旋转交叉推进瓣在单侧完全性唇裂鼻唇畸形整复中的应用

为评价旋转交叉推进瓣法修复单侧完全性唇裂的鼻唇畸形的疗效, 本研究回顾性纳入2018年10月至2019年7月就诊于福建医科大学附属协和医院口腔科采用旋转交叉推进瓣进行单侧完全性唇裂修复的患儿6例, 通过数码照片分析采集患者术前、术后即刻、术后1个月及术后1年复诊时唇高、唇长、鼻孔高度、鼻孔宽度、鼻孔面积等信息以评价该术式的疗效。本研究中6例患儿术前健患侧唇高比2∶1, 健患侧鼻孔高度比值约2∶1, 但鼻孔宽度及鼻孔面积比却为1∶2～1∶3。术后健患侧唇高比近1∶1, 鼻孔形态对称、鼻唇沟形态对称、鼻堤形态良好、术后瘢痕不明显, 未见明显切口不良愈合。旋转交叉推进瓣在单侧完全性唇裂患者鼻唇畸形整复上是一种安全可靠的术式。     

个体化单侧唇裂修复术式的改进

进一步探讨对每一例单侧唇裂患者畸形特点更具针对性的个体化单侧唇裂修复术式的设计,使手术设计简便,以利临床应用。方法：采用几何学解析的方法,以正常人两侧鼻民办基部和鼻小柱基部点到两侧唇峰的距离相等为模板,对个体化单侧唇上鼻小柱下方切口止点的设计是以健患侧唇峰与人中切迹连线所成夹角的角平分线和健侧人中嵴的交点定点;患侧鼻翼基部点的设计则是以过健侧鼻翼基部水平线与患侧鼻翼外侧缘的交点定的设计原则,根据单     

旋转推进与其改进法修复单侧完全性唇裂唇高效果对比研究

目的对比分析旋转推进与其改进法修复单侧完全性唇裂唇高恢复情况,为临床单侧完全性唇裂的治疗提供依据。方法选取2007—2010年中国医科大学口腔医学院口腔颌面外科收治的单侧完全性唇裂患儿60例,随机分为2组,每组30例。第一组采用旋转推进法进行手术修复,第二组采用在第一组手术方法基础上,在唇红上方设计一小三角瓣的改进法进行手术修复。两组患儿分别在手术后6个月复查,测量每名患儿健、患侧唇高并计算其差值,再进行两组对比。结果两组患儿手术完成即刻唇高差异无统计学意义(P>0.05);6个月后复查,两组健侧、患侧唇高的差异亦均无统计学意义(P>0.05),但两组间健-患侧唇高差的比较差异有统计学意义(P<0.05)。结论在修复单侧完全性唇裂初期手术时,增加皮肤小三角瓣,可减小瘢痕挛缩的程度,保持两侧唇峰高度对称,保证唇裂术后的远期效果良好。     

单侧唇裂修复术中唇红三角瓣术前术后定量分析

目的:单侧唇裂红唇修复中唇红三角瓣的设计进行术前数据的定量分析,及通过术后数据的定量分析对术后效果进行评价。方法:青岛大学附属医院26例单侧唇裂患儿,手术前后进行健患侧各项数据的测量,术前数据包括健患侧唇长、干唇长、唇红三角瓣边长及底长;利用医学统计学方法得出术前数据的相关性并进行唇红三角瓣的设计,为单侧唇裂唇红修复时三角瓣的设计提供理论参考。术后测量数据包括健患侧唇长、干唇高度及唇高,运用医学统计学分析健患侧有无差异,从主观及客观两方面分析术后唇红部形态、对称性及患儿上唇唇红部形态等,综合评价手术中设计唇红三角瓣的效果。结果:唇裂裂隙程度与唇红三角瓣底长有明显的相关性,术前健侧与裂隙缘唇峰干唇的高度差和红唇三角瓣底长呈正相关(P＜0.05);26例唇红修复主观评价项平均得分均大于4分,客观评价术后健患侧干唇高度、唇高、唇长均无差异,整复效果令人满意。结论:依照本文设计唇红三角瓣的方法修复单侧唇裂可使上唇唇红获得良好形态效果。     

改良 Millard Ⅱ式唇裂修复术修复单侧唇裂的临床研究

目的 探讨改良Millard Ⅱ式唇裂修复术修复单侧唇裂的手术要点.方法 随机选取伴或不伴腭裂的单侧唇裂患者50例,采用改良Millard Ⅱ式进行手术修复.手术设计明确5点定于鼻小柱基底中点、X点定于5-2连线上,均在手术后上唇中线上,摒弃环鼻翼切口.利用干、湿唇黏膜肌瓣重建唇红.结果 50例单侧唇裂患者修复术后,手术瘢痕基本和健侧天然标志线相对称,双侧唇高视觉相等,鼻底线、唇红缘、干湿唇交界线协调对称,唇红丰满,外形满意.结论 Millard Ⅱ式单侧唇裂修复术适度改良后设计明确,修复效果较佳.     

