58例腭裂术后6例复裂原因分析

５８例腭裂术后６例复裂原因分析广西桂林地区人民医院口腔科陈其明本科从１９８０年１０月至１９９６年１２月,总共收治腭裂患者５８例,均在全麻气管插管下行腭裂修复术,其中有６例术后出现不同程度的复裂,１年以后行Ⅱ期修复．本文对引起复裂的有关因素进行分析讨论...     

1例应用舌瓣修复腭裂术后巨大穿孔的研究报告

先天性唇腭裂是较为常见的畸形,其中腭裂对患儿的颌骨发育、语言及饮食等功能影响巨大。目前腭裂的主要治疗方法为手术修复,由于多种原因影响,腭裂术后出现复裂或穿孔很常见[1]。     

腭裂修复术后并发症的临床分析

目的:分析腭裂术后并发症的原因,提高手术质量。方法:总结我院1993-10—2008-05共601例腭裂修复手术病例,从患者年龄、腭裂类型、部位等方面进行分析统计。结果:601例患者中,学龄前组为482例,发生穿孔40例,学龄后组119例,发生穿孔4例。病变大多发生在腭垂部,其次为软硬腭交界部;601例患者中,术后出血32例,其中以鼻腔侧出血多见,其次见于硬腭的松弛切口和侧切口。结论:腭裂术后穿孔或复裂与患者年龄及腭裂程度及手术技巧有关;术后出血与术中操作不当,止血不彻底有关。提高手术技巧,加强术后护理和作好出院指导可有效预防腭裂术后并发症的发生。     

减少腭裂围手术期出血的几种措施

目的：探讨腭裂围手术期减少出血的方法。方法：38例腭裂患者围手术期采取麻醉控制、血压维持、手术操作、电刀应用、创面处理,术后用药等措施,评价各种措施对减少出血的影响。结果：全部病例术后伤口均Ⅰ期愈合,未发生感染、无继发出血及穿孔、复裂等并发症。结论：术中降低血压,应用电刀,操作轻柔,快捷,适量使用抗生素和止血药物,能有效减少出血,利于早期康复,促进伤口愈合。     

腭裂术后穿孔的分析及处理(附50例报告)

腭裂术后穿孔是腭裂修补术后较常见的并发症。为减少术后穿孔率,我们对近十三年来共收治的50例腭裂术后穿孔的原因进行了分析,提出了预防的措施,总结了再次修复的方法,现报告如下。临床资料     

腭裂术后穿孔(附46例分析)

本文分析了 6 87例腭裂修补术后穿孔 ,复裂的患者 46例 ,探讨穿孔原因 ,手术修复方法及术中 ,术后有关问题。提出了无张力缝合是创缘愈合的先决条件。手术操作细、准、柔是防止穿孔的有效措施。术后加强护理是防止穿孔的重要步骤。     

完全性唇腭裂患者两阶段手术的初步研究

目的：介绍采用两阶段手术方法治疗完全性唇腭裂患儿的初步结果。方法：对３７例患儿采用两阶段手术方法进行治疗的临床资料进行分析并采用了石膏模型进行测量。结果：除２例软腭裂修复术后有伤口裂开外,余未发生任何并发症,软腭裂修复后,硬腭裂逐渐缩窄。结论：早期软腭裂修复是可行的,它为采用兰氏手术修复硬腭裂创造的条件。     

568例腭裂手术治疗分析

目的:回顾总结568例腭裂手术治疗的效果与经验.方法:对568例不同年龄、性别的腭裂患者行手术治疗,术式均以两瓣法为主.术中配合使用高频电刀,两侧松弛切口填塞碘仿纱条或可吸收性止血纱布.观察其术后的饮食、体温变化、创口愈合情况及有无出血、复裂或穿孔等并发症.结果:全部病例术后均无明显感染征象,其中出现发热24例,多为术创填塞碘仿纱条者,而且恢复正常饮食时间亦较迟;并发术后出血8例,复裂或穿孔13例.结论:腭裂术中使用高频电刀,可明显减少手术出血量,一般无需输血;两侧松弛切口填塞止血纱布,更有利于创口愈合及术后康复;术中应尽量减少硬腭裸露骨面和手术创伤,以降低对上颌骨生长发育的抑制作用.     

饮食类型对腭裂术后愈合影响的初步分析

目的:探讨腭裂术后不同饮食类型对手术创口愈合的影响。方法:将腭裂患儿分成3组,第1组52例,嘱术后2周进流质,2周进半流质,1个月后进普食;第2组51例,术后1周进流质,1周进半流质,2周后进普食;第3组48例,术后1周进半流质,1周后进普食。观察术后1个月各组手术创口愈合情况。结果:第1组患儿术后1个月见创口愈合良好,无复裂穿孔,缝线处有呈白色的食物残渣覆盖。第2组患儿术后1个月见创口愈合良好,无复裂穿孔,食物残渣覆盖较少。第3组患儿术后1个月见创口愈合良好,无复裂穿孔,无食物残渣覆盖。结论:腭裂术后1周进半流质,1周后恢复普食,患儿创口愈合良好,无复裂穿孔,口腔卫生良好。     

