伴隐性唇裂双侧不对称性唇裂的手术修复效果初探

目的探讨伴有隐性唇裂的双侧不对称性唇裂的手术修复方式。方法自2007年9月至2011年9月,我中心共完成了125例双侧唇裂修复,从中筛选出18例双侧不对称性唇裂,其中有6例伴有隐性唇裂。6例中有3例行一次性手术,即将两侧裂隙分别按照单侧唇裂来修复,先修复裂隙较大的,再修复隐性唇裂。有2例则按照双侧完全性唇裂的方法来修复。有1例则只修复裂隙较大一侧,隐性唇裂未予以修复。结果 3例按照单侧唇裂分侧修复者,在术后1个月及3个月的随访中,红唇及人中嵴的外观均得到满意的效果,2例按照双侧完全性唇裂修复者,上唇组织较紧,白唇瘢痕明显,组织量缺失较多。1例只修复裂隙较大的一侧,隐性唇裂仍存在畸形,需二期手术修复。结论伴有隐性唇裂的双侧不对称性唇裂,采用单侧唇裂分侧修复一期完成,可达到较好的效果。     

先天性唇裂修复同期关闭齿槽嵴裂的手术分析

先天性唇腭裂患者中75%伴发不同程度的齿槽嵴裂[1],早期关闭齿槽嵴裂隙在稳定上颌骨、鼻畸形的矫正、改善患儿容貌和心理健康方面都能起到较好的作用,但多数学者的研究认为唇裂手术时或手术后不久早期植骨骨吸收明显,且上颌骨后续生长受到限制,植入骨本身形成的骨痴可能是影响上颌生长的主要原因.     

Treatment of cleft lip and cleft palate.

The first case of cheiloplasty recorded was in China at about 200 BC. The technique of course has been vastly improved over the centuries. Cleft lip and/or cleft palate are among the most common congenital anomalies in China and the world. There is controversy over some of the surgical techniques used and age for operation, especially in cleft palate, but the condition requires surgery. Unilateral cleft lip is operated on at 3-6 month of age and bilateral cleft lip at 6-12 month of age. Views on palatoplasty are: 1. Cleft palate should be repaired at an early age; 2. Supplementary orthodontic treatment to expand the upper arch postoperatively is necessary, and orthognathic surgery is performed if needed when the patient has matured. This is the best choice at present.

     

Epidemiology of cleft lip and cleft palate in China

During a period of 12 months (Oct. 1986 to Sep. 1987), 1,243,284 live and still births were monitored in 945 hospitals of 29 provinces cities and autonomous regions of China. A total of 2,265 cases of cleft lip and cleft palate were recorded, of which cleft lip with cleft palate accounted for 61.3%, isolated cleft lip for 30.5% and isolated cleft palate for 8.2%. The incidence of cleft lip and cleft palate in this country varied from 13.4 to 30.7 with a mean of 18.2 per 10,000. The total incidence of cleft lip and cleft palate in the rural area is higher (20.8 per 10,000) than that in the urban area (16.9 per 10,000) (P less than 0.01). A male preponderance (19.8 per 10,000) over the female (16.3 per 10,000) (P less than 0.01) was observed.     

Anaesthesia in cleft lip and cleft palate surgery of children

Three hundred and fifty children below 5 years of age undergoing surgery for repair of cleft lip and palate received endotracheal halothane anaesthesia. For induction of anaesthesia a mixture of nitrous oxide (N2O), oxygen (O2) and halothane was given by mask. Orotracheal intubation was carried out without administration of relaxants and spontaneous respiration was maintained. Adrenaline infiltration was used to minimise the blood loss. No life-threatening complications were seen during surgery or in the post-operative period. The mortality in this group was zero. The study showed that anaesthesia for cleft lip (CL) and cleft palate (CP) surgery could be given relatively safely in developing countries where facilities and resources available are minimal.     

Comparison of cleft lip only and cleft lip and palate, Hawai'i, 1986-2003

Using birth defects registry data, this investigation compared cleft lip only (CLO) and cleft lip and palate (CLP). CLP cases were more likely than CLO cases to expire after birth (3.2% versus 1.0%), be boys (68.0% versus 56.5%), Pacific Islander (26.5% versus 16.4%), have lower birth weight (20.4% versus 11.1%), and lower gestational age (22.6% versus 20.4%).     

