双侧唇裂或唇腭裂患者唇裂术后鼻唇畸形的Ⅱ期整复治疗

目的：介绍双侧唇裂／唇腭裂患者术后鼻唇畸形的Ⅱ期整复方法及效果。方法：将50例患者按鼻畸形、唇畸形的不同，分别采用三种不同的术式治疗。对上唇组织较多者，采用鼻底叉形瓣延长鼻小柱，上唇创缘直接缝合法；对鼻及上唇畸形较轻者，采用Noordhoff整复法治疗；对鼻唇畸形严重并有上唇过紧者，采用前唇组织瓣延长鼻小柱，下唇Abbe瓣旋转修复上唇正中缺损。结果：50例患者中，30例Ⅱ期修复后鼻形态正常，鼻孔大小对称，有良好的鼻堤，鼻小柱长度适中；恢复了上唇的高度和宽度，有明显的人中嵴、唇峰及唇珠，上下唇和谐。11例患者一般。结论：本文介绍的三种术式适用于不同类型双侧唇裂术后鼻唇畸形的患者。     

双侧齿槽嵴裂二期植骨术后的植骨效果分析

目的 分析双侧齿槽嵴裂二期植骨术后的植骨效果及影响植骨效果的因素。方法 对５１例行双侧齿槽嵴裂二期植骨的唇腭裂患者作回顾性研究。对术后随访的Ｘ线片进行植骨效果的客观评价，并根据手术时裂隙处尖牙的萌出情况及手术年龄，将患者分为Ａ、Ｂ、Ｃ三组，Ａ组为尖牙萌出前，Ｂ组为尖牙萌出后，Ｃ组年龄大于或等于１６岁，分析不同组别的植骨效果，同时分析手术类型与植骨效果的关系。结果 ①双侧齿槽嵴裂二期植骨的临床成功率     

双侧完全性唇腭裂患者的同期腭裂修复与齿槽嵴裂植骨

目的　分析 8岁以上双侧完全性腭裂患者同期行腭裂修复与齿槽嵴裂植骨的可行性及植骨效果。方法　对 15例同期行腭裂修复与齿槽嵴裂植骨的双侧完全性唇腭裂患者作回顾性研究。分析手术时间、术中出血、术后恢复和创口愈合情况。对术后随访的X线片进行植骨效果的客观评价。结果　所有手术均顺利完成 ,平均手术时间延长 5 2分钟 ,没有明显增加术中出血量 ,患者术后恢复好 ,无创口感染和植入骨暴露 ,植骨的临床成功率为 83.3% ,其中以 8～ 11岁组的成功率最高 (93.8% )。结论　双侧完全性腭裂患者的同期腭裂修复和齿槽嵴裂植骨是安全和可行的 ;对于 8岁以上的腭裂未修复的双侧完全性唇腭裂患者 ,均应同期完成腭裂修复与齿槽嵴裂植骨 ;双侧齿槽嵴裂同期植骨的最佳手术时间与二期植骨相同 ,为尖牙萌出前 ,年龄在 8～ 11岁之间。     

完全性唇腭裂齿槽裂植骨与鼻畸形的整复

对不同手术方法整复　齿槽裂与鼻畸形的比较分析 ,为完善唇腭裂的序列治疗提供参考。方法　将2 2例单侧完全性唇腭裂按分期整复组与同期整复组进行观察。通过对口鼻瘘封闭、尖牙萌出、鼻唇部美观等三种临床指标测定 ,进行统计学分析。结果　分期整复组的综合分析指标数高于同期整复组 ,有显著性差异 (P<0 .0 5 )。结论　完全性唇腭裂鼻畸形的整复在完善的齿槽裂手术后进行 ,能够取得更好的临床治疗效果。     

