咽后壁瓣修复术后并发阻塞性睡眠呼吸暂停的临床研究

探讨腭裂术后腭咽闭合不全（VPI）患者行咽后壁瓣修复术（PFS）后阻塞性睡眠呼吸暂停（OSA）的发生率及严重程度，并探讨手术年龄对OSA发生率及严重程度的影响。     

阻塞性睡眠呼吸暂停综合征患者的围术期管理

阻塞性睡眠呼吸暂停综合征是临床常见的疾病，患者大多存在上呼吸道狭窄及通气障碍，从而并发肺动脉高压、心律失常、左心衰竭等严重的呼吸及循环系统异常。此类患者一旦需进行各种手术治疗。如何保证围术期的呼吸、循环稳定与安全，对麻醉和手术医师提出了极大的挑战。围术期的高风险性决定了在此期间进行合理的管理的重要性。本文对这类患者的病情评估，术前、术中及术后的诊疗及处理手段进行了综述。     

18例小儿腭裂术后的末梢血氧饱和度监测

目的 观察小儿腭裂修复术后，早期低氧血症的发生率及吸氧后血氧饱和度的恢复情况。方法 18例腭裂修复术后患儿，返病房时用脉搏血氧仪探头夹于食指或拇指，观察即时、吸氧后、停吸氧5min后以及2h后多次停吸氧的血氧胞和度（SpO2）值。结果 术后回病房即时SpO2值均有明显下降，早期低氧血症发生率33．3％。严重低氧血症发生率11．1％，个别达6h；吸氧后SpO2值能立即回升，5min后达正常水平。结论 小儿腭裂修复后术后低氧血症的发生率较高，应重视上呼吸道管理，加强护理观察。     

腭裂修复术的围手术期处理

腭裂整复术创面大，术后并发症多，如呼吸道梗阻、出血、复裂、腭瘘等，所以围手术期处理显得尤为重要。笔者自1992年～2005年，对732例腭裂患者进行修复术，现将围手术期处理的经验总结分析如下。     

综合征与非综合征型腭裂患者颅颌面结构特征的对比研究

目的比较和认识综合征型与非综合征型腭裂患者颅颌面结构的差异和特点,揭示综合征型腭裂患者上下颌骨生长发育的规律以及腭裂与颌面部其他畸形之间的关系。方法采集符合特定条件的混合牙列期男性腭裂患者57例,其中Treacher Collins综合征8例,Pierre Robin综合征9例、非综合征型腭裂患者40例。所有患者行侧位头影测量检查,对侧位片进行定点分析并且选择18项指标进行测量,使用SPSS 12.0软件对其结果进行统计学分析。结果与非综合征型腭裂患者相比,综合征型腭裂患者下颌骨生长发育的差异主要表现为SNB的减小和ANB的增大（P<0.05）,提示综合征型腭裂患者下颌骨在前后方向上的发育较非综合征型腭裂患者相对不足;而两组患者的上颌骨前后向发育无统计学差异（P>0.05）,颅底的生长发育亦无统计学差异（P>0.05）。结论综合征型腭裂患者的上颌骨形态结构以及生长发育与非综合征型腭裂患者基本类似,两者之间存在着相似的生长发育潜力;腭裂患者颅颌面诸骨的生长发育既相互影响又相对独立。     

老年口腔肿瘤合并糖尿病患者的围手术期处理

目的：探讨老年口腔肿瘤伴有糖尿病的患者，围手术期的临床处理要点。方法：对21例伴有糖尿病的老年口腔肿瘤患者，进行围手术期控制血糖后手术治疗。结果：21例伴有糖尿病的老年口腔肿瘤患者手术过程顺利，术中、术后因合理使用胰岛素而血糖控制良好，均安全度过围手术期，无严重并发症发生。结论：对于伴有糖尿病的老年口腔肿瘤患者，术前较好地控制血糖，术中、术后积极监测及治疗糖尿病，使围手术期的血糖相对稳定，是手术成功及减少术后并发症的关键。     

综合征性腭裂与腭裂术后腭咽闭合不全

腭裂修复术后的语音恢复 ,一直是备受外科医师和语音治疗师关注的焦点问题之一 ,随着腭裂修复手术年龄的下降 ,术后的语音效果得到明显提高 ,但无论手术年龄多小 ,仍有 5 %～ 10 %的患者术后存在腭裂语音[1] ,而腭裂语音的产生与术前的口鼻腔相通和术后的腭咽闭合不全有直接的关系。为什么腭裂术后有一定比例的患者发生腭咽闭合不全 ?除了学者们公认的影响因素 ,如 :手术年龄、手术技术以及患者的解剖生理条件外[1] ,腭裂伴有其他先天畸形也是非常重要的影响因素。据文献报道共有 178种伴有唇腭裂的综合征、序列征、联合征以及其他畸形 ,占…     

