腭裂硬腭后缘裂隙宽度与上颌结节后缘平面宽度比例变化规律的研究

目的 通过研究单纯性腭裂患者硬腭后缘裂隙宽度与上颌结节后缘平面宽度的比例的增龄性变化,了解患者的腭裂畸形程度和生长发育之间的关联性。方法 应用回顾性研究的方法选取581例单纯性腭裂患者,年龄为8个月至38岁,根据术前测量时的年龄段共分为7组。在患者术前采用直接测量法所获得的各项测量数据中,选取上颌结节后缘平面宽度和硬腭裂隙宽度两项,以每位患者的硬腭裂隙宽度除以上颌结节后缘平面宽度的比值（即腭裂指数）来分析腭裂裂隙的相对宽度。结果 随着患者年龄增长,腭裂裂隙在上颌所占横向比例增大,即腭裂的畸形程度随患者年龄增长呈现上升趋势。结论 本研究证实了单纯性腭裂患者腭裂裂隙宽度和上颌结节后缘平面宽度与患者年龄增长存在关联性,腭裂的严重程度和手术难度会随着患者的年龄增长而逐步加重。     

腭裂胎鼠上颌畸形发育的实验研究

作者利用ＮＩＨ系小白鼠在妊娠第１０～１２天，每天注射大剂量的醋酸地塞米松（５０ｍｇ／ｋｇ），建立腭裂动物模型。然后，在妊娠第１６．５天取出胎鼠制作上颌标本，于扫描电镜下进行５个线距的测量并作统计学分析。结果表明，腭裂胎鼠的上颌宽度较正常组大，但原发胯长度、继发腭长度、上颌长度及牙槽突宽度较正常组小，提示先天性腭裂畸形伴有先天性的上颌发育不良。     

牙槽突和硬腭全裂隙植骨修复对腭裂上颌骨模型的生物力学影响

牙槽突及牙槽突加硬腭全裂隙植骨对腭裂上颌骨模型的生物力学影响。方法采用15岁男性患者头颅CT扫描DICOM数据建立3种单侧腭裂上颌骨三维有限元模型,通过叠加不同的植骨块形成牙槽突植骨修复及牙槽突加硬腭全裂隙植骨修复后的腭裂上颌骨模型。在上颌骨前牙区及两侧前磨牙区以正常上唇压力加载负荷,观察各种应力沿上颌骨分布的特点。结果未植骨模型,上颌骨段以变形和移位为主,各种应力集中于上颌骨前壁、牙槽突和腭板等处。植骨模型表现为应力分布均匀化。牙槽突植骨可以显著降低由于上颌骨变形而产生的剪应力和牙槽突的向内移位。牙槽突加硬腭全裂隙植骨可以使得应力分布更加均匀,但是与牙槽突植骨差异不大。结论唇裂修复手术后产生的压力是使未作植骨修复的牙槽突产生变形移位的主要原因。牙槽突植骨修复可以使腭裂上颌骨表面应力分布趋向均匀,生物力学意义重大。牙槽突加硬腭全裂隙植骨可以使得应力分布更加均匀,但与单纯牙槽突植骨效果相比,无显著性差异。     

腭裂及其修复术后上颌骨生长变化规律及机制的实验研究

采用连续动态观察狗头颅侧位和上下位定位Ｘ线片的方法，观察比较了正常对照组、腭裂组、腭裂两瓣法修复组和全裂隙植骨修复组的上颌骨长、宽、高三维方向上的变化过程。结果显示：腭裂和腭裂修复术后的上颌骨自身增长率的显著性改变始于术后２－４周，在术后１８周结束，与正常对照组相比，前颌骨的运动轨迹亦不同，揭示鼻中隔软骨的生长方向和前颌骨对上颌骨生长力传导的异常改变可能是腭裂和腭裂修复术上颌骨生长畸形的主要原因。     

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.     

早期腭裂修复术的临床评价

目的:探讨早期婴幼儿腭裂手术的临床疗效。方法:对232例腭裂患儿采用气管插管全身麻醉下进行腭裂修复术,按年龄大小分为早期组,延迟组及晚期组,对比观察术中、术后情况,并对157例患儿定期随访3～4年。评价各组临床疗效。结果:全部患儿均能耐受麻醉及手术,无严重并发症发生。早期组术中出血少,术后反应小,瘘孔率低,语音恢复好,对上颌骨发育无明显影响。结论:在麻醉、术后护理及手术技术条件具备下,早期手术具有明显优势。     

