颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫瓣移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面，或充填于腭部的口腔与鼻腔侧组织瓣之间，尤其是硬软腭交界处。颊脂垫不需用皮片覆盖，可以自行上皮化。结果共治疗腭裂６例，术后颊脂垫完全成活，无腭瘘形成，无颊间隙感染发生。２周后，颊脂垫自行上皮化。结论颊脂垫血供丰富，易于成活，可为Ⅱ期愈合的创面提供肉芽组织再生床，改善软硬组织血供，以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复     

颊脂垫瓣移转在腭裂修复中的应用

目的介绍颊脂垫辦移转的应用原理及用以腭裂修复的实践。方法将颊脂垫瓣移植于硬腭裂隙的口腔侧创面,或充填于腭部的口腔与鼻腔侧组织辦之间,尤其是硬软腭交界处。颊脂垫不需用皮片覆盖,可以自行上皮化。结果共治疗腭裂6例,术后颊脂垫完全成活,无腭瘘形成,无颊间隙感染发生。2周后,颊脂垫自行上皮化。结论颊脂垫血供丰富,易于成活,可为Ⅱ期愈合的创面提供肉芽组织再生床,改善软硬组织血供,以促进伤口的愈合。使通过常规的手术方法不能或难以修复的大的裂隙或缺损得以修复。     

Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣在完全性腭裂修复中的应用

目的 探讨一种对上颌骨发育影响较小,且能有效降低腭瘘发生率的功能性腭裂修补术。方法 自2013年起,采用Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣修补38例腭裂患者。结果 所有患者均一期愈合,均无腭瘘发生。术后随访1~2年,患者语音清晰度满意。结论 Sommerlad腭帆提肌重建联合带蒂颊脂垫瓣,可有效降低腭瘘的发生率,远期腭咽闭合良好,避免了裸露骨面对上颌骨生长发育的影响,是一种值得推荐的功能性腭裂修复术。     

两种术式对大龄腭裂患儿术后瘘发生率及语音清晰度改善的影响

目的探讨腭帆单纯提肌重建以及腭帆提肌重建联合带蒂颊脂垫瓣和咽后壁瓣两种术式,对大龄腭裂患儿术后瘘发生率及语音清晰度的影响。方法 60例大龄腭裂患儿(4~9岁),随机分为2组,分别予以单纯腭帆提肌重建(A组)及腭帆提肌重建联合颊脂垫瓣和咽后壁瓣修复(B组),观察并比较术后腭瘘的发生率及语音清晰度情况。结果术后A组瘘发生率明显高于B组(P<0.05);两组术后语音清晰度均较术前提高(P<0.05),且B组优于A组(P<0.05);腭部瘢痕情况B组优于A组(P<0.05)。结论对于大龄腭裂患儿,腭帆提肌重建联合咽后壁瓣及带蒂颊脂垫瓣的术式有效降低了腭瘘的发生率,可获得更好的语音清晰度,并可避免裸露骨面,减少腭部瘢痕形成及对上颌骨生长发育的影响,是一种值得推荐的功能性腭裂修复术式。     

应用颊肌黏膜瓣修复腭裂术后裸露骨面的临床研究

目的:探讨应用颊肌黏膜瓣修复腭裂术后减张切口裸露骨面的临床效果。方法:选择2012年8月-2016年1月在笔者科室就诊的腭裂患者15例,均为单侧Ⅲ度腭裂。利用健侧腭部黏骨膜瓣推进修复腭部裂隙,于健侧遗留减张切口。以上颌结节后方减张切口临近处的组织为蒂设计朝向口角方向的颊肌黏膜瓣,根据腭部裸露骨面的大小,颊肌黏膜瓣宽1.5~2.5cm,终止于口角后方附近。连同颊咽筋膜掀起设计的颊肌黏膜瓣,旋转90°后覆盖腭部裸露骨面,缝合于周围黏骨膜瓣上,供区切口直接拉拢缝合。结果:所有患者随访3个月~2年,供区均无并发症发生,腭裂修复后恢复良好,腭部正中切口均无裂开,无腭瘘形成。有2例患者于颊肌黏膜瓣远端出现细小水疱,观察1周后,水疱消失。所有患者受区裸露骨面覆盖良好,无外露,所有患者无张口受限及其它继发功能障碍。结论:应用颊肌黏膜瓣辅助修复腭裂术后裸露骨面是一种简单可靠的方法,尤其适用于裂隙较宽的Ⅲ度腭裂患者。     

应用烦肌粘膜瓣转移延长软腭

目的:探讨颊肌粘膜瓣的解剖及应用其延长软腭,同时改善腭咽闭合不全.方法:在软硬腭交界处切开腭粘膜肌层,腭肌下分离,形成以舌腭弓为蒂的口腔侧腭粘膜肌瓣.由软腭正中纵形切开鼻腔侧粘膜,形成边长为1.0～1.5cm的对偶三角瓣,交叉缝合.口腔侧腭粘膜肌瓣后推位与鼻腔侧粘膜瓣缝合固定,软硬腭交界处形成一个横形创面,应用一侧颊肌粘膜瓣转移覆盖以延长软腭,供瓣区直接缝合.结果:本组16例患者,软腭平均延长1.0～1.5cm,腭咽闭合不全基本矫正.颊肌粘膜瓣无一例出现血运障碍.结论:应用鼻腔粘膜的"Z"字成形及口腔侧的腭粘膜肌瓣后推,颊肌粘膜瓣转移,能有效地延长短缩的软腭,明显改善腭咽闭合不全,使腭裂音质的改善有了解剖学基础.     

