用颈椎骨龄对单侧完全性唇腭裂患者发育情况的评估

目的：用颈椎骨龄来评估单侧完全性唇腭裂（unilateral complete cleft lip and palate ,UCLP）患者的发育情况。方法将45例9～16岁的UCLP患者作为试验组（UCLP组）;另选取年龄、种族与UCLP组相匹配的45例非唇腭裂（none cleft lip and palate,Non?cleft）患者作为对照组（Non?cleft组）。拍摄头颅定位侧位片。通过头颅定位侧位片分别测量计算UCLP组与Non?cleft组的颈椎骨龄。对相同性别的UCLP组与Non?cleft组分别进行独立样本t检验。结果 UCLP组男性患者的颈椎骨龄比Non?cleft组小且差异有统计学意义（P<0.05）,而UCLP组女性患者的颈椎骨龄与Non?cleft组差异无统计学意义（P>0.05）。结论与Non?cleft患者相比,9～16岁年龄段男性UCLP患者的发育相对迟缓,而女性患者之间无明显差异。     

唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究

目的　利用锥形束CT（cone-beam CT,CBCT）评价不同类型唇腭裂患者上颌前部牙槽骨厚度和形态,以及上前牙骨开窗、骨开裂情况。方法　选择016年8月至019年10月间在南京医科大学附属口腔医院就诊拟行口腔正畸治疗的唇腭裂患者85例（男51例,女34例,平均年龄（14.65±4.95）岁）,其中单侧唇裂伴牙槽突裂（unilateral cleft lip and alveolus,UCLA）患者19例,单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者5例,双侧完全性唇腭裂（bilateral complete cleft lip and palate,BCLP）患者14例。在正畸治疗开始前均予以拍摄颌面部CBCT,应用Image J软件测量其上前牙唇腭侧牙槽骨厚度（alveolar bone thickness,ABT）,计算骨开窗、骨开裂发生率,并比较不同唇腭裂类型患者上颌前部ABT及上前牙骨开窗、骨开裂发生率的差异。结果　UCLP、UCLA患侧上前牙骨开裂发生率（34.9%、4.9%）显著高于其健侧（10.7%、11.1%）,但骨开窗发生率无统计学差异。UCLP健侧上中切牙（5.9%）、侧切牙（9.7%）骨开裂发生率低于UCLA。UCLA、UCLP、BCLP三组间患侧上前牙骨开裂及骨开窗发生率均无统计学差异。UCLP、UCLA患侧上前牙ABT在多部位小于其健侧。除UCLP/UCLA患侧侧切牙外,UCLA、UCLP、BCLP各类型上前牙唇侧平均ABT均小于腭侧。UCLA、UCLP、BCLP三组间患侧上前牙唇腭侧平均ABT无统计学差异。UCLP患侧上侧切牙、尖牙分别在唇侧和腭侧根颈处ABT大于UCLA。结论　单侧唇腭裂患者患侧上前牙骨开裂发生率高于健侧,ABT则在多部位小于其健侧;而三种类型患者上前牙唇侧ABT均小于其腭侧。单侧唇裂伴牙槽突裂与单侧完全性唇腭裂患者健侧上中切牙、侧切牙骨开裂发生率及患侧侧切牙、尖牙根颈处牙槽骨厚度存在差异;单侧与双侧完全性唇腭裂间上前牙骨开窗、骨开裂发生率及牙槽骨厚度则无差异。     