三维CT评价腭裂骨缺损对羊上颌骨发育的影响

目的 采用外科手术方式建立全层、全长腭裂骨缺损的山羊动物模型,并通过头颅CT三维重建来观察和研究单纯腭裂骨缺损对上颌骨生长发育的影响。方法 将8只山羊随机分为2组,组Ⅰ:正常组,4只;组Ⅱ:外科手术方式形成硬腭部0.5 cm×10 cm全层、全长硬腭骨裂隙,4只。于术后32周进行头颅螺旋CT拍摄,然后利用Mimics软件进行颅骨三维重建,对上颌骨长度、宽度和高度进行测量和统计分析。结果 上颌宽度的五个指标中:组Ⅱ均小于组Ⅰ,有统计学差异。上颌长度的一个指标(裂隙侧AH),组Ⅱ小于Ⅰ组,有统计学差异。上颌高度:各组间无统计学差异。结论 硬腭骨缺损阻碍上颌骨宽度和长度的生长发育,提示对腭裂骨缺损进行修复具有积极意义。     

两种腭裂修复方式治疗过宽不完全腭裂的临床效果比较

目的:比较兰氏法和改良兰氏法修复过宽不完全腭裂的临床效果。方法:选取2012年1月~2014年12月于徐州医科大学附属徐州市立医院接受腭裂修复术的不完全腭裂患儿40例,年龄2~5岁,裂隙宽度均大于2.5 cm,按接受腭裂修复的不同方式分为2组,实验组:20例,行改良兰氏法(兰氏法联合颊肌黏膜瓣)修复腭裂,对照组:20例,行兰氏法修复腭裂。2017年1月~2019年9月(术后5~7年)进行随访,此时两组患者年龄7~9岁,平均年龄为8岁。分别观察两组患者术区恢复状态,应用锥形束CT(CBCT)观察比较上颌骨发育情况,使用头颅侧位片评价腭咽闭合功能,并且进行语音清晰度评估。结果:相比于对照组,实验组的患者恢复较好,术区瘢痕轻微,上颌骨发育好,腭咽闭合完全,语音清晰度高。结论:对于裂隙过宽的腭裂患者,使用联合颊黏膜瓣的兰氏法可有效避免裸露的骨面,减轻了瘢痕增生,有利于上颌骨发育,增进腭咽闭合,提高了语音清晰度是一种更为值得推广的腭裂新手术方法。     

大年龄未手术腭裂患者上颌牙弓形态发育的研究

目的：探讨影响上颌牙弓生长发育的因素。方法：对２０例未手术腭裂患者的牙颌模型进行测量,并与２０名正常成人作对照分析。结果：大年龄未手术腭裂患者与正常成人在尖牙区宽度存在显著性差异（Ｐ〈０．０５）。而上颌深度及后牙区的宽度无显著性差异（Ｐ〉０．０５）。结论：在腭裂组,畸形的存在主要是在切牙区及尖牙区,对后牙区横向和垂直向的影响较小。     

Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the mandible demonstrated a minimal counter-clockwise rotation of the body (mandibular plane = −0.2 ± 3.2°) and ramus (−0.6 ± 4.3°). Maxillary DO in CLP had no significant effect on the shape or rotation of the mandible. The maxillary advancement remained stable after 1 year.     

Sagittal growth of the facial skeleton of 6-year-old children with a complete unilateral cleft of lip, alveolus and palate treated with two different protocols

OBJECTIVE: The purpose of the study was to compare sagittal growth of the facial skeleton of 6-year-old children treated in two cleft centres with different surgical protocols. MATERIAL AND METHODS: Each group consisted of 20 consecutive non-syndromic children with complete unilateral cleft lip, alveolus and palate. They all had presurgical orthopaedics with a passive plate and external strapping until lip repair. Centre 1 had lip repair at the age of 3 months and one stage palatal closure at the age of 1 year. Closure of the alveolar cleft was planned at 9 years with bone grafting. In centre 2 lip repair was performed at the age of 6 months, soft palate repair at 12 months and hard palate repair together with mucoperiosteal closure of the alveolar cleft at the age of 30 months. At the time of investigation, the children from both centres had not received any postoperative orthodontic treatment. Sagittal growth was evaluated on lateral cephalograms using the angles SNA, SNB, ANB and SNPg. For control, Droschl standards were used. The Mann-Whitney U test was used for statistical analysis. RESULTS: There was no statistically significant difference in SNA, SNB, ANB and SNPg between the centres at the age of 6 years. There were no children with a class III jaw relationship. The sagittal dimensions were close to the values of non-cleft control persons (Droschl standards). CONCLUSION: There was considerable similar sagittal growth of the facial skeleton in both centres which has not been affected by the different surgical protocols so far. A final evaluation should be delayed until the growth of the facial skeleton is complete.     