应用单侧岛状颊肌黏膜瓣和双反向双Z成形术修复宽大腭裂

目的应用单侧岛状颊肌黏膜瓣加双反向双Z成形术修复较宽大的腭裂,延长软腭,不做牙槽弓内侧松弛切口,腭部无骨性创面裸露和瘢痕形成,以减少或避免对上颌骨和牙槽弓生长发育的影响。方法应用改良的双反向双Z成形术延长软腭,裂缘蒂的口腔侧黏骨膜瓣翻转关闭鼻腔侧的裂隙,一侧岛状颊肌黏膜瓣修复腭部口腔侧创面,牙槽弓内侧不做松弛切口。结果应用该法共治疗36例,2例出现了腭瘘,其余伤口愈合良好,软腭延长显著,无组织瓣坏死、伤口感染、张口困难、面神经损伤等并发症发生。随访8例患者,均获得完善的腭咽闭合功能。结论一侧岛状颊肌黏膜瓣与双反向双Z成形术联合应用修复较宽大的腭裂,既延长了软腭,又避免了腭部骨性创面裸露、瘢痕形成而影响上颌骨和牙槽弓生长发育,是一项安全可靠的手术。     

应用颊肌粘膜瓣转移延长软腭

目的：探讨颊肌粘膜瓣的解剖及应用其延长软腭,同时改善腭咽闭合不全。方法：在软硬腭交界处切开腭粘膜肌层,腭肌下分离,形成以舌腭弓为蒂的口腔侧腭粘膜肌瓣。由软腭正中纵形切开鼻腔侧粘膜,形成边长为1．0—1.5cm的对偶三角瓣,交叉缝合。口腔侧腭粘膜肌瓣后推位与鼻腔侧粘膜瓣缝合固定,软硬腭交界处形成一个横形创面,应用一侧颊肌粘膜瓣转移覆盖以延长软腭,供瓣区直接缝合。结果：本组16例患者,软腭平均延长1．0～1．5cm,腭咽闭合不全基本矫正。颊肌粘膜瓣无一例出现血运障碍。结论：应用鼻腔粘膜的“Z”字成形及口腔侧的腭粘膜肌瓣后推,颊肌粘膜瓣转移,能有效地延长短缩的软腭,明显改善腭咽闭合不全,使腭裂音质的改善有了解剖学基础。     

无覆盖带蒂颊脂垫瓣在修复口腔缺损中的应用

目的：介绍无覆盖带蒂颊脂垫瓣用于口腔缺损修复的实践。方法：将颊脂垫瓣转移到相应的口腔缺损区,暴露的颊脂垫瓣表面无需植皮,可以自行上皮化。结果：共治疗口腔缺损病例13例,均获成功,颊脂垫瓣封闭效果好。结论：无覆盖带蒂颊脂垫瓣作为局部区域性组织转移瓣,对口腔内颊部、软腭和牙槽等部位软组织缺损的修复尤为适宜,是一种口腔内软组织缺损理想的充填材料。     

带蒂颊脂垫瓣在关闭腭裂鼻腔黏膜缺损中的应用

2001年以来，我们采用带蒂颊脂垫瓣关闭先天性双侧完全性腭裂修复术时软硬腭交界处遗留的鼻侧菱形缺损，并延长软腭8例，取得满意效果。     

Roles of palatine bone denudation repairing with free buccal or palatal mucosal graft on maxillary growth: an experimental study in rabbits

Most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. The present study was designed to investigate growth patterns of the maxilla following palatal bone denudation covering with free buccal or palatal mucosal graft in rabbits with surgically created defects simulating palatal bone denudation. Forty-five purebred New Zealand rabbits were used in this experiment. The animals were divided into 3 groups: 1 control group (left palatal bone denudation was not repaired and the right side was unoperated as a control) and 2 experimental groups (the right side of palatal bone denudation was covered with free buccal or palatal mucosal graft, respectively, and the left side was not repaired). Nineteen metric cranial variables were measured directly from the cleaned skulls. Direct cephalometric measurements were taken in the following dimensions: maxillary length, width and height, posterior facial width, and nasal deflection. Significant differences were noted between 2 sides of maxilla in all animals for the 19 cephalometric measurements. The cephalometric measurements of the right side in maxillary length, height, and width were significantly greater than those in the left side. There was no statistically significant difference between free buccal mucosal graft repaired group and free palatal mucosal graft repaired group for the cephalometric measurements. There was also no statistically significant difference for the cephalometric measurements between the 3 groups. The results of this study demonstrate that palatal bone denudation repaired by free buccal or palatal mucosal graft might prevent maxillary deformity following cleft palate surgery.     