双侧唇裂/唇腭裂术后继发畸形的临床分类研究

目的：对双侧唇裂／唇腭裂术后继发畸形进行临床分类研究。方法：选中南大学湘雅医院口腔颌面外科双侧唇裂／唇腭裂术后继发畸形患者50例作为研究对象，观察鼻部、唇部、He／颌骨畸形等19项内容，它们分别是：鼻尖低平、鼻翼塌陷、双侧鼻孔不对称、鼻堤缺失、鼻小柱短小；上唇过紧、上唇过松、人中及唇峰不显、唇珠缺如、口哨畸形、红唇不显；前牙反He、313移位或缺失、牙槽嵴裂、牙弓小、牙列不齐、前牙槽嵴缺失和上颌后缩。结果：50例双侧唇裂／唇腭裂术后畸形患者均有鼻尖低平、鼻翼塌陷、双侧鼻孔不对称、鼻堤缺失、鼻小柱短小、人中不显、唇峰不显、唇珠缺如。50例患者中，42例有牙槽嵴裂和牙列不齐；33例行加长法Ⅱ期修复双侧唇裂者均有前牙反He、牙列不齐和上颌后缩；28例有口哨畸形存在。结论：双侧唇裂／唇腭裂I期修复后仍有鼻、唇及He或颌畸形存在，对这些畸形必须讲行Ⅱ期整复治疗．     

唇腭裂患者齿槽嵴裂植骨修复术后随访结果分析

目的分析影响齿槽嵴裂修复术后效果的因素。方法对同一术者所行齿槽嵴裂植骨术的唇腭裂患者５４例进行回顾性研究，所有患者均有术前及手术后３个月以上的完整资料。分析植骨区的Ｘ线组织影像的临床分级与手术年龄、裂类型及手术类型等的关系。结果①齿槽嵴裂的植入骨成活率为９４％，临床成功率为８９％；②齿槽嵴裂的植骨效果与患者的年龄有关，１８岁以上患者植骨的临床成功率明显低于其他年龄患者；③除腭瘘修补术外，齿槽嵴裂植骨术与其他唇腭裂手术同期完成者其临床成功率与单纯行齿槽嵴裂植骨术的临床成功率相似；④单纯伴发唇裂或不完全腭裂的齿槽嵴裂植骨效果优于完全性唇腭裂的齿槽嵴裂植骨效果。结论良好植骨床的形成和植骨区严密的缝合是保证齿槽嵴裂植骨成功的关键     

Bio-Oss与引导骨再生胶原膜联合植入牙槽嵴裂的临床观察

目的 观察进入青春期唇腭裂的患者鼻畸形修复及牙槽嵴裂同期植入天然多孔骨无机材料(Bio-Oss)及可吸收双层生物胶原膜(Bio-Gide)的临床效果。方法 对30例同期行牙槽嵴裂植入天然多孔骨无机材料及可吸收双层生物胶原膜与鼻畸形修复进行研究，对术后随访的X线片进行效果客观评价。结果 随访6～12月，其中1例拆线后牙龈处伤口裂开，但无Bio-Oss颗粒脱出，经换药伤口愈合。其余效果满意。结论 对于错过植骨最佳时期进入青春期的患者，牙槽嵴裂植入天然多孔骨无机材料能够代替植入的松质骨，避免再开辟第二术区给患者造成痛苦，联合应用可吸收双层生物胶原膜，进一步保障了植入天然多孔骨无机材料的成功。     

用髂骨修复唇腭裂患者齿槽裂的临床研究

目的　评价用髂骨修复唇腭裂患者齿槽裂的临床效果。方法　对 10 2例唇腭裂患者的齿槽裂应用髂骨植骨修复 ,术后随访 6个月以上。对其植骨后的临床效果进行评价。结果　所有患者的手术均顺利完成 ,术后 6个月植骨结果为 :优 4 1例(4 0 .2 % ) ,良 4 6例 (4 5 .1% ) ,差 15例 (14 .7% ) ,临床成功率为 85 .3% ,其中以 8～ 11岁组的成功率最高 (93.1% )。结论　用髂骨修复唇腭裂患者齿槽裂是一种有效的治疗方法     

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.     

Prosthetic Management of Nasoalveolar Clefts in Newborns: A Series of Case Reports

Orofacial clefts are congenital deformities that manifest at birth causing difficulty in breathing and feeding. The severity depends on the extent of involvement that can include lip, alveolar ridge, hard palate and soft palate. Prosthodontic management poses a great challenge due to lack of cooperation from the patient and the inadequate size of oral cavity. Two case reports of prosthodontic management of nasoalveolar clefts that were treated in our department are presented.     