双侧唇裂术后继发红唇畸形的修复

目的：报道双侧唇裂术后继发红唇重度凹陷的临床治疗体会。方法：应用上唇粘膜V-Y成形联合双侧红唇皮下蒂组织瓣矫正双侧唇裂术后红唇重度凹陷。结果：2000年以来。临床应用8例。皮瓣全部成活，感觉正常，红唇外形满意。瘢痕不明显。结论：该手术方法操作简单。损伤小，而且通过近远期随访观察。效果满意。     

单侧唇裂修复术改善鼻部畸形

目的探讨单侧唇裂修复手术对鼻部畸形的治疗影响。方法我院2002年至2006年收治单侧唇裂186例,回顾分析其手术方式与鼻唇部修复情况。结果单侧唇裂修复术后,鼻畸形35例,其中Millard法修复术后鼻畸形12例（12/77,15.6%）;Tennison法修复16例（16/56,28.6%）,上旋转下三角瓣法修复7例（7/53,13.2%）。结论对于单侧唇裂,选择适宜的手术方式,可同期修复鼻部畸形,减少患者痛苦。     

单侧唇裂继发鼻畸形的修复

目的探讨单侧唇裂继发鼻畸形的修复方法。方法根据鼻畸形的特点和形成原因,手术切口沿鼻翼缘轮廓线、鼻小柱基底,充分显露鼻翼软骨,使鼻翼外侧脚旋转复位,鼻腔填塞预制纱垫以利塑形;同期延长鼻小柱。结果22例单侧唇裂继发鼻畸形患者均得到满意外观,患侧鼻翼隆起,恢复正常弧度,鼻孔对称,切口隐蔽,术后瘢痕不明显。结论依据鼻畸形特点及形成原因个性化设计鼻翼缘、鼻小柱基底切口并妥善处理鼻翼软骨的修复方法合理,操作简单,灵活性强,动态效果满意,并发症少,瘢痕不明显。     

The management of the cleft lip and palate patient

We believe that early closure of the hard palate defect with a palatal appliance and surgical closure of the lip and soft palate according to the rule of tens are very important. Delaying the hard palate closure allows for maximal growth of the palatal shelves. We also feel that pressure equalizing tubes placed in the ears at the initial surgical procedure allows for more normal function of the middle ear, less middle ear infections, better hearing, and ultimately better speech. We feel that early closure of the soft palate may decrease velopharyngeal incompetence by normalizing the position of the pterygoid plates. It may also help to reduce serous otitis media by improving eustachian tube function.     

单侧唇裂术后继发鼻畸形的美学修复

目的探索唇裂术后继发鼻畸形的矫正方法,改善鼻畸形的修复效果。方法应用改良开放鼻整形切口,以鼻小柱为蒂,掀起包括健侧鼻底和前唇C瓣的前唇组织,矫正鼻小柱偏斜,延长鼻小柱。解剖出双侧鼻翼软骨,并使患侧鼻翼软骨脱套。经此切口切取鼻中隔软骨,矫正鼻中隔偏斜。部分患者另切取耳甲软骨。应用切取软骨行鼻小柱支撑缝合,加强薄弱的患侧鼻翼软骨。将患侧侧鼻软骨及鼻翼软骨分别悬吊至鼻背筋膜。缝合收拢双侧鼻翼软骨穹窿部,应用软骨行帽状移植、盾牌移植改善鼻尖形态。解剖复位异位口轮匝肌,并折叠缝合重建人中嵴,鼻翼脚松解推进重建鼻孔形态。应用软骨或去表皮瘢痕组织充填鼻底凹陷,重建鼻堤。结果69例患者中56例均取得较好效果,鼻形态良好,鼻孔基本对称;8例患者患侧鼻底仍不够丰满,5例严重鼻畸形患者患侧鼻翼仍有轻度塌陷,鼻尖稍有偏斜。结论应用鼻整形技术矫正唇裂术后继发鼻畸形可明显改善唇裂鼻畸形修复效果。     

改良式Millard法修复单侧完全性唇裂

目的探讨单侧完全性唇裂的修复术式。方法在MillardⅡ’s法的基础上作了改进，取消了8点，充分利用回切，对45例单侧完全性唇裂患者行修复整形。结果全部患者均获随访，手术效果满意，唇部外形静态协调自然，鼻底及鼻翼外侧角恢复满意。结论改良的Millard修复单侧完全性唇裂对唇部和鼻畸形均得到了良好的矫正。     

唇裂与齿槽裂合并牙颌畸形一期整复手术体会

目的唇裂与齿槽裂合并牙颌畸形一期整复。方法整复牙颌畸形、修复齿槽裂隙、修复唇裂。结果效果理想,外形满意。结论本法在修复唇裂时同期修复齿槽裂隙,即矫正了牙颌畸形又修复了唇裂,且效果理想,外形满意。     

双侧唇裂修复法的改进及其应用

目的：探讨双侧唇裂修复的新方法。方法：采用改进的修复方法修复双侧唇裂17例，并运用新的评价标准对术后效果进行评价。结果:经1－5年随访，14例术后效果良好。结论：此法在重建上唇解剖结构及运动形态等方面均优于传统的修复方法。