梯度旋转下降法修复单侧完全性唇裂的初步研究

目的探讨梯度旋转下降法修复单侧完全性唇裂的术后效果。方法分析85例单侧完全性唇腭裂患儿的术前，术后即刻以及术后一年的面部石膏模型唇部指标，同时比较这85例单侧完全性唇腭裂患儿术后一年的唇部指标与相似年龄的45例单纯不完全性腭裂患儿的唇部指标。结果在术后即刻虽然健患侧唇高、健患侧唇宽的差值减小，但其健患侧仍不协调。术后一年，健患侧唇高和健患侧唇宽都达到协调。与对照组进行比较，唇高在术后一年恢复到正常值，而唇宽在一年后无论是健侧还是患侧，仍然低于正常值。结论采用梯度旋转下降法修复单侧完全性唇裂可以达到一个很好的唇部美观效果。     

单侧完全性唇裂鼻底修复的临床研究进展

单侧完全性唇裂裂隙侧上颌骨与前颌骨分离,健侧前颌骨前端向健侧旋转,患侧上颌骨发育不足和外移,加重了患侧鼻孔扁平、鼻底过宽、鼻翼塌陷、鼻翼基部外旋和下沉畸形.大部分单侧完全性唇裂皆伴牙槽突裂及腭裂,鼻底完全消失.单侧完全性唇裂鼻底修复有单侧完全性唇裂术前正畸治疗和单侧完全性唇裂鼻底修复的手术治疗.术前正畸可缩小鼻底裂隙间隙,缩短手术时间,手术方法简单.后者有旋转推进法:手术操作简单,术中、术后出血少,术后早期渡过平稳;唇裂裂缘黏膜瓣修复:在修复鼻底和恢复鼻底形态的同时,消灭了所有裸露创面,保留了所有可利用的组织,操作进一步简化,手术时间短,术中、术后出血少.下鼻甲黏膜瓣修复完全性唇裂鼻底裂隙:可有效地增加组织量、减少术区张力、保证伤口愈合、减少并发症,安全的闭合鼻底.术前的正畸治疗在中国还处于积累和总结经验的阶段,治疗效果还不稳定;因此,需要人们不断去探索寻找新的突破口,以弥补传统整复方法的不足.     

重度完全性唇裂整复方法的研究

目的 探讨一次性治疗单侧严重唇裂和鼻翼畸形的可行性。方法 选择贫困地区单侧重度完全性唇裂患儿35例,采用笔者提出的一次性手术的方法进行治疗。结果 35例患儿术后33例两侧唇高完全相等,2例修复侧唇高分别大于健侧0.5 mm和1.0 mm;鼻翼形态经肉眼评估,满意的有31例,仍有4例患者有肉眼可辨的扁平畸形。结论 该方法能有效矫正严重唇裂患者的鼻翼上唇畸形,适用于无条件进行序列治疗的患儿。     

梯度旋转下降法治疗单侧完全性唇裂效果评价

目的：探讨梯度旋转下降法治疗单侧完全性唇裂术后鼻唇部对称性的改善程度及稳定性。方法：采用梯度旋转下降法修复30例左侧完全性唇裂患者,分别于术前、术后1周及术后1年采集照片,测量鼻唇部的相关指标,并使用配对t检验比较其对称性和稳定性,采用SPSS 19.0软件包对数据进行统计学分析。结果：术前鼻翼点、鼻翼基部点、唇峰点健、患侧之间有显著差异（P<0.05）;术后1周,鼻翼点、鼻翼基部点、口角点健、患侧之间有显著差异（P<0.05）,而唇峰点无显著差异（P>0.05）;术后1年,除鼻翼点（P<0.05）外,其余标志点健、患侧之间均无显著差异（P>0.05）。术后1周,各指标距面部中线的距离均小于术前。除鼻翼点外,其他标志点术后1周与术后1年的对称率差异无显著性（P>0.05）。结论：使用梯度旋转下降法修复单侧完全性唇裂,唇部的对称性恢复较为理想,且术后效果稳定;而鼻部对称性较差,但经过自我调整,1年后略有好转。     

