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。     

翼钩凿断和板间切开对中耳功能的影响

目的:了解翼钩凿断和板间切开对中耳功能的影响。方法:对20只新西兰大耳白兔行翼钩凿断和板间切开后,观察腭腱膜及中耳腔粘膜的变化,以明确手术对中耳功能的影响。结果:翼钩组均出现腭帆张肌松弛,中耳腔粘膜杯状细胞明显增多;板间切开组无1例出现上述变化。结论:翼钩凿断不利于咽鼓管的开张,而板间切开影响较小,因而主张腭裂手术时应尽量不凿断翼钩以保持其解剖位置和功能。     

腭裂患者听力变化特点的临床分析

目的 探讨腭裂患者术前听力下降的原因及手术对听力的影响。方法 采用术前检查２２例患者鼓膜及耳语检测听力，术后问诊１８例和变化情况。结果 腭裂患者较正常力下降率明显升高，部分腭裂口才术后听力进一步下降。结论 １．腭裂患者尽量避免上呼吸道感染。２．腭裂手术时应避免损伤腭帆张肌和咽鼓管在鼻咽部的开口。     

腭形成术与术后语音效果的研究

目的：探讨不同手术时机对腭裂修复术后语音效果的影响，方法：对48例早期腭形成术（手术时平均年龄为3．2个月）及33例延迟腭形成术（手术时平均年龄为15．0个月）的2组术后患儿进行包括语音音色，音素，过高鼻音与过低鼻音的评估，观察其不良的语音习惯，从而作出语音效果评估。结果：2组手术后病儿的语音评估结果有显著性差异（P＜0．05），。即早期接受腭修复手术者，语音发育效果好，结论：腭形成术实施时间早，则可尽早为良好的语音发育创造正常的解剖生理条件，因而语音发育效果好。     

腭裂修复术对腭裂患者中耳状况及听力的影响

目的 了解腭裂修复术对腭裂患者中耳状况及听力状况的影响。方法 分析23例腭裂患者术前、术后(平均复诊时间8．6个月)声阻抗检查结果及纯音听阈变化情况。结果 腭裂修复术后渗出性中耳炎患病率及平均听闻值均有所下降，但无显著性差异，而耳声反射阳性率有明显提高。结论 腭裂修复术后短时间内，咽鼓管功能及听力恢复表现的不明显，声反射是反映中耳状况较为敏感的指标，可作为腭裂总者术前、术后渗出性中耳性监到的重要指标之一。     

腭裂修复术同期中耳置管治疗渗出性中耳炎

目的:评价腭裂修复同期鼓膜切开中耳置管对腭裂渗出性中耳炎及听力损失的作用。方法:选择在腭裂修复前作声阻抗检查鼓室图为B型、声镫骨肌反射阴性、脑干听觉诱发电位检查V波反应≥30dB的患儿76例,随机分为A、B2组,A组45例在腭裂修复同期中耳置管,B组31例为单纯性腭裂修复,术后2周行鼓室图、脑干听觉诱发电位检查,结果采用t检验和χ2检验。结果:A组手术前与手术后V波反应阈值、听力损失及鼓室图均有显著性差异(P<0.001),B组手术前与手术后V波反应阈值、听力损失及鼓室图均无显著性差异(P>0.05),术前A、B2组间V波反应阈值、听力损失及鼓室图无显著性差异(P>0.05),术后A、B2组间V波反应阈值、听力损失及鼓室图有显著性差异(P<0.001)。结论:中耳置管可作为防治腭裂术后渗出性中耳炎及听力损失的常规治疗手段,避免黏连性中耳炎发生,提高患者听力。     

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。     

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。     

Sommerlad腭帆提肌重建术修复腭裂的临床研究

目的探讨采用Sommerlad腭帆提肌重建术修复腭裂的效果。方法采用Sommerlad腭帆提肌重建术修复先天性腭裂11例,其中完全性腭裂3例,不完全性腭裂8例。患者朗读汉语普通话测试字表,对比手术前后的发音准确率。结果 11例患者手术顺利,术中出血少,均不需输血。术后伤口无感染,无裂开,手术成功。发音准确率由术前的20%提高到术后的60%。结论 Sommerlad腭帆提肌重建术修复腭裂是一种较好的功能性腭裂修复术,值得在临床推广。     