替牙期单侧完全性唇腭裂患者下颌骨体积的测量分析

目的　比较替牙期单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者裂隙侧与非裂隙侧下颌骨体积的差异,并将两者分别与非唇腭裂（non cleft lip and palate,NCLP）儿童单侧下颌骨体积比较,以研究唇腭裂对下颌骨生长发育的影响。方法　选取2012—2016年于青岛大学附属医院口腔正畸科就诊的替牙期UCLP患者25例作为UCLP组,另选同期就诊的替牙期NCLP儿童25名作为NCLP组。对所有研究对象的头颅部进行锥形束CT（cone-beam CT,CBCT）扫描,获取影像数据,利用Mimics 17.0软件对下颌骨进行三维重建。比较两组双侧的下颌升支、体部及半侧下颌骨体积,并将UCLP组裂隙侧和非裂隙侧的上述测量指标分别与NCLP组进行比较。结果　（1）UCLP组裂隙侧下颌升支体积大于非裂隙侧,差异有统计学意义（t = 2.192,P < 0.05）;而下颌体部及半侧下颌骨的体积比较,差异无统计学意义（均P > 0.05）;NCLP组两侧的下颌升支、体部及半侧下颌骨体积差异均无统计学意义（均P > 0.05）。（2）UCLP组裂隙侧与非裂隙侧的下颌升支体积均小于NCLP组,UCLP组非裂隙侧半侧下颌骨体积小于NCLP组,差异均有统计学意义（t值分别为-2.938、-3.325、-2.023,P < 0.05）。结论　替牙期UCLP患者两侧下颌骨体积存在差异,裂隙侧下颌升支体积大于非裂隙侧,且替牙期UCLP患者下颌骨的生长发育较NCLP儿童差。     

婴幼儿期唇腭裂患者术前鼻-腭-牙槽骨矫形治疗的研究进展

唇腭裂（cleft lip palate,CLP）患者经过一系列手术后仍存在比较严重的错【牙合】畸形，据统计，唇腭裂患者恒牙期时的错【牙合】畸形发生率为97％，需要正畸治疗。随着人们对唇腭裂先天畸形认识的深入、生活水平的提高和医疗技术的发展，唇腭裂患者的治疗由单一的手术治疗转为序列治疗。唇腭裂序列治疗中婴幼儿期颌骨的术前矫形治疗是唇腭裂序列治疗中最为基础的环节，它有利于唇腭裂患者上颌骨前段的对位、     

替牙期唇腭裂术后前牙反骀患者上气道结构特征研究

目的研究替牙期唇腭裂术后患儿上气道结构特征。方法以52例替牙期男性单侧完全性唇腭裂（unilateral cleft lip and palate,UCLP）术后前牙反殆患者作为研究对象,52例年龄分布与之相近的替牙期非裂反胎患者作为对照,分别对这些患者的上气道结构进行头影测量分析。结果UCLP组患者舌根后气道间隙及会厌谷后气道间隙大小分别为10．44mm±3．23mm及13．82mm±2．82mm,非裂对照组舌根后气道间隙及会厌谷后气道间隙大小分别为13．78rnm±3．47Inrn及15．63mm±2．79rain,两组差异具有统计学意义（P=0．00）;UCLP组及非裂对照组下颌平面角大小分别为39．78°±5．22°及33．41°±4．35。,差异具有统计学意义（P=0．00）;而UCLP组患者软腭长、腭咽气道深度及腭咽闭合需值与对照组相比皆无统计学差异。结论较非裂反骀患者而言,UCLP患者更符合阻塞性睡眠呼吸暂停综合征患者气道及颅面的某些特征;腭裂术后腭咽闭合不全发生的原因不仅仅与软腭长及腭咽气道深度有关。     

反向Twin-block矫治器治疗替牙期安氏Ⅲ类错畸形的临床疗效观察

目的 探究反向Twin-block矫治器在替牙期安氏Ⅲ类错畸形治疗中的临床矫治效能。方法 使用反向Twin-block矫治器治疗替牙期安氏Ⅲ类错畸形患者10例，测量对比患者治疗前后的各项头影测量数值。结果 患者治疗后∠SNA增加（3.18±2.58）°，∠ANB增加（3.57±1.26）°，Wits值增加（3.66±2.72）mm，∠U1-SN增加（8.12±7.67）°，∠L1-MP减小（-2.91±4.00）°，变化均具有统计学意义。结论 反向Twinblock矫治器针对于替牙期安氏Ⅲ类错畸形具有一定的疗效，可协调上下颌骨的位置关系，有效解除反。     

