小切口自体髂骨松质骨移植牙槽突裂修复术

唇腭裂畸形治疗已由单纯关闭唇腭部裂隙 ,发展到序列治疗[1] 。术前后正畸 ,腭裂术后语音训练 ,腭咽闭合不全的二次手术 ,应用自体髂骨松质移植 ,行牙槽裂修复术 ,已成为唇腭裂畸形序列治疗的重要步骤之一。它可恢复上颌牙弓的完整性 ,彻底关闭口鼻腔前庭瘘 ,为正畸及正颌外科打下基础 ,并帮助矫正鼻底继发塌陷畸形。国外在 80年代已广泛开展 ,对其成功率、并发症、影响成功的因素等方面已有文献报道 ,其结论有所不同[2～ 4 ] 。国内在 90年代初开始了自体骨移植牙槽突裂修复术。本文通过同一术者应用圆筒形取骨器 ,小切口自体髂骨松质行牙…     

98例唇腭裂患者牙颌面畸形的正畸-正颌外科联合治疗分析

目的 评价正畸-正颌外科联合治疗唇腭裂伴牙颌畸形的效果。方法 回顾分析1990年1月-2000年6月期间在上海第二医科大学和香港大学口腔颌面外科收治的98例唇腭裂伴牙颌面畸形患者，男性52例，女性46例，年龄16—40岁，平均年龄20．5岁。所有患者均在手术前完成正畸治疗，排齐牙列，关闭间隙等。上颌骨手术采用标准化截骨前移手术，伴牙槽裂的患者同期行髂骨取骨植骨术。手术方法包括：①牙槽裂已植骨修复者。采用标准Le fortⅠ型截骨前移术；②牙槽裂未植骨修复的单侧腭裂患者，采用改良上颌骨截骨手术，即非裂侧用Le Fort Ⅰ型截骨术,裂隙侧采用牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨术；③牙槽裂未植骨修复的双侧腭裂患者，采用前颌骨截骨手术(Wunderer法)和双侧上颌骨后份牙槽骨截骨手术(Schuchardt法)，同期行牙槽裂植骨修复术。骨间采用小钛板坚强内固定。随访时间1／2—5a。平均2．6a。结果 术后患者的面型均取得了明显的改善，面部比例协调，咬合关系相对稳定。结论 正畸-正颌外科联合治疗唇腭裂伴牙颌面畸形的效果稳定，应该作为这类畸形治疗的常规方法。     

唇腭裂序列治疗指南

唇腭裂序列治疗是指以唇腭裂患者达到良好外形、正常功能和心理健康为目标, 通过多学科协作, 共同制订治疗计划, 以外科整复为主要手段, 在最佳的时间点进行最合适治疗的团队治疗模式。唇腭裂序列治疗团队是一个多学科组成的医疗团队, 建议至少包括口腔颌面外科医师、口腔正畸医师、病理语音师、心理咨询师等组成。本指南是由中华口腔医学会唇腭裂专业委员会于2019年正式申请立项并获学会批准, 于2022年正式发布。本指南描述了适宜中国唇腭裂患者人群的序列治疗相关诊疗技术, 涵盖唇裂、牙槽突裂及腭裂的初期、二期手术、正畸治疗、语音治疗、护理、心理等方面, 适用于中国开展唇腭裂序列治疗的临床工作。     

牵张成骨术在腭裂畸形矫治中的应用和研究进展

牵张成骨是矫治骨骼畸形及缺损的一种新型外科技术,它对先天性腭裂的各种畸形进行整复和矫治已取得明显效果。本文阐述了腭裂术后继发性面中份发育畸形利用该技术矫治的优点、术期的选择、术中注意事项及如何提高矫治精度和质量,并对腭咽闭合不全、上颌骨横向发育不足、牙槽突裂及原发性腭裂等颌骨畸形及缺损的矫治方法、效果及相关机理进行了介绍。     

