腭部岛状瓣修复腭裂3例报道

在常规的腭裂修复中 ,除了因腭部裂隙本身过宽外 ,术中设计错误 ,操作不当 ,均可导致鼻侧黏膜关闭困难 ,以致术中就遗留穿孔的隐患。我科应用3例腭部岛状瓣修复腭裂 ,3例为单侧完全腭裂 ,年龄平均为 5岁 ,裂隙最宽者为 2cm ,均采用二瓣法行腭裂根治术。 2例因术者经验不足在裂隙剖开时 ,没有留有足量的鼻侧粘骨膜 ,导致缝合困难 ,其中 1例鼻腔创缘距已超过 1cm ,1例因本身鼻侧粘骨膜过薄 ,分离时不慎出现裂口而不能直接缝合。在此情况下 ,改用腭部岛状瓣修复术。　　基于术前拟行的均为二瓣法修复腭裂 ,可以非常容易决定岛状瓣的切取 ,3例均…     

不等距切口腭裂修复术9例报告

腭裂术后创口裂开是一较棘手的并发症,笔者在腭裂修复术中设计裂隙边缘不等距切口,经9例修复治疗,效果良好,现报道如下。行腭裂修复术剖开裂隙边缘时,一侧切口作在裂隙边缘鼻侧约3～5mm处,另一侧切口作在腭侧5～7mm处(图1)。由于两侧切口不等距,拉拢缝合后,鼻腭侧缝合口相距0.5～1cm左右(图2),使鼻腭侧两个缝合创面不直接接触,互相覆盖,互相保护。如一面缝     

舌肌黏膜瓣修复腭裂术后硬腭巨大穿孔的临床研究

目的:探讨舌肌黏膜瓣修复腭裂术后硬腭区巨大穿孔的临床应用特点。方法:采用前蒂舌肌黏膜瓣对15例先天性腭裂术后硬腭区巨大穿孔的患者进行手术修复。在腭部穿孔区周缘偏口腔侧环形切开粘骨膜,向内反转并对位缝合,以封闭穿孔区的鼻腔侧;在舌背部设计相对应的前蒂舌肌黏膜瓣,将其向前翻转后覆盖腭部创面对位缝合,以关闭穿孔区的口腔侧。结果:除1例患者舌肌黏膜瓣与腭部穿孔区边缘出现微小裂孔外,其他14例患者的伤口均愈合良好。所有病例未发现舌体运动受限、感觉及味觉减退,术后语言功能得到明显改善。结论:舌肌黏膜瓣血供丰富,应用方便灵活,是修复腭裂术后硬腭区巨大穿孔的有效方法。     

舌肌黏膜瓣修复腭裂术后硬腭裂术后硬腭巨大穿孔的临床研究

目的:探讨舌肌黏膜瓣修复腭裂术后硬腭区巨大穿孔的临床应用特点.方法:采用前蒂舌肌黏膜瓣对15例先天性腭裂术后硬腭区巨大穿孔的患者进行手术修复.在腭部穿孔区周缘偏口腔侧环形切开粘骨膜,向内反转并对位缝合,以封闭穿孔区的鼻腔侧;在舌背部设计相对应的前蒂舌肌黏膜瓣,将其向前翻转后覆盖腭部创面对位缝合,以关闭穿孔区的口腔侧.结果:除1例患者舌肌黏膜瓣与腭部穿孔区边缘出现微小裂孔外,其他14例患者的伤口均愈合良好.所有病例未发现舌体运动受限、感觉及味觉减退,术后语言功能得到明显改善.结论:舌肌黏膜瓣血供丰富,应用方便灵活,是修复腭裂术后硬腭区巨大穿孔的有效方法.     

丁卡因过敏性休克1例

临床资料1.分别选择单侧Ⅱ°、Ⅲ° ,双侧Ⅲ°腭裂各 2例 ,均为唇裂术后患者 ,其中 2例裂隙宽大。2 .手术方法2 .1　按两瓣法常规作松弛切口 ,凿断翼钩 ,适当游离腭前神经血管束 ,掀起黏骨膜瓣 (图 1)。2 .2　解剖裂隙缘 ,对裂隙较宽者 ,首先增加鼻腔侧裂隙缘的宽度 ,确保裂隙缘创面整齐 ,缝合后无张力 ,无撕裂。缝合软腭裂隙的肌层及口腔层 ,形成半菱形创面 (图 1)。2 .3　将一侧 (单侧腭裂取黏骨膜瓣短的一侧 )黏骨膜瓣旋转推进插入至半菱形创面 ,使黏骨膜瓣前端与菱形创面最远端中点对位缝合 ,将对侧黏骨膜瓣骑跨在已旋转推进后的黏骨膜…     