全麻唇腭裂修复术脉搏血氧监测的重要性

目的：探讨唇腭裂手术脉搏血氧饱和度监测的重要性。方法：围术期采用美国产MEC503脉搏血氧监测仪测SpO2（血氧饱合度），测定低氧血症的发生率，结果：76例全麻病人中有36例发生低氧血症，占47％，结论：全麻手术期间，为保持连续无创监测SpO2（血氧饱合度），可期发现低氧血症，并及时提术者进行吸引和观察吸引是否奏效，苦有呼吸道脱开或呼吸管理不当造成通气障碍等意外情况，麻醉者能尽快寻找原因，积极处理，对确保围术期的闰人安全有重要意义。     

口服抗栓药物患者门诊拔牙围手术期管理的专家共识

血栓栓塞性疾病包括静脉血栓栓塞性疾病和动脉血栓栓塞性疾病，已成为导致全球人口死亡的第一因素，这类患者需要服用抗栓药物对血栓形成进行防治，但在接受外科手术时其出血风险随之增加。拔牙手术是口腔外科门诊最常见的手术，尽管目前普遍认为口服抗栓药物的患者行拔牙手术时无需停药，但这类患者的围手术期管理依旧困惑着大部分口腔外科医师，一些潜在的出血危险因素也需要进一步深入研究。为了提高口腔外科医师对口服抗栓药物拔牙患者的围手术期管理能力，最大程度保障患者健康，相关专家起草本共识，从术前出血风险评估、术中操作规范和术后护理等方面总结相关临床经验，以期为广大同行提供参考。     

腭裂修复术手术年龄对中耳功能的影响

目的：探讨腭裂患者中耳功能障碍听力损失发病特点，腭裂修复术手术年龄对听力的影响。方法；对住院12岁以下腭裂患者60例，术后6个月分别用脑干听觉诱发电位，声阻抗进行听力及中耳功能检测，术前鼓室分泌物细菌培养。结果：腭裂患儿术前听力损失发病率为74．17％正常鼓室图为20％，3岁前高达81．16％，术后6个月患儿听力有一定程度恢复，正常鼓室图占58．33％，听力在婴儿时已经损失严重，随年龄增长听力有所改善，听力损失与腭裂部位类型无关。鼓室分泌物细菌培养，G^ ,G^-阳性率为22．86％，23．53％，且多为低毒性条件致病菌。结论：腭裂患者听力损失在婴幼儿已经存在，早期修复腭裂有助于咽鼓管功能恢复，有利于语言发育。     

Clinical outcomes of the furlow z-plasty for primary cleft palate repair

Objective: To review the clinical outcomes following the Furlow Z-plasty for primary cleft palate repair. The primary objective was to determine if the presence of an associated sequence or syndrome (i.e., Pierre Robin sequence), age at palate repair, cleft type, or surgeon experience influenced speech outcomes after a Furlow Z-plasty. Design: The outcomes of 140 patients who underwent palate repair were analyzed retrospectively. Speech evaluations were performed to score the severity of hypernasality, nasal escape, articulation errors, and velopharyngeal insufficiency. Results: The mean age at latest evaluation was 4 years 9 months (age range 2 years old to 12 years old and 4 months). Of the 140 patients, 83% had no evidence of hypernasality, 91% had no presence of nasal escape, and 69% had no articulation errors. Overall, 84% of patients had no evidence of velopharyngeal insufficiency. Secondary posterior pharyngeal flap to correct velopharyngeal insufficiency was required in only 2.1% of patients. The formation of an oronasal fistula occurred in only 3.6% of patients. Nonsyndromic patients with Pierre Robin sequence and syndromic patients did just as well as purely nonsyndromic patients in terms of velopharyngeal insufficiency, hypernasality, and nasal escape. Syndromic patients were more likely to make mild-to-moderate articulation errors. In addition, age at palate repair, cleft type, and surgeon experience had no statistically significant effect on speech results. Conclusions: The Furlow Z-plasty yielded excellent speech results in our patient population with minimal and acceptable rates of fistula formation, velopharyngeal insufficiency, and the need for additional corrective surgery.     