1988～1992年中国非综合征性唇腭裂发生率的动态变化

目的　了解我国 1988～ 1992年非综合征性唇腭裂发生率的动态变化趋势及流行病学特征。方法　采用以医院为单位的整群抽样方法 ,对 1988～ 1992年期间我国 5 0 0多所医院孕 2 8周至产后 7天的 3 2 46 40 8例围产儿 ,4349例非综合征性唇腭裂病例进行回顾性分析。结果　我国 5年非综合征性唇腭裂发生率无显著性差异 ,城乡发生率也无显著性差异。男性发生率为 14.9/万 ,女性发生率为 11.7/万 ,差异有显著性 ,非综合征性唇腭裂的性别比为 1.3∶ 1。三类非综合征性唇腭裂各自的发生率为 :CL± P:7.8/万 ,CL:3.8/万 ,CP:1.8/万。结论　我国非综合征性唇腭裂发生率无变化趋势 ,城乡无差异。男性高于女性 ,唇裂合并腭裂为最常见类型。     

Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire‐bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.     

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.     

自体颏骨、Bio-Oss骨粉、胶原膜联合修复牙槽裂

目的 研究唇腭裂术后牙槽裂植骨修复的新方法。方法 21例牙槽裂患者，取自体颏骨松质骨并与骨替代材料Bio-Oss松质骨颗粒混合后植入牙槽裂术区，在植入骨表面覆盖Bio-Gide胶原膜。Bio-Oss松质骨起弥补颏骨取骨量不足、支撑牙槽裂宽度和高度的作用，胶原膜对植入骨组织及周围血凝块有良好屏障保护作用，通过3种材料的优势组合，共同促进牙槽裂术区骨组织的重建。结果 21例患者术后伤口均获一期愈合，口鼻瘘得以严密关闭。随访6个月～3年，重建牙槽突外形和功能Ⅰ级10例，Ⅱ级8例，Ⅲ级2例，Ⅳ级1例。20例术后顺利进行后续正畸或正颌手术治疗，1例需再次进行植骨手术。结论 自体颏骨松质骨、Bio-Oss松质骨颗粒、Bio-Gide胶原膜联合应用修复唇腭裂术后牙槽裂具有方便可行、骨生成潜能好、患者痛苦少、容易被接受的优点。     

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

2531例先天性唇腭裂畸形特征与发病因素分析

目的研究唇裂±腭裂中各发病因素的作用方法对2531例唇裂±腭裂患者的临床资料进行详细调查与分析结果单纯性唇裂1452例唇裂伴腭裂1079例有确切遗传史者为204例占8.1%有服药史者怀孕初期为831例占32.8%结论唇裂的病因是复杂的遗传因素与特定的环境因素的协同作用是其根本病因     

Nasoalveolar Molding with Active Columellar Lengthening in Severe Bilateral Cleft Lip/Palate: A Clinical Report

Severe bilateral cleft‐lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5‐day‐old male infant with bilateral cleft‐lip‐palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft‐lip/palate cases, simple modifications in the appliance can achieve rapid results.     

1996～2002年大连地区先天性唇腭裂的调查研究

目的：了解大连地区唇腭裂发生情况,比较综合征性唇腭裂与非综合征性唇腭裂的流行病学差异。方法：对大连地区38家县级以上助产医院1996～2002年期间的新生儿的出生缺陷资料进行整理,对263例非综合征性及38例综合征性唇腭裂病例进行回顾性分析：结果：1996～2002年大连地区非综合征性唇腭裂发病率为12．0／万;综合征性唇腭裂发病率为1．7／万：在66例总唇裂患儿中．有4例伴发全身其它畸形．占6．1％;在53例总腭裂患儿中,有8例伴发全身其它畸形,占15．1％：结论：腭裂伴发其它畸形的发生率要高于唇裂伴发其它畸形;腭裂伴发其它畸形,男性发病多于女性;非综合征性与综合征性唇腭裂在患儿体重及转归上有显著性差异。