犁骨瓣固定于硬腭用以修补完全腭裂

为了获得腭裂裂隙的双层关闭,采用犁骨瓣修补完全腭裂。然而,有时鼻侧粘膜组织不足,将犁骨瓣缝合于鼻侧粘膜,操作相当困难,裂隙宽时难度更大。作者介绍一种将犁骨瓣固定于裸露硬腭骨边缘的简单而可靠的方法。操作方法是:用2毫升注射器连接22号皮下注射针头,在硬腭裂隙两侧边缘,钻3～4个孔(图1)。因腭骨薄弱,操作应轻柔。固定犁骨瓣的缝合为:从鼻侧到口腔方向穿过骨孔,再由口腔至鼻侧穿过犁骨瓣,在鼻侧打结(图2)。用4/8或5/8     

腭裂术后复裂、穿孔72例手术治疗

目的:探讨腭裂术后复裂、穿孔的手术修复方法。方法:对13例患者行直接剖开缝合;20例患者行两侧松弛切口,剖开裂隙缝合;19例患者施行转瓣手术;20例患者接受了两瓣法腭裂修复术。结果:随访4～6周后,除3例患者于原位出现复裂,其余伤口均愈合良好。结论:除腭垂部及部分软腭部小的穿孔外,多不主张直接缝合,尤其是硬腭部的穿孔多用转瓣及两瓣腭裂修复术,无张力及充分的组织瓣覆盖是保证手术成功的必要条件。     

一种后推手术修复完全性单侧腭裂

修复腭裂的目的,当然是再造一个长而活动的上腭,使其在说话时有良好的胯咽闭合。本文作者介绍一有效的将腭推后,用鼻粘膜瓣及铰链式口腔粘骨膜瓣修复腭裂手术。术后发音及腭部长度说明这一手术是有价值的。手术方法在健侧的硬腭切口较一般切口更为靠外,以便获得一个有足够宽度的瓣(封闭前份腭裂)。内侧切口与裂隙边缘之间的距离视裂隙的宽度而定(图1)。     

颊肌黏膜瓣在腭裂术后硬腭穿孔修补术中的临床应用

目的　研究颊肌黏膜瓣在腭裂术后硬腭穿孔修补术中的可行性及临床应用。方法　10例6～13岁唇腭裂患者腭裂术后并发硬腭部穿孔及前庭瘘,穿孔大小约5～10mm×8～15mm ,手术方法:将硬腭前分穿孔周边偏口腔侧切开达骨面,在口腔侧向鼻腔侧翻瓣,鼻腔侧黏膜作内翻缝合。制作同侧颊肌黏膜组织瓣并将瓣旋转绕过牙槽裂达腭侧与口腔侧黏骨膜对位褥式加间断缝合,碘仿纱布加压固定,术后10d拆线,无需断蒂。结果　所有病例伤口均一期愈合,组织瓣血供良好,未出现复裂。结论　应用颊肌黏膜瓣修补腭裂术后硬腭前分穿孔能达到良好效果,该组织瓣血供丰富,可操作性强,为修补腭裂术后穿孔提供一种有效的方法。     

单瓣法修复腭裂22例临床观察

目的观察单瓣法手术治疗Ⅱ度腭裂和单侧完全性腭裂的临床疗效。方法应用单瓣法修复22例腭裂患儿,利用其患侧的腭黏骨膜瓣关闭裂隙,并制备腭骨瓣后退延长软腭。结果本组22例患儿均未输血;术中测量软腭后退长度平均7.5mm;术后切口愈合良好,发音效果改善明显。结论单瓣法治疗Ⅱ度腭裂和单侧完全性腭裂,创伤小、出血少、效果好、操作简便。     

A salvage procedure in cleft palate repair: suturing nasal mucosa directly to palatine process.