Impact of early intravelar veloplasty at six months on mandibular growth in patients with Pierre Robin Sequence

Pierre Robin Sequence (PRS) combines mandible microretrognathia, asynchronism of the pharynx and tongue, glossoptosis and, in some cases, cleft palate. Its principal functional consequences are respiratory and feeding problems during the neonatal period.In this study, we focused on the impact of early closure of the cleft at six months on mandibular growth in patients with PRS.We performed a retrospective study of 15 patients followed for PRS and undergoing surgery performed by the same senior surgeon (HB) at our cleft center between 2005 and 2012. These patients underwent early closure of the cleft (at a mean age of 5.87 months) by intravelar veloplasty, as described by Sommerlad.Only one article with exploitable data analyzing facial and mandibular growth in a cephalometric study of children with PRS has been published. The children in this series, constituting the control group for our study, underwent veloplasty between the ages of 12 and 18 months, often accompanied by labioglossoplasty, and the cephalometric study was carried out between the ages of four and seven years. We compared this control group in which surgery was performed at 12–18 months with our series of children undergoing surgery at six months, in a cephalometric study based on teleradiographic profile measurements performed between the ages of four and seven years.We found that early closure of the cleft soft palate yielded results identical to those for the control group in terms of mandibular growth, without the need for labioglossopexy. Finally, early intravelar veloplasty led to early functional improvement in terms of speech and phonation.     

Airway obstruction following palatoplasty: analysis of 247 consecutive operations.

OBJECTIVE AND METHODS: Between February 1987 and September 1997, 247 patients underwent primary repair of a cleft of the secondary palate by one surgeon, using the double-opposing Z-plasty (Furlow) technique. This retrospective study reviews perioperative and postoperative airway compromise among these patients. The purposes of this study were to identify factors associated with airway obstruction following palatoplasty and to analyze the management of those patients. Although infants experiencing airway problems following Wardill-Kilner and Von Langenbeck palatoplasty have been described, airway complications in a group of Furlow repair patients has not been previously reported. RESULTS: Fourteen patients (5.7%) had airway problems. The average age of these patients was 18 months, which was not significantly different from those without airway problems. Airway obstruction occurred as late as 48 hours after the completion of surgery. Twelve of the 14 patients had severe airway compromise requiring continued postoperative intubation, reintubation, or tracheostomy (one). There were no deaths. Thirteen of the 14 patients with postoperative airway problems (93%) had other congenital anomalies in addition to clefting, a named congenital disorder, or both. Seven of those 13 had Pierre Robin sequence. In contrast, only 40 of the 233 patients without airway problems (17%) had additional congenital anomalies or named disorders. Presence of other congenital anomalies was associated with a significantly increased risk of airway obstruction (p =.005). CONCLUSION: Patients with cleft palate with the Pierre Robin sequence or other additional congenital anomalies had an increased risk of airway problems following palatoplasty. Awareness of this risk permits identifying those patients prior to surgery so that they can be monitored and managed appropriately, minimizing the likelihood of major complications or death.     

皮罗序列征患儿腭裂的改良手术治疗：12例临床分析

目的 探讨治疗皮罗序列征患儿腭裂安全、有效的功能性外科方案。方法 选择12例重度皮罗序列征腭裂患儿,腭裂修复术前,为纠正重度缺氧,均实行下颌骨牵张成骨。采用软腭不后退腭帆提肌重建的改良手术进行腭裂修复。结果 12例患皮罗序列征的腭裂患儿,经软腭不后退提肌重建的改良手术后,随访10~12个月,均获得了腭咽闭合功能恢复又不造成呼吸困难的临床效果。结论 对皮罗序列征的腭裂患儿进行腭裂修复手术,有别于一般的腭裂修复手术,应防止腭瓣后徙引起的呼吸窘迫。     

A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions.

OBJECTIVE: To examine the natural history of feeding skills in babies with clefts and identify risk factors and predictors of poor feeding. PARTICIPANTS: Sixty-two babies with clefts were examined at 2 weeks, 3 months, and 14 months of age. MAIN OUTCOME MEASURES: Feeding ability, oral motor function, and feeding efficiency were assessed. Univariate analyses were used to determine whether oral motor function and sequelae varied according to feeding ability or cleft condition. Multivariable logistic regressions were used to determine risk factors for poor feeding. RESULTS: Poor feeding skills were detected in one third of newborns. The prevalence of poor feeding reduced to 19% at 3 months of age and 15% at 14 months of age. Oral motor dysfunction and sequelae (particularly nasal regurgitation) were more commonly observed in babies with poor feeding skills irrespective of comorbidity. The main risk factor for poor feeding was a diagnosis of syndrome or Pierre Robin sequence (PRS). At 2 weeks of age, babies with syndrome or PRS were 15 times more likely to have poor feeding skills than their nonsyndromic counterparts. When syndrome or PRS was controlled for, babies with cleft palate and cleft lip and palate were equally likely to have poor feeding skills. Parental report of feeding efficiency was predictive of poor feeding in young babies. CONCLUSIONS: Poor feeding skills are relatively common in newborns with cleft palate and cleft lip and palate. Treatment for feeding problems may be needed beyond the first year of life, especially for babies born with PRS or a syndrome.     