改良旋转推进法修复先天性单侧不完全性唇裂的临床研究

目的：探讨针对单侧不完全性唇裂的修复术式,改良经典旋转推进法,并应用于临床,通过主、客观评价探讨其效果.方法：选择30例单侧不完全性唇裂患者为研究对象.应用改良法手术：7点定于患侧裂隙顶点;患侧梯形推进瓣;保留旋转推进法切除组织.对术后拆线后照片,进行主观评价WAS评分系统）;客观数据以SPSS17.0统计软件包进行配对样本t检验.结果：主观评价中除鼻孔对称性及人中嵴形态外,均值接近8.0.客观评价：术后健患侧鼻翼口角距及健患侧鼻翼唇峰距差异无统计学意义（P＞0.05）,其余差异均有统计学意义（P＜0.05）.健患侧唇峰口角距、鼻底宽及鼻孔宽度对称率较术前接近1,差异有统计学意义（P＜0.01）.人中切迹点及鼻小柱基部中点偏离程度减小,回归率高于50％.结论：改良旋转推进法修复单侧不完全性唇裂可达到良好的美观效果,术后健患侧基本对称.     

A lining vomer flap for palate pushback in unilateral cleft palate repair.

A combinaation vomer mucoperiosteal flap and nasal floor mucoperiosteal flap is described which is used to achieve nasal coverage in unilateral cleft palate patients requiring pushbacks. A posteriorly based readily accessible vomer flap is raised on the cleft side and used as nasal lining for the palatal mucoperiosteal flap on the non-cleft side. On the cleft side, a symmetrically sized nasal floor flap is easily elevated under direct vision and used to cover the nasal aspect of the corresponding mucoperiosteal palatal flap.     

改良Onizuka法修复单侧唇裂

目的 探讨改Onizuka法修复单侧唇裂的效果.方法 采用改Onizuka法修复24例单侧唇裂,将旋转瓣止于鼻小柱基底中点,在推进瓣的唇红缘上方形成小三角瓣插入到裂隙近中侧唇峰上方.沿鼻小柱基底线去除C瓣的皮肤,将C瓣的肌层向外侧旋转与裂隙侧鼻翼基底缝合加强鼻堤.推进瓣前端形成与鼻小柱基底相吻合的切口,隐蔽鼻底切口线....     

Modified VIP-CT flap in late maxillary alveolar cleft surgery

ObjectiveThis article describes a new application for the modified vascularized interpositional periosteal-connective tissue flap (modified VIP-CT flap) to solve problematic cases of late maxillary alveolar cleft bone grafting.MethodsThis study analysed the ability of the VIP-CT flap to provide coverage of bone grafts in maxillary alveolar cleft surgery. Donor site morbidity was also evaluated.ResultsThirteen patients were operated on using this technique, seven patients were female, the age range was between 12 and 25 years, and all of them were missing at least one permanent anterior tooth adjacent to the cleft. Two patients had bilateral alveolar clefts. In most of the operated patients one VIP-CT flap was used, but in two patients (cases 3 and 4) bilateral VIP-CT flaps were used for treatment of wide alveolar clefts. In case 3 both of the flaps were used for closure of the oral side and in case 4 one flap was used for nasal closure and another for oral side coverage. Two patients had alveolar cleft only with normal palatal anatomy, and the remaining patients had previously operated cleft palates (11 patients).ConclusionVIP-CT flaps can readily be used in adult patients with cleft lip (alveolar only) and in many operated unilateral and bilateral complete cleft lip and palate patients successfully.     

旋转推进原则中C瓣的应用研究

目的：分析探讨旋转推进原则在唇裂整复术中C瓣的应用。方法：采用旋转推进原则对62例单侧完全唇裂的患儿进行了整复手术，裂缘健侧唇峰点高度的调整靠组织瓣旋转来完成，患侧唇峰点高度的调整靠C瓣的应用来选择3种不同的方法。方法：唇峰点下降足够的选择矩形瓣放在健侧；唇峰点下降不足小于2mm的选择小三角瓣插入患侧鼻前庭；唇峰点下降不足大于2mm的选择大三角瓣插入患侧鼻底。术后6个月复查分析。结果：62例整复病例中，51例上唇形态满意，双侧唇高相等。结论：应用C瓣的主要目的是调整恢复患侧唇高，而根据患侧峰点的下降程度来选择3种不同的方法，灵活运用C瓣是非常有效的。     

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。     

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。     

Effect of primary repositioning of the nasal septum on facial growth in unilateral cleft lip and palate.