OBJECTIVE: Palatal fistulas are among the complications of cleft palate repair requiring additional surgery. Suturing the nasal mucosa and mucoperiosteal flaps together in a tension-free manner to create a double-layered closure in the hard palate is one of the most important points in prevention of dehiscence and fistula formation. In this report, we describe a salvage procedure to repair nasal mucosa that might be lacerated while being freed from the upper surface of the palatal process. METHOD: To restore the nasal lining, an ipsilateral vomer mucoperiosteal flap or the opposite nasal mucosa flap is advanced to the palatine bone and sutured directly to the palatal process in order to guarantee an intact cleft palate repair. RESULTS: This method is an easy, simple, and time-saving procedure. It should be a useful addition to the armamentarium of every plastic surgeon, especially those working as consultants in training units.     

腭侧入路牙槽突裂植骨术的初步应用与评价

目的 改进牙槽突裂植骨术的技术方法,并对腭侧入路牙槽突裂植骨术的即刻效果进行初步评价。方法 选取20名非综合征性单侧牙槽突裂患者为研究对象,其中不完全性牙槽突裂患者8名,完全性牙槽突裂患者12名。 对20例患者实施腭侧入路牙槽突裂植骨术,在术前和术后分别拍摄锥形束CT（CBCT）片,使用Image-Pro Plus 5.1软 件测量相关数据并进行统计学分析。结果 20名患者中总体植入骨量比率为88%,唇侧植入骨量比率为93%,腭侧植入骨量比率为84%。结论 腭侧入路牙槽突裂植骨术弥补了既往腭侧植入骨量不足的缺点,裂隙内鼻腔瓣三角瓣的切口设计兼顾了鼻底裂隙和唇侧裂隙的关闭,避免大范围的松弛切口以及颊侧黏膜推进瓣的应用。     

Cleft palate repair using a marginal musculo-mucosal flap.

OBJECTIVE: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. METHODS: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. RESULTS: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. CONCLUSIONS: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non-push-back method of hard palate repair.     

双岛黏骨膜瓣修复不完全性腭裂

目的:探索双岛黏骨膜瓣修复不完全性腭裂的效果。方法:采用双岛黏骨膜瓣修复12例不完全性腭裂,将2个黏骨膜瓣分别置于软腭的口、鼻腔面,延长软腭;临床观察黏骨膜瓣生长情况,软腭后推程度以及对语音的影响。结果: 12例黏骨膜瓣存活良好,无穿孔、复裂、感染、坏死等并发症;软腭明显后推, 语音有一定改善。结论:双岛黏骨膜瓣由腭前神经血管束供养,营养丰富,成活力强,能有效地使软腭后推,是修复不完全性腭裂的一种良好方法。     

Reconstruction of palatal defect using mucoperiosteal hinge flap and pushback palatoplasty.

This article describes a simple, new surgical technique to provide a complete two-layer closure of palatal defect resulting from a surgical complication of trans palatal resection of skull base chordoma. The nasal layer was reconstructed with triangular shape oral mucoperiosteal turn over hinge flap based on anterior margin of palatal defect and rectangular shaped lateral nasal mucosal hinge flaps. The oral layer was reconstructed with conventional pushback V-Y advancement 2-flaps palatoplasty. Each layer of the flaps were secured with two key mattress suture for flap coaptation. This technique has some advantages: simple, short operation time, one-stage procedure, no need of osteotomy. It can close small- to medium-sized palatal defect of palate or wide cleft palate and can prevent common complication of oronasal fistula, which could be caused by tension.     

Cytokeratin expression in palatal and marginal mucosa of cleft palate patients

OBJECTIVE: The margin of a palatal cleft is a unique anatomical site since the palatal mucosa is continuous with the nasal or nasopharyngeal mucosa. The aim of this study was to compare the expression patterns of cytokeratins and basal membrane components of the mucosa in the area of the cleft. DESIGN: Biopsies from the mucosa of the hard palate and from the cleft margin in the soft palate were obtained from five patients during the primary surgical closure of the cleft. The tissues were processed for haematoxylin-eosin staining and for immunohistochemistry. Antibodies against the cytokeratins (CK) 4, 7, 8, 10, 13, 16 and 18, and the basal membrane components heparan sulphate (HS) and collagen type IV (CIV) were used for immunostaining. RESULTS: The nasopharyngeal epithelium was thinner than the epithelium of the soft palatal mucosa, and showed less interpapillary ridges. The nasopharyngeal epithelium was stratified but expressed the keratins of a simple epithelium (CK 7, 8 and 18). The expression pattern abruptly changed into that of a typical non-keratinized stratified epithelium (CK 4, 13) at the transition to the soft palatal epithelium. The epithelium of the hard palate was a fully differentiated, keratinized and stratified epithelium (CK 10, 16). The basal membrane was thinner in the nasopharyngeal epithelium, which might be related to the presence of abundant inflammatory cells. CONCLUSION: The area around the palatal cleft showed three different types of epithelium. There was an abrupt transition in phenotype of the epithelium from the oral side to the nasopharyngeal side.     