Pierre Robin sequence: report of two cases

Pierre Robin sequence (PRS) or anomalad, a well-recognized presentation, is the association of the first brachial arch malformation. It presents with a classic triad of micrognathia, glossoptosis, and cleft palate. In a neonate with a complete cleft palate, problems with feeding are commonly encountered. Presented here are two cases with PRS in whom palatal obturators were constructed.     

Management of cleft palate among patients with Pierre Robin sequence

Pierre Robin Sequence (PRS) is a congenital craniofacial anomaly distinguished by the presence of micrognathia, glossoptosis, and upper airway obstruction. Cleft palate occurs in over 3/4 of patients with PRS. The wide U-shape cleft and airway dysfunction create challenges in clinical management. Currently, disputes exist on the treatment protocol and prognosis of cleft palate management among patients with PRS. This review is focused on the deformity features, intervention timing, technique selection, airway support, and outcome evaluation of cleft palate among patients with PRS, aiming to provide reference to further evolution in the management of PRS-related cleft palate.     

The mandibular catch-up growth controversy in Pierre Robin sequence.

The purpose of this retrospective longitudinal cephalometric study was to investigate differences in craniofacial and especially mandibular morphology between patients with Pierre Robin sequence and isolated cleft palates. The experimental group comprised 96 patients (54 males and 42 females) with a history of Pierre Robin sequence. This group was compared cephalometrically with a control group of 50 patients (25 males and 25 females) with a history of isolated clefting of the palate. All 96 patients in the PR group had a lateral cephalogram at a mean age of 5.5 years. Thirty-eight of those patients had additional cephalograms at the mean ages of 10.3 years and 16.8 years. All patients in the cleft palate group had 3 corresponding cephalograms at the following mean ages: 5.7 years, 10.6 years, and 17.0 years. Twenty-nine cephalometric measurements were performed on each cephalogram with the use of computerized cephalometric software. Significant differences were identified between the 2 groups, particularly in the size and sagittal position of the mandible, which was consistently shorter in the Pierre Robin group at all 3 ages. Less severe differences were noted in the inclination of the palatal plane, the facial height proportions, and the midface depth. We conclude that patients with Pierre Robin sequence have a significantly smaller mandible as compared with patients with isolated cleft palate, and the difference does not change after the age of 5 years.     

Perioperative complications in cleft palate repair with Robin sequence following Tuebingen palatal plate treatment

Our study aimed to evaluate perioperative complications following our institutional pre- and intraoperative management in cleft palate repair with Robin sequence (RS).RS patients who underwent cleft palate repair between 2000 and 2020 were retrospectively analysed. RS children with complete documentation and whose initial treatment involved the Tuebingen palatal plate (TPP) were included. Clinical records and operative charts were reviewed with regard to clinical characteristics as well as the neonatal and perioperative course. Results before and after adjustment of the anesthesiology protocol in 2014 were compared.143 RS patients (41% male, 59% female) were included. Median pretherapeutic mixed-obstructive apnea index (MOAI) after birth was 9.4/hour (IQR 20.0). TPP treatment was associated with normalisation of the MOAI and adequate weight gain until surgery. At surgery, median age was 10 months (IQR 3), MOAI 0.1/h (IQR 0.5), and weight 8.7 kg (IQR 1.7). In 93% of cases (n = 133), the postoperative course was uneventful. Refinement of the anesthesiology protocol showed positive effects on the perioperative course and led to a reduction in perioperative events (10.7% vs. 2.9%). No severe perioperative complications occurred.We recommend the adoption of TPP treatment in the therapy of RS children. Our favourable results show that early TPP treatment minimizes perioperative complications in cleft palate repair by effectively and sustainably correcting upper airway obstruction.     

Fast and early mandibular osteodistraction (FEMOD) in severe Pierre Robin Sequence

Pierre Robin Sequence (PRS) is a congenital abnormality characterized by mandibular hypoplasia, glossoptosis and often secondary palate cleft.It may be an isolated or part of a most complicated syndrome. The genetic syndrome that most frequently co-occurs is Stickler syndrome characterized by skeletal abnormalities, joint pain, congenital myopia and retinal detachment.The authors describe their fast and early mandibular osteodistraction (FEMOD) protocol in severe cases of PRS airway obstruction.