牵张成骨术在腭裂畸形矫治中的应用和研究进展

牵张成骨是矫治骨骼畸形及缺损的一种新型外科技术，它对先天性腭裂的各种畸形进行整复和矫治已取得明显效果。本文阐述了腭裂术后继发性面中份发育畸形利用该技术矫治的优点、术期的选择、术中注意事项及如何提高矫治精度和质量，并对腭咽闭合不全、上颌骨横向发育不足、牙槽突裂及原发性腭裂等颌骨畸形及缺损的矫治方法、效果及相关机理进行了介绍。     

唇腭裂牙槽突裂同期植骨修复术

先天性牙槽突裂是唇、腭裂常见的伴发畸形,并造成口腔形态和功能异常以及面部整体发育不协调。早期修复牙槽突畸形,恢复上颌骨骨性结构的完整和连续性,有助于恢复口腔正常形态和功能,利于面中、下部骨性支架的生长发育,是唇腭裂序列治疗中极为重要的一环。为此,近3年来作者在行唇、腭裂修复术的同时进行牙槽突一期植骨修复术(简称同期手术),近期效果满意,并对此进行讨论。1材料和方法1.1 临床资料1997年5月～1999年12月在西安交通大学口腔医学院颁面外科唇腭裂治疗科进行唇、腭裂修复术的患者中选择26例行牙槽突裂同期植骨修复术,其中男20例,女6例,年龄6月～16岁,平均5.2岁。26例均合并有牙槽突裂,其     

颏部取骨牙槽突裂修复术78例报告

目的 探讨颏部取皮质骨于唇腭裂伴齿槽裂整复术中同期植骨的可行性及临床效果。方法 78例唇腭裂伴齿槽突裂患者整复术中，同期自下颌骨颏骨取骨植入牙槽突裂隙。结果 78例术后均一期愈合，容貌有较大改观。结论 该方法成功地恢复了上颌牙槽骨弓的连续性，保证了颌骨的稳定性，有利于上颌牙齿的正常萌出，促进了上颌骨的发育，同时矫正了患侧鼻底及上唇塌陷畸形，为正畸治疗打下基础，是唇腭裂序列治疗必要步骤。     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

牙槽突裂治疗方法的研究进展

牙槽突裂整复术现已成为唇腭裂序列治疗的重要环节,上颌骨裂隙骨移植在20世纪初就已提出,但至今,对牙槽突裂的治疗方法仍存在许多争议,本文就牙槽突裂整复术的手术时机、植入物选择、手术方法、术前术后正畸干预等方面的研究进展作一综述。     

牙槽突裂植骨研究进展

<正>先天性唇腭裂的治疗已由早期单纯关闭唇腭裂隙发展到序列治疗。它包括正畸治疗、矫形修复、牙槽骨缺损修复、正颌外科治疗。以及耳鼻喉科治疗及语音训练和心理治疗等综合治疗方法。牙槽突裂植骨术是其序列治疗的一个重要环节,它可以恢复上     

Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair: an audit of 211 children born between 1990 and 2004.

OBJECTIVE: We present an audit of primary cleft palate surgery at our unit, including rates of oronasal fistula development, speech outcomes, and rates of velopharyngeal insufficiency requiring secondary surgery. DESIGN: A retrospective study of patients with all cleft palate types, born between January 1990 and December 2004, who underwent primary palatoplasty at Middlemore Hospital, Auckland, New Zealand. PATIENTS: The study included 211 patients, collectively operated on by five different surgeons. RESULTS: The overall rate of true fistula development was 12.8% over a mean follow-up period of 4 years 10 months. The incidence of true fistulae that required surgical repair was 8.1%. Fistula rates were higher for more severe degrees of clefting but were not affected by gender or type of surgical repair. Overall, 31.8% of the study population had some degree of hypernasality following primary palatoplasty. Secondary surgery for velopharyngeal insufficiency was required in 13.3% of patients. Following surgical correction of velopharyngeal insufficiency, no patients were reported to have appreciable hypernasality and 21.7% were reported to have mild hypernasality, a result comparable to previously published audits. The requirement for secondary surgery was higher in patients with more severe clefts. CONCLUSION: Our results are comparable to other recent studies. We believe that highly coordinated cleft care helps ensure such outcomes. These data provide a benchmark against which we can measure future performance in our attempts to improve outcomes of cleft repair.     