河南省部分地区唇腭裂患者术后继发畸形调查分析

目的：了解唇裂、腭裂一期手术后继发畸形的情况。并探讨其影响因素及有效的解决方法。方法：采用普查法对河南省部分地区人群进行随访,对唇腭裂患者进行术区照相,根据照片记录手术类型、术后继发畸形情况,将结果进行统计学分析。结果：共随访唇腭裂术后患者2046例。单侧唇裂患者1514例,术后继发畸形1268例,,双侧唇裂患者488例,术后继发畸形466例,腭裂患者446例,术后继发硬腭穿孔及软腭复裂26例。结论：适当选择唇腭裂手术类型,对唇腭裂术后患者进行定期随诊及普查,及时发现、治疗术后继发畸形,对提高唇腭裂手术的治疗效果具有极为重要的意义。     

罕见先天性唇裂、鼻翼裂、面横裂、附耳等多发畸形伴斜疝1例

贵阳医学院附属医院口腔颌面外科收治1例先天性唇裂、鼻翼裂、面横裂、附耳等多发畸形伴斜疝的病例,患儿男性,10个月。对患儿采用一次性手术根治所有畸形,术中严密控制出血,按无菌原则顺序先行疝囊高位结扎,再进行附耳切除及鼻翼裂、唇裂、面横裂整复。治疗后伤口一期愈合,畸形得到改善。     

Factors related to relapse after Le Fort I maxillary advancement osteotomy in patients with cleft lip and palate.

OBJECTIVE: To identify factors associated with relapse after maxillary advancement in cleft lip and palate patient. SUBJECTS: Seventy-one cleft lip and palate patients underwent Le Fort I maxillary advancement osteotomy between 1988 and 1998, and 58 patients (42 unilateral cleft and 16 bilateral cleft) with complete data were investigated for relapse by clinical and cephalometric analysis. The clinical follow-up period ranged from 1.5 to 8.5 years (mean 2.5 years). RESULTS: Horizontal advancement averaged 6.9 mm. There was a significant correlation between surgical movement and postoperative relapse in both the horizontal and vertical planes. In vertical repositioning, 15 patients had maxillary intrusion and 31 had inferior repositioning. There was a significant difference between the intrusion group and the inferior repositioning group. There was a significant correlation between surgical and postoperative rotation regardless of the direction. Other factors were evaluated by the horizontal relapse rate. Type of cleft and the rate of relapse were statistically associated. A relapse was more likely to occur in patients with bilateral cleft. There were no significant associations with the rate of relapse in type of operations or previous alveolar bone grafting. There was no significant correlation between the rate of relapse and the number of missing anterior teeth, postoperative overbite and overjet, and age at operation. Four of 71 patients experienced major relapse, and 3 of them underwent jaw surgery again. CONCLUSIONS: Based on clinical and cephalometric analysis, two-jaw surgery should be performed in cases of severe maxillary hypoplasia, and overcorrection may be useful in inferior repositioning or surgical rotation. Special attention should be paid to the patient with bilateral cleft, multiple missing teeth, or shallow postoperative overbite.     

双侧唇裂术后复裂的因素分析

目的:探讨双侧唇裂术后复裂的原因,以利于提高双侧唇裂的整复效果.方法:选择采用格洛弗式法经治的412例双侧唇裂术后复裂的患儿38例,对其复裂前的临床表现、复裂的时间特点及全身和局部情况进行分析.结果:完全性、混合性等严重复裂,复裂前的全身及局部症状较轻,复裂的高峰期在手术后第5、6天.结论:完全性复裂主要原因是松弛减张不彻底;而部分复裂与患儿的全身及局部情况、操作技巧及术前、术中、术后护理密切相关.     

Relapse rate after surgical treatment of maxillary hypoplasia in non-growing cleft patients: a systematic review and meta-analysis

Maxillary hypoplasia in cleft lip and palate is a complex deformity. Despite surgical improvements, postoperative relapse persists. This systematic review was performed to determine the mean horizontal relapse rates for the surgical techniques used to treat maxillary hypoplasia: Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis. This study followed the PRISMA statement. The PubMed, Embase, Science Direct, and Web of Science databases were searched through to June 2018. Studies on non-growing cleft lip and palate patients who had undergone one of the three surgical procedures and who had postoperative horizontal maxillary changes assessed at >6 months post-surgery were included. Stata SE was used to estimate pooled means, heterogeneity, and publication bias. The search strategy identified 326 citations, from which 24 studies were selected. Relapse rates following Le Fort I osteotomy with rigid fixation, Le Fort I distraction osteogenesis, and anterior maxillary distraction osteogenesis were 20%, 12%, and 12%, respectively. Relapse rates with and without bone grafting were 19% and 66%, respectively. The relapse rate following distraction osteogenesis with internal distraction was lower than that with external distraction. Study limitations were heterogeneity, which was above moderate, the low number of high-quality studies, and unidirectional assessment of postoperative maxillary movement.     