OBJECTIVE: The objective of this study is to evaluate whether manipulation of the nasal septum, its release, and changing of its abnormal position in infancy has an impact on maxillary growth and facial development in patients with unilateral cleft lip and palate. DESIGN: Roentgencephalometric investigation. SETTING: Cleft Centre at the Clinic of Plastic Surgery, Prague. PATIENTS: Two consecutive groups of male patients (n = 32 and 30) with complete unilateral cleft lip and palate without associated malformations at 15 years of age. INTERVENTIONS: The patients were operated on by the same team of surgeons and by the same method (lip: Tennison and primary periosteoplasty; palate: pushback with pharyngeal flap surgery), with the exception of complete primary repositioning of the nasal septum performed only in one group. MAIN OUTCOME MEASURES: Roentgencephalometric data of both series of patients were compared with a t-test. All measurements were performed by one investigator. RESULTS: Patients with primary repositioning of the nasal septum had a more favorable nasal prominence and better vertical growth of the upper and whole face in posterior height. Better growth in anterior height was only suggested; maxillary retrusion was equal in both groups. CONCLUSIONS: Primary repositioning of the nasal septum has a favorable effect on nasal development, and it neither deteriorates nor markedly improves maxillary growth in patients with unilateral cleft lip and palate.     

Acoustic airway profiles in unilateral cleft palate patients.

OBJECTIVE: This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile. DESIGN: A consecutive sample of patients was measured. SETTING: Cleft palate rehabilitation center of the University of Mainz, Germany. PATIENTS: Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency. INTERVENTION: A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylometazoline per nostril. Minimum cross-sectional area, nasal volume, and decongestion capacity were calculated for both the cleft side and the contralateral side and for both nasal sides in controls. RESULTS: Pathologic obstructions (<0.4 cm2) were detected on the cleft side in 75% of patients but were detected in only 15% of patients on the contralateral side (p < .001). The valve area of the cleft side (0.32 +/- 0.2 cm2) yielded significantly (p < .001) lower cross-sectional values compared with the contralateral side (0.56 +/- 0.1 cm2). Total nasal volume was determined to be 35% smaller on the cleft side (p < .001). Significantly higher decongestion capacity was verified on the cleft side, thus indicating mucosal hypertrophy. CONCLUSION: Despite a wide range of interindividual variability, we recognized a characteristic "descending W" airway pattern in cleft palate patients. Acoustic rhinometry seems to be a powerful tool for acquiring topographic information about the individual airway profile. It has proven helpful in visualizing the location and amount of pathologic obstructions, rendering it especially useful for preoperative investigation and quality control in corrective cleft nose surgery.     

Craniofacial morphological outcome following treatment with three different surgical protocols for complete unilateral cleft lip and palate: a premilinary study

This study compared craniofacial morphology between three groups of children with complete unilateral cleft lip and palate, treated with different surgical protocols. The study included 66 10-year-old children (42 boys and 20 girls) with a complete unilateral cleft lip and palate (22 patients in each of the three groups). Children aged 7 months underwent one-stage surgery, performed by a single surgeon. During surgery, the soft and hard palate and the lip underwent correction. The difference between the groups depended on the hard palate closure. Group I patients had the mucoperiosteal flap elevated on both sides of the cleft. Group II patients had the mucoperiosteal flap elevated on the non-cleft side, and had only a minimal 2–3 mm mucoperiosteal flap elevated on the cleft side. Group III patients had mucoperiostium elevated from the septum vomer to create a single-layered caudally pedicled flap, and had only a minimal 2–3 mm palatal flap elevated on the cleft side. Craniofacial morphology was defined using lateral cephalometric analysis. Significant craniofacial morphological differences were identified between groups I, II and III. Group III demonstrated the most favourable morphology. This indicates that the technique of hard palate closure has significant influence on craniofacial growth and development.     

Three-dimensional Z-plasty in the correction of the unilateral cleft lip nasal deformity.

OBJECTIVE: Numerous methods have been introduced for correction of the cleft lip nasal deformities, but no single procedure has given sufficiently satisfactory results to provide a surgical standard. Much effort has been put on restoring cartilaginous structures using alar cartilage modification and suspension. But even after the cartilage framework is repositioned well, redundant alar webbing is still unsightly and frequently conspicuous. This paper presents a procedure combining the usual open rhinoplasty technique and three-dimensional Z-plasty in an external approach to remove the alar web and to lengthen the columella at the same time. METHODS: Open rhinoplasty was performed in 26 consecutive patients with unilateral cleft lip nasal deformity from 1991 to 1996. We used an open rhinoplasty approach, which is a combination of the usual infracartilaginous incision on the noncleft side and a small triangular flap on the cleft side. RESULTS AND CONCLUSIONS: This external rhinoplasty incision can provide a wide surgical field for the handling of the whole cartilage framework. The three-dimensional Z-plasty utilizing redundant alar skin not only removes the alar web but also helps lengthen the columella and provides soft tissue to the nasal vestibule. This technique is easy, and the postoperative result is very consistent. Our open rhinoplasty approach has several advantages and can be a useful approach in the correction of the unilateral cleft lip nasal deformity.