联合应用前方牵引器关闭拔牙间隙与滑动法关闭拔牙间隙矫治恒牙早期安氏Ⅲ类错(牙合)的比较研究

目的对比联合应用前方牵引器关闭拔牙间隙与滑动法关闭拔牙间隙矫治恒牙早期安氏Ⅲ类错牙合的临床疗效。方法选择恒牙早期安氏Ⅲ类错牙合患者30例,随机分为两组,每组15例。治疗组口内直丝弓矫治器联合应用前方牵引器关闭拔牙间隙进行矫治。对照组口内直丝弓矫治器滑动法关闭拔牙间隙进行矫治。在治疗前后分别拍摄X线头颅侧位定位片进行头影测量分析。结果治疗开始后6~12个月,治疗组拔牙间隙关闭,安氏Ⅲ类错牙合纠正,上颌骨前方生长明显,下颌骨向前方生长抑制。SNA平均增加1.40°,SNB平均减少2.50°,ANB增大3.90°。对照组拔牙间隙关闭,上下颌骨无明显改变,SNA平均减少0.12°,SNB平均增加0.27°,ANB减少0.15°。Ⅲ类骨面型仍存在。结论在恒牙早期联合应用前方牵引器关闭拔牙间隙并矫治安氏Ⅲ类错牙合能促进上颌骨前移,抑制下颌骨向前方生长,可有效改善侧貌外形。     

联合应用前方牵引器关闭拔牙间隙并矫治恒牙早期安氏Ⅲ类错(牙合)

目的：观察联合应用前方牵引器关闭拔牙间隙并矫治恒牙早期安氏Ⅲ类错（牙合）的临床疗效.方法：15例恒牙早期安氏Ⅲ类错（牙合）病例,上颌拔除两个第二前磨牙.上下颌粘结直丝弓矫治器,下颌全牙列平面塑料（牙合）垫,排齐整平牙列后,联合应用前方牵引器关闭拔牙间隙并矫治恒牙早期安氏Ⅲ类错（牙合）.治疗前后分别摄X线头颅侧位片进行头影测量.结果：15例患者拔牙间隙关闭,安氏Ⅲ类错（牙合）纠正,SNA平均增加1.40,SNB平均减少2.50,ANB由-2.80增加到1.10.结论：在恒牙早期联合应用前方牵引器关闭拔牙间隙并矫治安氏Ⅲ类错（牙合）能促进上颌骨前移,抑制下颌骨向前方生长,可有效改善侧貌外形.     

Damon Q自锁托槽在安氏Ⅲ类错牙合不拔牙矫治中的应用

目的：探讨DamonQ自锁托槽控制安氏Ⅲ类错牙合患者上切牙转矩的临床疗效。方法收集32例安氏Ⅲ类错牙合患者,分别使用Damon Q自锁托槽（试验组）和Gemini MBT托槽（对照组）进行不拔牙矫治,在矫治前后进行头影测量分析,比较2组患者矫治前后上下切牙倾斜度和面部软组织侧貌的变化。结果矫治后,试验组SNA、ANB、U1-SN、U1-NA、U1-L1、A′Ls-FH的变化与对照组相比,差异均具有统计学意义（ P＜0．05）。结论使用Damon Q自锁托槽矫治安氏Ⅲ类错牙合,可以有效地控制上切牙根唇向转矩,减小上切牙唇倾度,改善软组织侧貌美观。     