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唇裂是口腔颌面外科的常见病之一,主要在婴儿期采用唇裂修补术来进行治疗。呼吸道的管理对手术安全具有非常重要的作用。注意术前预防呼吸道感染、术中防止缺氧及气道水肿、术后防止呼吸抑制及喉痉挛等呼吸道并发症,可以有效预防麻醉意外及并发症的发生,提高手术安全性。     

单侧唇裂术后鼻畸形整复方法的探讨

目的：对38例单侧唇裂术后鼻畸形患者实施整复治疗的临床资料进行回顾性分析,以寻求成熟且效果肯定的手术方式。方法：以38例单侧唇裂术后鼻畸形患者为研究对象,男21例,女17例,年龄17～34岁,平均20．8岁。针对不同的畸形程度,采用悬吊或充填患侧鼻翼,纠正塌陷畸形；对严重的鼻中隔软骨偏斜患者,通过手术矫正不对称畸形和改善鼻通气,并以生物材料或软组织充填鼻翼基底,弥补患侧上颌骨发育不足；解剖复位鼻唇肌,以保持两侧肌张力的均衡。术后制作塑料鼻塞,保持2～3个月。结果：术后38例患者的鼻畸形均得到不同程度的改善,随访27例(71．05%),随访时间3个月～1a,5例患者有复发倾向；11例植入生物材料的患者,均未发生材料的排异反应。结论：单侧唇裂继发鼻畸形的病因复杂,可通过对骨、鼻软骨、鼻唇组织等多方面的矫正,有效地改善畸形；而鼻唇肌的复位,对防治术后复发十分重要。     

牙槽突裂植骨术研究进展

本文阐述了牙槽突裂植入骨的来源,认为自体骨如髂骨仍是最佳材料。有研究应用重组人骨形成蛋白、小牛骨粉及生物胶原膜、组织工程成骨材料修复牙槽突裂取得一定效果。术前适当的正畸治疗对于部分牙槽突裂患者相当重要,术后正畸也必不可少。影响牙槽突裂移植骨成活率的原因较多,包括适应证的选择、手术时机及手术技巧等。应用三维CT评价牙槽突裂植骨较以往的牙片可以获得更全面的信息。     

正畸正颌联合治疗腭裂术后上颌骨严重发育不良症

目的：探讨正畸、正颌联合治疗唇腭裂术后引起的上颌骨严重发育不良症的临床效果。方法:j临床选择腭裂术后患者10例（男6人，女1人）。矫正开始前，先共同进行会 诊确定手术方案和术前正畸的内容。术前正畸包括扩大上颌牙弓，整平咬合曲线并排齐牙齿，为手术做好准备。手术时依据上颌骨发育受限的程度设计单颌手术，或下颌拔除第一牙以便缩小下牙弓与有限前徒的上颌相匹配。手术之后再配合必要的术后正畸以调整牙齿咬合关系。结果：经过正畸、正颌联合矫治10例腭裂术后严重上颌骨发育不良的患者，均取得了十分明显的疗效。患者上下颌骨达到协调，侧面形态得到很大改善，牙弓形态理想，前牙覆He覆盖关系正常。患者对治疗结果均表示满意。结论：正畸、正颌联合矫治腭裂术后严重上颌发育不良症是一种疗效显著、患者满意的治疗方法。     

组织补片在腭裂修复术软组织缺损中的应用

目的：探索一种软腭有效延长的新方法。方法：7例腭裂患者应用口腔组织补片植入鼻腔侧菱形创面,观察伤口愈合情况。结果：7例患者伤口均一期愈合,术后13d及63d鼻咽显微镜检查可见口腔组织补片全部成活,未见明显挛缩。结论：口腔组织补片的植入可去除或减少腭裂修复术中产生的鼻腔侧菱形创面愈合后的瘢痕,保证软腭延长的效果,有利于恢复语音功能。     

Velopharyngeal insufficiency after maxillary advancement in patients with cleft palate − a survey of risk assessment in the United Kingdom and Ireland

Patients with cleft lip and palate may require orthognathic surgery to correct severe impairments in midfacial growth. Maxillary advancement in this group, however, is linked to deterioration in velopharyngeal function (VPF), and it is not clear how cleft teams assess this risk. We therefore surveyed surgeons from 15 cleft units who provide orthognathic treatment, to gain an understanding of current practice in the UK and Ireland. A total of 16/21 surgeons from 14/15 units responded. While 14/16 surgeons agreed that these patients are at risk of a deterioration in VPF after maxillary advancement, two disagreed. Preoperative assessment of perceptual speech is required in all cases, but only 9/14 routinely did an instrumental assessment of VPF. One third of respondents thought that they could not identify “borderline” cases. There were differences in how surgeons obtained preoperative consent regarding deterioration in VPF, and whether surgical plans should be modified accordingly. There was considerable variation in current practice regarding risk, assessment, and management of potential changes in VPF after orthognathic surgery. A national forum for multidisciplinary discussion would allow for the standardisation of care across the UK and Ireland. Further study is needed to establish the effects of orthognathic surgery on VPF in this group, as well as the clinical benefits of instrumental assessments.