Primary cheiloplasty on an elderly man: case report and review of the literature

It is rare for surgeons in the United States to perform primary repair of a cleft lip on an adult. However, in developing nations with limited specialized health care, late presentation for primary cheiloplasty occurs due to limitations in access to care, lack of awareness of treatment availability, and inability to afford treatment. Oral and maxillofacial surgeons who participate in humanitarian surgical mission trips to the developing world may encounter this subpopulation of cleft patients. The following case report describes the repair of an incomplete bilateral cleft lip in a 68-year-old man performed during a mission trip to rural Bangladesh. Based on an extensive literature search, this is the oldest patient to have undergone primary cheiloplasty reported in the English-language surgical literature.     

Correction of earlobe cleft with tongue-in-groove technique

Cleft earlobe is a common surgical problem, which can be easily managed in an outpatient setting. There are various surgical techniques to repair this condition. Our method, the "tongue-in-groove technique" for the cleft earlobe repair, composed of 3 right-angled Z-plasties on the anterior, inferior, and posterior surfaces of the earlobe, is described.Between January 2007 and January 2010, a total of 13 patients presenting earlobe cleft underwent surgical correction using this tongue-in-groove technique. All patients were women and had a traumatic complete cleft earlobe. The lesions were unilateral in all cases: 8 women had left-side lesion, and 5 women had a right-side lesion.The patients have been followed up for a period ranging from 6 months to 3 years after the operation. All patients healed uneventfully, without any complications. The resulting scar was minimal and aesthetically acceptable.Cleft earlobe is the most common complication of the ear that requires surgical correction. We introduce our method, the tongue-in-groove technique, which is aesthetically acceptable, preserves more volume of the earlobe, and is easy to perform.     

单侧唇裂鼻畸形的初期和二期整复

单侧唇裂患者鼻畸形的整复，已被认为较唇裂本身修复更难的课题。因为唇裂患者鼻畸形的病理解剖较唇裂更复杂，且鼻又位于面部的显赫位置，任何不对称畸形都可产生比唇部畸形更不协调的感观。长期以来，矫正单侧唇裂患者的鼻畸形未被列入初期唇裂整复的重要内容，其主要论据是唯恐手术对鼻翼软骨的创伤，会引起鼻翼软骨生长发育受限。本文报道了对手术方法的改进和实践，以供临床参考。     

Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip,alveolus, and palate: A clinical report

PatientA 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention.DiscussionThe alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate.ConclusionAs a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.     

Early and late treatment of unilateral cleft nasal deformity.

Surgical techniques have been developed to correct nasal deformity associated with unilateral cleft lip, alveolus, and palate. This deformity can be significantly corrected during the primary cleft lip repair, as performed by the technique described by the author. Secondary corrective procedures focus mostly on skeletal support and lining distortions as well as on rearrangements of lower lateral cartilages. At the final stage, esthetic appearance can be significantly improved by contour remodeling with the addition of cartilage and/or bony implants. Choice of surgical technique depends upon the severity of the deformity and the experience and proficiency of the surgeon. At the present time, correction of the nasal deformity associated with a unilateral cleft is an integral part of primary cleft lip repair and part of multidisciplinary management of cleft deformities.     

单侧唇裂鼻偏曲的分类与治疗

目的 总结单侧唇裂鼻偏曲的分类和相应的外科治疗方法,以提高临床治疗效果.方法 分析2007至2009年在上海交通大学医学院附属第九人民医院口腔医学院唇腭裂治疗中心治疗的单侧唇裂继发鼻畸形176例.根据外鼻锥与面中线的关系,将唇裂鼻偏曲分为3类:骨性鼻偏曲、软骨性鼻偏曲、鼻小叶偏曲,与之对应的手术方法为:骨性鼻锥矫正术、软骨性鼻锥矫正术、鼻小叶矫正术和鼻中隔矫正术.结果 176例患者临床检查无鼻偏曲者93例(53%),伴鼻偏曲畸形者83例(47%).83例鼻偏曲患者中,骨性鼻偏曲8例(10%);软骨性鼻偏曲29例(35%);鼻小叶偏曲46例(55%).以上患者接受相应矫正手术,大部分术后获得满意的效果.结论 单侧唇裂继发鼻畸形患者中近50%可出现鼻偏曲,其中骨性鼻偏曲畸形患者最少,鼻小叶偏曲畸形最多.唇裂鼻偏曲的分类对临床治疗唇裂术后鼻偏曲畸形具有指导意义.     

