾病的发病情况。方法 :对 121例腭裂患儿 ,242耳 ,分为早期腭帆修复组 (手术时平均年龄为 3 2个月 )与延迟腭帆修复组 (手术时平均年龄为 15个月 ) ,在术前、术后 1年进行耳镜 ,耳显微镜检查和鼓膜穿刺术或鼓膜切开术。结果 :两组患儿均有 90 %以上的中耳有病理性渗出 ,但延迟手术组患儿的中耳渗出向粘稠化 ,感染化转变 ,两组患儿中耳渗出情况在术后 1年明显好转。结论 :腭裂患儿应尽早作耳科相关检查 ,对病理性渗出的中耳 ,应置放鼓室平衡管 ,以消除负压和引流 ,早期的腭帆修复术对咽鼓管及中耳功能的恢复有明显的改善。     

腭裂后推术组织瓣固定方法的改进

先天性软腭裂病人适用后推手术方法予以修复,近年来笔者对后推术组织瓣固定方法进行改进,经临床应用证明本法固定效果较好现介绍如下。一、改进的后推术组织瓣固定方法。常规切口并剥离腭粘骨膜瓣,再凿断翼钩将腭腱膜或连同鼻侧粘膜剪断。为使游离粘骨膜瓣固定牢固并防止软硬腭交界缝合处裂开,笔者在硬腭后缘用口腔科702号裂钻(小儿用701号裂钻)共钻     

腭裂修复术中翼钩与腭腱膜去留问题的探讨

腭裂修复术中 ,凿断翼钩 ,剪断腭腱膜 ,至今仍为国内外传统腭裂修复方法中的常规步骤 [1-4 ]。但任何一个正常解剖结构 (除废用退化器官 )都必然具备一定的正常生理功能。如果保存、恢复和重建正常或接近正常的解剖结构 ,也就保存、恢复和重建正常或接近正常的生理功能。基于此 ,在腭裂修复术中 ,近年陆续有不断翼钩和腭腱膜的报告 [5-6]。究竟断好或留好 ?又留哪一个为好 ?意见尚不统一。为此我们从临床实际出发 ,自 1 983年起采用保留翼钩的手术方法 52例 ,既区别于两者均断掉的传统方法 ,又区别于两者均保留的某些改进方法。1　材料与方…     

Abnormalities of the muscles of the soft palate and their impact on auditory function in patients operated on for cleft palate: a case-control study

Patients with cleft palate have a high incidence of otitis media (OM), which, even after palatal repair, can persist and lead to auditory dysfunction. We aimed to identify what predisposes such patients to develop OM and correlate it with auditory function. We designed a prospective case-control study of adults who had had their cleft palates repaired in childhood. We examined the anatomy of the eustachian tube and the paratubal muscles of the soft palate with magnetic resonance imaging (MRI), assessed auditory function, and correlated the results to evaluate the impact of the pathological anatomy on the function of the middle ear. A total of 64 ears in 32 patients were evaluated (Group A, n = 16) (Group B, controls = 16). MRI showed a short eustachian tube with a shortened tensor attachment in Group A when compared with Group B. The pterygoid hamulus was found to be intact in both groups, but extensive perihamular fibrosis was seen in Group A. A total of 15 ears in Group A had loss of hearing (prevalence ratio (PR) 1.08), (13 mild loss, and 2 moderate loss), and impedance audiometry showed effusion of the middle ear in 12 ears in 16 patients, and dysfunction of the eustachian tube with high negative pressure in the middle ear in four ears in the 16 patients (PR 4.6). These could be positively correlated with the pathological anatomy using Pearson’s correlation coefficient. Otitis media is persistent and can lead to conductive hearing loss in adults who have been operated on for cleft palate. This can be attributed to abnormalities in the development of the eustachian tube and the paratubal musculature.     

The Relationship Between Craniomandibular Disorders and Otitis Media in Children

Most of the literature written about temporomandibular joint (TMJ) or craniomandibular dysfunction has looked at the problem in adults, probably because most of the patients we see with problems are adults. This article first establishes the fact that young children also exhibit signs and symptoms of craniomandibular dysfunction, almost at the same percentage as seen in adults. A review of otitis media with effusion (OME) in children establishes that malfunction of the eustachian tube is the underlying cause of this disease process. Because of the close anatomical and embryological relationship between the TMJ and the middle ear, there exists the possibility that a dysfunctioning TMJ may initiate the bout of OME, primarily by its relationship to the tensor veli palatini muscle. This muscle controls the function of the eustachian tube. This author feels that we might be able to decrease the incidence of OME by improving the function of the eustachian tube. This could be done by altering the relationship between the TMJ and the muscles of mastication, similar to the way we treat craniomandibular (TMJ) dysfunction in adults.     