替牙期安氏Ⅲ类错(牙合)畸形治疗方法的探讨

目的 探讨替牙期安氏Ⅲ类错(牙合)的治疗方法.方法 选择替牙期安氏Ⅲ类错(牙合)患者30例,据正中关系位X线头颅测位片的ANB角将其分为两个治疗组:0°＜ANB＜2°为导弓治疗组;-2°＜ANB＜0°为联合治疗组.两组病例均用改良导弓矫治器先将前牙反(牙合)解除,联合组继续用前方牵引器治疗,并对治疗前后的头影测量结果进行了统计学分析.结果 两组病例均去除了下颌功能性前伸因素.导弓组平均疗程为5.2个月,导弓矫治器治疗后, SNA 平均增加0.5°,随访2年后有2例复发;联合组导弓矫治5.4个月,SNA 平均增加0.5°,继续前方牵引平均5.6个月,建立前牙正常的覆(牙合)覆盖和Ⅰ类磨牙关系,SNA增加1.65°,患者的凹面型均有不同程度的改善,追踪2年无复发.结论 正确的决定治疗方案在替牙期安氏Ⅲ类错(牙合)的诊治中十分重要.     

Evaluation of cheiloplasty and palatoplasty on palate surface area in children with oral clefts: longitudinal study

This study evaluated the palatal surface area in children with different oral clefts after primary surgeries and at five years of age. This longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analysed at four time periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 – (at five years of age). Area of the dental arches was measured through stereophotogrammetry software. Measurements evaluated with Student’s test and ANOVA followed by the Tukey test (p<0.05) (AQ 1). In the UCL group, the palatal surface area significantly increased among phases. In the primary surgery periods, UCLP and CP significantly decreased (p<0.001). Palatal area in the UCLP group was significantly greater than the CP group. Overall, no statistically significant differences occurred among groups. At T4, the area of the palate in the UCL group was significantly greater than the UCLP group and no significant differences occurred between UCLP and CP groups. This study suggests that cheiloplasty did not inhibit the growth of the palatal surface area in children with UCL and UCLP. Palatoplasty significantly decreased the palatal area in children with UCLP and CP, demonstrating a significant negative effect of palatal repair on maxillary growth. At five years, children with UCLP and CP had a significantly smaller palate area than those with UCL.     

Abnormal maxillary trapezoid pattern in human fetal cleft lip and palate.

OBJECTIVE: To elucidate abnormal growth patterns of human fetal maxillae with cleft lip and palate (CLP). SUBJECT: A total of 71 fetal maxillae with CLP were obtained from aborted human fetuses. METHOD: Dimensions of the maxillary trapezoid (MT), formed by the maxillary primary growth centers (MxPGC), were taken from radiographic images. The CLP dimensions were compared with maxillary trapezoid dimensions of normal fetuses from a previous study (Lee et al., 1992). MAIN OUTCOME MEASURES: Cleft lip subjects without a cleft palate, unilateral cleft lip-alveolar cleft or cleft palate (UCL+A/UCLP), and bilateral cleft lip-alveolar cleft or cleft palate (BCL+A/BCLP) displayed abnormal MT patterns. MT abnormalities were most marked in the BCL+A/BCLP cohort. RESULTS: The MT growth of prenatal CLP maxillae was severely arrested, resulting in abnormal MT shape on palatal radiograms. BCL+A/BCLP subjects had a more protruded nasal septum than subjects with other types of CLPs, while UCL+A/UCLP subjects showed severe deviation of the protruded nasal septum toward the noncleft side. Cleft lip-only subjects also exhibited abnormal MT growth. CONCLUSION: MT is primarily involved in CLPs, so that the MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.     

Maxillary and sella turcica morphology in newborns with cleft lip and palate.