岛状颊肌粘膜瓣修复腭瘘的临床研究

目的：探索应用岛状颊肌粘膜瓣方法修复较大面积腭瘘的临床实践,探讨该方法的优缺点。方法：应用蒂在前上的岛状颊肌粘膜瓣修复腭瘘4例;应用蒂在后的岛状颊肌粘膜瓣修复腭瘘14例,其中有7例在修复腭瘘的同时延长软腭以矫正腭咽闭合不全。结果：共修复腭瘘患者18例;其中15例腭部瘘孔获得关闭,颊肌黏膜瓣成活良好,无感染、腮腺导管损伤或阻塞、面神经损伤,无张口受限、瘢痕挛缩及咀嚼障碍;2例因岛状颊肌粘膜瓣远端愈合不良再次出现硬腭前端瘘口,但面积较原来明显减小,其中1例再发腭瘘应用已转移到腭部的颊肌粘膜瓣组织行二次手术修复后愈合;1例岛状颊肌粘膜瓣部分坏死。结论：应用蒂在前上和蒂在后的岛状颊肌粘膜瓣修复腭瘘是一种比较安全可靠的方法,其成活率高,可以灵活转移修复各个部位的腭瘘,在修复软硬腭交界部位腭瘘的同时可延长软腭、矫正腭咽闭合不全。即使腭瘘再发,可以应用已转移到腭部的肌黏膜瓣修复之。     

Soft tissue chondroma of hard palate associated with cleft palate

Soft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence after 2 years of follow-up.KEY WORDS: Cleft palate, soft tissue chondroma, benign palatal tumour, palatal swellings     

Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair

Many methods of cleft palate repair have been described. Two effective methods are commonly used for repair of soft palate clefts: the Wardill-Kilner V-Y push back and the Furlow double opposing Z-plasty; each has advantages and disadvantages. The aim of this study was to compare between the V-Y push back technique and the Furlow Z-plasty technique regarding effectiveness in palatal reconstruction and improvement of velopharyngeal closure in cases of cleft soft palate. Also, operative duration time and blood loss were considered. This study was conducted on 60 patients diagnosed to have cleft soft palate. The patients were randomly classified into two equal groups A and B. In group A, the cleft palate was repaired using V-Y push back technique while in group B the cleft palate was repaired using Furlow double opposing Z-plasty technique. Flexible nasopharyngoscopy and perceptual speech resonance evaluation were used to assess the velopharyngeal closure and speech outcome, respectively. Nasalance score was measured for nasal and oral sentences in both groups. The average operative duration time and blood loss were lesser in Z-plasty than in V-Y pushback technique. Two of the cases subjected to V-Y pushback technique developed fistula while none of the cases subjected to Z-plasty showed this complication. Velopharyngeal closure and speech outcome was better after Z-plasty than after V-Y pushback technique with significant nasometric data. The Furlow Z-plasty is better than the V-Y pushback technique in the repair of clefts involving the soft palate as it has a higher success rate regarding speech outcome and velopharyngeal closure; also, it has a lower operative time and blood loss.     

应用岛状颊肌粘膜瓣修复腭裂初步报告

目的：介绍应用岛状颊肌粘膜瓣修复腭裂的临床实践。方法：应用裂缘葶粘骨膜瓣闭合硬腭裂隙的鼻腔侧、软腭后推、软腭鼻侧粘膜Z成形术延长、腭帆提肌吊带重建,再以蒂在后的血管神经蒂岛状颊肌粘膜瓣修复软腭后推后在腭部遗留的横行创面和硬腭裂隙的口腔侧创面。结果：1997年以来共治疗12例,术后岛状颊肌粘膜瓣完全成活,软腭延长显著,无腭瘘形成,无血肿、感染、肋腺导管和面神经损伤及开口功能障碍等并发症发生。结论：岛状颊肌粘膜瓣血运好,易成活;术后早期不需配戴牙垫,不影响恒磨牙的萌出,不干扰咬合,无埯断蒂,不破坏翼下颌皱襞形态和结构,供区易于缝合,感觉功能好。     

下鼻甲黏骨膜瓣在腭裂修复中的应用

目的 探讨在裂隙宽大的腭裂修复术中闭合软硬腭交界处裂隙的鼻侧面，确保缝合伤口一期愈合的方法。方法 设计蒂在后的下鼻甲黏骨膜瓣，并将该瓣转移至裂隙软硬腭交界处的鼻侧面，有效地减少局部组织缝合张力、闭合裂隙。结果 用本法治疗21例患儿，术后伤果口均一期愈合，无腭瘘发生，软硬腭交界处无明显的瘢痕形成。结论 应用下鼻甲黏骨膜瓣修复软硬腭交界处裂隙的鼻侧面，减少宽大腭裂的组织缝合张力，是一种简单而有效的方法。