A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft)

Aim of the study was to evaluate the effect of infant orthopaedics (IO) on maxillary dimensions in infants with unilateral cleft lip and palate (UCLP). The study design was a prospective two-arm randomised controlled trial in parallel with three participating academic Cleft Palate Centres. Treatment was assigned by means of a computerised balanced allocation method. One group (IO+) wore passive maxillary plates during the first year of life, the other group (IO-) did not. Maxillary casts, made at birth, and at 15, 24, 48, 78 wk were digitised three-dimensionally. Before lip closure alveolar, midpalatal and posterior cleft width reduced significantly more in IO(+) than in IO(-). After lip closure, the alveolar cleft width reduced significantly more in IO(-). Until soft palate closure the slope of the palatal vault flattened significantly by IO. It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure. Therefore, infant orthopaedics as a tool to improve maxillary arch form could be abandoned. However, other outcome variables like facial and dental appearance, speech outcome, and cost-effectiveness need to be investigated further in order to assess the comprehensive effect of infant orthopaedics.     

Exceptional isolated cleft of the hard palate

We describe an extremely rare type of isolated cleft of the hard palate, which extends the published classification of the Type III cleft.     

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目的 探讨成年单侧完全性腭裂患者上颌骨发育情况。方法 选择2005年11月至2007年11月中国医科大学口腔医学院收治的16例未伴有唇裂的成年单侧完全性腭裂患者（腭裂组）,通过拍摄标准头颅定位X线片 ,测量相关头影指标,并同时与20名正常成人（正常组）的指标进行比较,评价其上颌骨在三维方向上的发育情况。结果 男性和女性研究群体中,上颌骨相对于颅底的位置关系以及上颌骨长度与颅底长度的比值、面中份的高度与全面高的比值、上颌宽距与上面宽的比值,腭裂组与正常组间差异均无统计学意义。结论 成年单侧完全性腭裂患者上颌骨的长度、高度和宽度的发育基本正常。     

Tooth agenesis patterns in bilateral cleft lip and palate

Bartzela TN, Carels CEL, Bronkhorst EM, Rønning E, Rizell S, Kuijpers-Jagtman AM. Tooth agenesis patterns in bilateral cleft lip and palate. Eur J Oral Sci 2010; 118: 47–52. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci
Individuals with cleft lip and palate present significantly more dental anomalies, even outside the cleft area, than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis and patterns of hypodontia in a large sample of patients with complete bilateral cleft lip and palate (BCLP). Serial panoramic radiographs (the first radiograph was taken at 10.5–13.5 yr of age) of 240 patients with BCLP (172 male patients, 68 female patients) were examined. Third molars were not included in the evaluation. Agenesis of at least one tooth was present in 59.8% of patients. Upper laterals and upper and lower second premolars were missing most frequently. Using the tooth agenesis code (TAC), 52 different agenesis patterns were identified, of which simultaneous agenesis of 12, 22, 15, 25, 35, and 45 was the most frequent pattern. Nine of the 240 patients showed combined BCLP and oligodontia.     

Short-term changes in temporomandibular joint function in subjects with cleft lip and palate treated with maxillary distraction osteogenesis

OBJECTIVES: To investigate the short-term effects of maxillary distraction osteogenesis (DO) on temporomandibular joint (TMJ) function in 21 subjects with cleft lip and palate (CLP). Design - Morphological changes in the maxillofacial region were measured using lateral cephalometric radiographs taken immediately before (pre-DO) and after DO (post-DO) and 1 year after DO (1-year follow-up). A questionnaire was evaluated using a visual analog scale. A chi-square test was used to compare the prevalence of TMJ symptoms between pre-DO and 1-year follow-up. The Spearman correlation coefficient was used to determine the correlation between changes in cephalometric variables and TMJ symptoms in association with maxillary DO. Statistical significance was set at p < 0.05. Results - The ANB (anteroposterior relationship of the maxilla with the mandible) angle and the mandibular plane angle at pre-DO, post-DO, and 1-year follow-up were -4.3 degrees , +5.8 degrees , +4.3 degrees and 32.1 degrees , 33.5 degrees , 33.6 degrees , respectively. The average amounts of anterior and downward movement of the maxilla at post-DO and 1-year follow-up were 8.3, -1.3 and 0.9, 1.1 mm, respectively. The prevalence of TMJ symptoms showed no significant increase in association with maxillary DO. Moreover, there was no significant correlation between changes in cephalometric variables and TMJ symptoms. Conclusion - These results suggest that there was no short-term (i.e., up to 1 year after DO) effect of maxillary DO on TMJ function in subjects with CLP.