口腔黏膜瓣用于非综合征型单侧完全性唇裂鼻底修复的效果评价

目的: 探讨非综合征型单侧完全性唇裂患儿一期手术中采用口腔黏膜瓣进行鼻底修复的效果,并对鼻底、鼻翼外形对称性等指标进行评价。方法: 对2014年9月—2016年9月采用口腔黏膜瓣进行鼻底修复的16例非综合征型单侧完全性唇裂患儿的临床资料进行回顾分析,根据患儿术前、术后1周、术后1年恢复情况,拍摄正面、仰视照片,测量健、患侧鼻底宽度,鼻小柱高度,鼻孔高度及宽度,鼻的长度及宽度。采用SPSS19.0软件包对数据进行统计学分析。结果: 16例患儿术后均未出现口腔-鼻腔瘘及鼻底凹陷,鼻翼塌陷得到明显改善,术后1年鼻底宽度对称比0.79±0.15,鼻孔宽度对称比0.856±0.17,鼻孔高度对称比1.44±0.17,鼻小柱高度对称比1.62±0.48。结论: 非综合征型单侧完全性唇裂患儿一期修复手术中采用口腔黏膜瓣,进行鼻底修复,不仅能减少口腔-鼻腔瘘的发生,还能严密封闭鼻底裂隙,恢复鼻底形态,并保持良好的鼻翼外形及鼻孔对称性。     

Cleft palate cells can regenerate a palatal mucosa in vitro

Cleft palate repair leaves full-thickness mucosal defects on the palate. Healing might be improved by implantation of a mucosal substitute. However, the genetic and phenotypic deviations of cleft palate cells may hamper tissue engineering. The aim of this study was to construct mucosal substitutes from cleft palate cells, and to compare these with substitutes from normal palatal cells, and with native palatal mucosa. Biopsies from the palatal mucosa of eight children with cleft palate and eight age-matched control individuals were taken. Three biopsies of both groups were processed for (immuno)histochemistry; 5 were used to culture mucosal substitutes. Histology showed that the substitutes from cleft-palate and non-cleft-palate cells were comparable, but the number of cell layers was less than in native palatal mucosa. All epithelial layers in native palatal mucosa and mucosal substitutes expressed the cytokeratins 5, 10, and 16, and the proliferation marker Ki67. Heparan sulphate and decorin were present in the basal membrane and the underlying connective tissue, respectively. We conclude that mucosal cells from children with cleft palate can regenerate an oral mucosa in vitro.     

Prosthetic treatment by pushing back part of the hard palate in third-degree cleft palate

In the third degree of cleft palate, the palate bones are short, the cleft is wide, the degree of palatal tissue atrophy and the anterior displacement of the muscles are great. It is difficult to repair satisfactorily. We carried out a treatment plan by pushing the soft palate and posterior part of the palatal bone fully back to the physiological closure position by surgical means without cutting through the palatal aponeurosis. By using a palatal plate with pharyngeal prong immediately after operation to fix the composite flap posteriorly and restore the defect of the hard palate. The palatal palate is changed with a silicon obturator or performed secondary operation to repair the perforation of the hard palate after the primary wound is well healed. 24 cases have been performed by this means since 1984. The outcomes are good. It is well conditioned for surgical orthodontics of severe crossbite which results from undeveloped maxilla also.     

Single layer closure of palatal fistula using anteriorly based dorsal tongue flap

Palatal fistulas are the common complications seen after cleft palate repair. Small fistula may be asymptomatic, the large ones produce various symptoms including regurgitation of fluids into nasal cavity and interference with normal speech. Although small fistulas can be successfully treated with local flaps such as palatal or buccal mucosal flaps, large fistulas pose difficulty. Because of rich blood supply, tongue is a suitable and convenient source of large flap. The anterior based dorsal tongue flap is a safe and effective method for closure of relatively large recurrent palatal fistula with out any functional impairment of donor site. This article describes one such case treated by single layer closure using anteriorly based tongue flap with excellent outcome.