腭裂患者中耳功能及听力障碍

目的了解腭裂患者中耳功能及听力障碍的情况。方法对５９例腭裂患者，１１７耳进行了鼓室图测定，对部分患者进行了纯音测听。结果有８０４％中耳功能不正常，５９４％有不同程度传导性听力下降。结论腭裂患者应尽早并定期进行中耳功能测定，如果是分泌性中耳炎，应采取鼓室置管（压力平衡管）代偿咽鼓管功能不足，避免引起粘连性中耳炎的结局，应预防和减少腭裂患者的中耳疾患     

Inner ear barotrauma

Inner ear barotrauma was observed by compressing or decompressing guinea pigs. The barotrauma in compression was greatly influenced by auditory tube function, and, in the animals deprived of this function, we could observe far more severe damage of inner ear hair cells and far more frequent round window rupture than in animals not thus deprived. Barotrauma in decompression was brought about in guinea pigs not deprived of auditory tube function with a decompression speed of 0.1 kg/cm2/sec, which is so severe that even a healthy auditory tube could not endure it. It can be said that the middle and inner ear are more apt to be damaged in decompression than in compression.     

The TMJ and the middle ear: structural and functional correlates for aural symptoms associated with temporomandibular joint dysfunction

Several anatomic relationships existing between the ear and the temporomandibular joint have been proposed to account for the presence of aural symptoms that occur in some patients with temporomandibular joint dysfunction. There are a plethora of functional hypotheses for aural symptoms relating to disturbed functions of the eustachian tube (as well as neuromuscular relationships and neurovascular functions integrating with these hypotheses). Investigators explain the presence of aural symptoms relative to the anatomic relationship of the middle ear to the TMJ as hypothetically due in part to the "tiny ligament," the sphenomandibular ligament, or the diskomalleolar ligament. This article reviews hypotheses, explanations, and current research on this controversial issue.     

腭裂患者中耳功能障碍及治疗

目的 探讨腭裂患者中耳功能障碍与腭裂修复术及术前年龄的关系,了解腭裂患者分泌性中耳炎鼓室分泌物细胞培养的情况及鼓室置管治疗的初步效果。方法 采用声导检查和纯音测听判断中耳功能及听力,鼓室分泌细菌培养,了解分泌性中耳炎分泌物特点,结果 腭裂术前患者７５．５％为异常鼓室图,其中３岁前患者高达８１％,术后患者４１．２％为异常鼓室图,鼓室分泌物细菌培养,革兰氏阳性和阴性菌阳性率分别为２０．１％和２４％。６     

腭裂修复术同期鼓室置管的疗效及并发症防治

目的　探讨腭裂伴渗出性中耳炎患儿的联合治疗。方法　比较38例(49侧耳)单纯性腭裂修复术与24 例(39侧耳)腭裂修复同期行鼓膜切开、PE管置入术对中耳积液的消除及听力的影响,并对置管术的适应证、操作要点、并发症的防治进行讨论。结果　腭裂修复同期鼓膜切开置管组术后6月48·7%的患耳中耳积液消失,明显高于单纯腭裂修复组。听力损害的患儿置管后听力平均提高17 dB。结论　有中耳积液的腭裂患儿在腭裂修复术同期行鼓室切开、PE管置入术,有助于改善患儿的中耳功能。     

腭裂患者分泌性中耳炎的治疗

目的 探讨伴分泌性中耳炎的腭裂患者鼓室置管术对听力和中耳功能的影响。方法 对53例(62耳)患有分泌性中耳炎的腭裂分为鼓室置管组和对照组，采用纯音测听和鼓室图测试，了解近期和远期效果。结果 治疗组在置管后近期和远期纯音测听分别为23．3dB和23．4dB，属正常听力范围，但仍有64％属于B型和C型鼓室图。结论 鼓室置管能改善听力，但不能改善咽鼓管阻塞状况。     

Relevance of the pharyngotympanic tube.

The auditory (Eustachian) tube connects the middle ear with the nasopharynx. This conduit permits equalisation of pressure between the middle ear and the throat. Balanced pressure allows the eardrum to vibrate freely as sound waves strike it. The auditory tube is also a potential anatomical route whereby opportunistic pathogens may migrate from the nose and throat to the middle ear. Eustachian tube (ET) function is disturbed in children with cleft palate, thereby rendering them susceptible to chronic otitis media with effusion (OME) and temporary conductive deafness. ET obstruction follows in these patients, and is thought to be related to the inability of the tensor veli palatini (TVP) to function properly. This anatomical overview reviews the clinical importance of the ET in the normal population and children with cleft palate.     

The anatomy of the auditory tube and paratubal musculature in a one month old cleft palate infant

The auditory tube, middle and inner ear, and paratubal musculature were removed en bloc at autopsy from a 1 month old white cleft palate female. The specimen was serially sectioned in a coronal plane and studied under light microscopy. Severe inflammatory changes were observed in the middle ear and osseous portion of the auditory tube in association with the presence of a middle ear effusion. While the posterior tubal lumen, tubal cartilage, and tensor veli palatini (TVP) and tensor tympani muscles were similar to those of an age-matched control specimen, the anterior tubal lumen was seen to be superoinferiorly abbreviated with a large intrusive malpositioned levator veli palatini (LVP) muscle occupying the inferior tubal floor. This muscle was noted to divide into two bundles on proceeding posteriorly with the more superior bundle taking an abnormal origin from the inferior surface of the tube. The luminal compression observed in this specimen is reminiscent of that previously described in cleft fetuses though the abnormal morphology of the LVP muscle has not been reported for the few cleft palate specimens studied. It is probable that this morphology is idiomatic to the present specimen and not a characteristic of the cleft palate condition.