OBJECTIVE: The first aim was to examine maxillary developmental fields by analyzing bone size parameters within the maxillary bone complex in newborns with unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The second aim was to evaluate sella turcica morphology in unilateral cleft lip and unilateral cleft lip and palate. SUBJECTS AND METHODS: Axial and profile radiographs from 40 newborns (boy-girl, 1:1) in each group (20 unilateral cleft lip and 20 unilateral cleft lip and palate) were randomly selected among radiographs taken for optimizing treatment planning. Analysis of maxillary bone size was performed on axial radiographs and size parameters were measured. Furthermore, analysis of sella turcica morphology was performed on profile radiographs. The results were divided into groups with normal morphology and severe deviations in the morphology. RESULTS: The maxillary areas were significantly shorter and broader in unilateral cleft lip and palate than in unilateral cleft lip. A profound asymmetry in the maxillary areas was seen in unilateral cleft lip and palate, but not in unilateral cleft lip. In both cleft types, approximately half of the individuals had deviations in sella turcica morphology. The most severe deviations occurred in newborns with unilateral cleft lip and palate. CONCLUSIONS: In newborns with unilateral cleft lip and palate, the maxillary areas are significantly shorter, broader, and more asymmetric than in newborns with unilateral cleft lip. The present study showed that bone structures are a suitable parameter for characterizing the craniofacial developmental fields. Additionally, a high incidence of deviations in sella turcica morphology might indicate that this area is affected in individuals with clefts.     

Cephalometric findings in a normal Nigerian population sample and adult Nigerians with unrepaired clefts

Cephalometric values have been established for twenty adult Nigerians, three adults with unrepaired unilateral cleft lip and alveolus (UCLA) and two adults with unrepaired unilateral cleft lip and palate (UCLP). Normal values for SNA and SNB were 85.5 degrees +/- 3.5 and 82.7 degrees +/- 3.2 respectively, and the mean ANB values were 3.1 degrees +/- 0.8. The cephalometric data for unilateral cleft lip and alveolus (UCLA) subjects whose clefts were not repaired until adulthood did not differ significantly from normal controls. However, in two adults with unrepaired unilateral cleft lip and palate (UCLP), the SNA values were less than normal controls and the ANB values were reduced to negative levels. Bimaxillary protrusion of the incisors appears to be a normal feature in Nigerians. There appears to be inhibition of maxillary growth in UCLP patients but not in UCLA cases.     

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

ObjectivesTo determine if the skeletal form of individuals born with oral clefts was associated with maxillary position.Materials and MethodsLateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III).ResultsWhen comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group.ConclusionsThere are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.     

唇腭裂手术对上颌骨矢状向生长发育影响的研究

目的：研究唇腭裂手术对单侧完全性唇腭裂患者上颌骨矢状向生长发育的影响。方法：混合牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者18例;16岁以上恒牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者15例。所有患者均拍摄头颅定位侧位片,测量分析矢状方向的线距和角度;分别以相应年龄段的非唇腭裂正常者作为对照,采用SPSS11.0软件包对数据进行单因素方差分析（ANOVA）。结果：混合牙列期单侧完全性唇腭裂仅修复唇裂患者表现为上颌长度缩短,而唇腭裂术后患者除上颌长度的缩短外,还存在上颌位置后缩;16岁以上恒牙列单侧完全性唇腭裂仅修复唇裂患者主要表现为上颌位置后缩,存在明显Ⅲ类倾向,术后患者上颌位置后缩外,上颌长度也缩短。结论：唇裂手术及早期腭裂手术对上颌骨矢状向生长可能有干扰作用。     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.     

Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen

Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n=7 or unilateral [UCLP]; n=22) or isolated cleft palate (CP; n=9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate.The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反[牙合]畸形的研究

目的探讨前方牵引治疗单侧完全性唇腭裂（UCLP）患者术后前牙反[牙合]畸形的效果。方法进行前瞻性临床研究设计,UCLP术后骨性前牙反[牙合]患者治疗组18例,年龄9．63±1．24岁,观察对照组14例,平均8．71±1．92岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗或观察前后拍摄头颅侧位片并测量,进行成组设计和配对设计t检验。结果UCLP治疗组前方牵引后,上颌骨前移;下颌后移合并后下旋转;上下颌间关系和面型改善明显,上颌与下颌改变的比值为1：1．7。对照组上下颌不调、前牙反覆盖、凹面型加重。结论UCLP术后轻中度骨性前牙反[牙合]畸形,前方牵引能够促进上颌骨向前,改善上下颌骨关系和软组织面型,应该早期矫形治疗。