基于可吸收生物膜的软腭后退腭裂修复方案及其临床应用

目的:为解决常规腭裂修复术存在的问题,利用组织引导再生技术的原理,设计基于膜引导的腭裂整复方案,为需要后退软腭的腭裂修复提供新的途径或方法。方法:使用聚-DL-乳酸制成厚0.5mm、有一定强度与韧性的可吸收生物膜。先行软腭成形术,然后剖开硬腭裂隙边缘,于口腔侧骨膜瓣与腭骨水平板间形成一间隙,将膜植于其中并固定,利用膜的引导再生特性与桥梁支架作用,引导两侧软组织向中线生长而关闭裂隙。选择3-10岁需行软腭后退的腭裂患者19例,于全麻下行软腭后退成形术及硬腭裂隙植膜的临床试验,临床追踪观察6个月,了解腭裂修复的临床效果。结果:该腭裂修复方案切实可行,全部患者均按设计方案实施了腭裂修复术,方法简单,操作容易。3个月后19例患者均获临床一期愈合,6个月时临床观察软腭形态佳,腭咽闭合良好,达到腭裂硬腭软组织缺损修复、保证软腭充分后退的目的。结论:基于膜引导组织再生技术的后退软腭的腭裂修复方案,是一个创新的腭裂修复方案,手术操作简单、实用,临床效果满意,为腭裂修复提供了新的途径及方法。     

Unilateral cleft lip-nose repair: a 33-year experience

A 33-year experience with a proven method of repair for primary unilateral cleft lip-nose is presented. The technique used by the authors has been improved by modifications that have led to better symmetry and balance with less scarring. The technique involves ignoring the abnormal skeletal base, use of perisurgical passive orthopedics, and primary surgical correction of the nose and lip. Improved results can consistently be achieved by approaching the nose laterally through an inferior turbinate incision, freeing completely the lip and nose components so they can be translocated to match the normal side. Accurate positioning and symmetry of the alar base and sill is aided by limiting the transverse incision in the lip. This results in less scarring and improved sill reconstruction. The technique for floor-of-the-nose reconstruction avoids a small nostril without discarding any tissue. It is important to leave tissue in the floor to compensate for the skeletal deficiency. The senior author has performed this procedure in more than 750 patients. Approximately 35% have or will require minor secondary reconstruction at age 5 years. An aesthetic rhinoplasty is performed on most patients after growth is complete. Self-esteem is enhanced by early nasal reconstruction and has become the authors' standard of care for rehabilitation of the unilateral cleft lip and palate. Many surgeons remain reluctant to perform primary nasal repair. With careful proper technique, any experienced cleft surgeon can learn this procedure. For the beginner, conservatism is recommended.     

Repair of bilateral complete cleft lip and nasal deformity--state of the art.

OBJECTIVE: Dissatisfaction with the stigmata of repaired bilateral cleft lip has stimulated surgeons to change conventional operative strategies. The old staged labial repairs, one side and later the other, have been replaced by simultaneous closure. For nasal correction, most surgeons no longer believe that the columella is deficient, and thus there is no need to recruit tissue from the lip or nostril sills as a secondary procedure. The columella is concealed in the nose. The new strategy is to construct the columella and nasal tip by anatomic positioning of the alar cartilages and sculpting the investing skin. Furthermore, nasal correction is done at the time of bilateral labial repair and, whenever possible, the alveolar clefts are closed as well. The goal is primary repair of the primary palate. CONCLUSION: Although the principles of synchronous repair of the bilateral complete cleft lip and nasal deformity are established, the techniques continue to evolve. Bilateral nasolabial repair requires continual study of three-dimensional form and fourth-dimensional changes that are normal and altered by the deformity. Every surgeon who lifts a knife to care for these children has an obligation to periodically assess outcome.