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…     

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     

腭裂手术和鼓室置管对中耳功能的影响

目的:了解早期腭裂整复术和鼓室置管术对患者的听力及中耳功能的影响。方法:比较已做腭裂整复术但仍伴分泌性中耳炎的22侧患耳鼓室置管前后及38例行腭裂整复术患者术前术后听力及中耳功能变化。结果:22 侧鼓室置管患耳听阈平均提高了17 dB;早期腭裂修复术对患者中耳功能有一定的改善但尚无统计学差异(P> 0105)。结论:对伴发分泌性中耳炎的腭裂患者应积极采用置管术以改善患者的听力,利于语言的学习。     

Effect of palatoplasty on the function of the Eustachian tube in children with cleft palate

Eustachian tube function of 24 children with cleft palate (37 ears) was evaluated longitudinally utilizing the inflation-deflation and forced-response tests before and after palatoplasty. Our results for children in this longitudinal study showed that the passive function of the tube was improved following palatoplasty. Active tubal function, which measures the muscle-induced tubal dilations, was little affected by the procedure. The majority of ears tested both before and after palatoplasty demonstrated tubal dilations with swallowing. In contrast, cross-sectional data conducted on the children with a history of otitis media and repaired cleft palates, documented a severe defect in this active tubal function with 70 percent of the tests evidencing a tubal constriction. These data suggest that the results of Eustachian tube function tests may be prognostic of the future course of ear disease in these children.     

Tensor veli palatini muscle tension sling for eustachian tube function in cleft palate. Surgical technique and audiometric examination

The high incidence of middle ear effusion in cleft lip and/or palate infants and children led to the development of a tension sling for the tensor veli palatini muscle for better Eustachian tube function after intravelar veloplasty.--The surgical technique is outlined in this paper and an audiometric examination was conducted to determine the influence of this surgical modification, performed in the same procedure as the intravelar veloplasty, on the Eustachian tube function. The intra- and intergroup comparisons indicate that this surgical technique has a positive influence on the tube function.     

腭裂患儿渗出性中耳炎与听力减退的发病情况

对５６例腭裂患儿和５０例正常儿童的渗出性中耳炎及听力减退的发病情况进行了观察。研究对象年龄在５－１４岁。所有儿童均进行耳科常规检查，听力测验及声阻抗检查。发现腭裂患儿渗出性中耳炎的发病率高，为４６％；下沉对照儿童为６％。腭裂患儿听力减退的发生率也明显高于对照儿童，语言频率气－骨导差值在１１ｄＢ以上者占５７％，而对照儿仅占４％。     

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 role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems

Objective

Otitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited.This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair.

Materials and methods

A literature search on the MEDLINE database was performed using a combination of the keywords “tensor veli palatini muscle,” “Eustachian tube,” “otitis media with effusion,” and “cleft palate.”

Results

Several studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tube’s dilatation mechanism.

Conclusion

More research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems.

Clinical relevance

Optimized surgical management of cleft palate could potentially reduce associated middle ear problems.

     

Conservative management of otitis media in cleft palate.

AIMS: Eustachian tube dysfunction affects nearly all children with cleft palate but its management is controversial. Some units perform routine prophylactic grommet insertion at the time of palate repair, whilst others are more conservative, inserting grommets only when signs and symptoms of otitis media with effusion are present. This study aims to present outcome data from one cleft team practising a conservative approach. DESIGN: This is a retrospective study in which consecutive palate repairs over 10 years are analysed and compared with previously published data. The spectrum of clefting and severity (LAHSHAL), otological and speech outcomes were recorded. Patients were excluded if incomplete data was available, and if sensorineural deafness or syndromic clefting was present. RESULTS: Data is presented for 72 of 109 consecutive patients and the 37 excluded patients are discussed. Following a conservative approach to otitis media with effusion, 29% of cases required grommets. The use of grommets seemed to be more common in those with more severe clefting. Despite this, the group receiving grommets had better speech results than those who did not, although this improvement was not statistically significant. CONCLUSIONS: There is no evidence of poor overall otological outcome in this series. The data demonstrates that those receiving grommets had better results despite more severe clefting.     

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.