完全性唇腭裂婴儿术前正畸治疗的临床研究

目的 观察术前鼻-牙槽突矫治器(PNAM)在完全性唇腭裂婴儿术前矫治中的作用.方法 采用术前鼻-牙槽突矫治器对45例非综合征性完全性唇腭裂患儿(平均年龄为18.33 d)进行唇裂术前正畸治疗,测量治疗前后的鼻小柱倾斜度、鼻小柱长度、鼻孔宽度、鼻孔高度和牙槽骨裂隙宽度,并用SPSS 10.0软件进行统计分析.结果 经PN...     

术前正畸在婴儿期单侧完全性唇腭裂治疗中的作用

术前正畸在婴儿期单侧完全性唇腭裂治疗中的作用广州市儿童医院口腔科（５１０１２０）邓利琴王洪涛作者对婴儿期单侧完全性唇腭裂的患者进行了术前正畸治疗，通过对术前正畸联合唇腭裂手术与单纯唇腭裂手术的比较，观察术前正畸对完全性唇腭裂治疗的作用，报告如下。材料...     

术前鼻-牙槽骨塑形在双侧完全性唇腭裂患儿治疗中的应用

目的：探讨双侧完全性唇腭裂婴儿术前鼻-牙槽骨塑形的方法与技术,并进行初步疗效评价。方法：9例双侧完全性唇腭裂婴儿进行术前鼻-牙槽骨塑形治疗。将前颌骨向后移动,排列在两侧牙槽骨之间,使牙槽骨成为较为规则的弧形排列;鼻软骨塑形及鼻小柱延长。采用SPSS15.0软件包对所得数据进行t检验。结果：9例患儿经5个月左右的术前鼻-牙槽骨塑形,前颌骨的前突量从37.64mm减至29.94mm,治疗前、后差异显著（P〈0.01）,牙槽骨排列成较为规则的弧形;鼻翼塌陷畸形得到改善,鼻尖形态改善,鼻底宽度减小（P〈0.05）,鼻小柱得到延长,从1.13mm增加至3.78mm（P〈0.05）。结论：双侧完全性唇腭裂患儿为了获得较为理想的鼻唇形态及牙槽骨的规则弧形排列,术前鼻-牙槽骨塑形是值得采用的序列治疗方法。     

新生儿完全性唇腭裂术前鼻撑和正畸治疗的临床观察

目的 观察新生儿完全性唇腭裂术前鼻撑和正畸治疗的效果。方法对38例完全性唇腭裂，通过模型测量矫治前后牙槽裂距的改变，观察治疗效果；用鼻外形的评价标准对术后患儿进行初步评价。结果经过108—152天的治疗，26例单侧完全性唇腭裂齿槽左右裂隙较矫治前平均缩小5．3mm，前后裂距较矫治前平均缩小3．5mm；鼻外形评价的优良率为76％。12例双侧完全性唇腭裂齿槽左侧裂隙平均缩小4．7mm，右侧裂隙平均缩小4．2mm，左右裂距平均扩大1．6mm，前后裂距平均缩小5．1mm，前牙槽突宽度平均增大1．2mm；鼻外形评价的优良率为66％。结论对完全性唇腭裂患者在新生儿期做术前鼻撑和正畸治疗，患儿易适应，有利鼻发育，可减小手术的难度，提高整复效果。     

唇腭裂婴儿术前正畸的研究进展

随着唇腭裂序列治疗的不断完善和改进,其术前正畸治疗也变得越来越重要,尤其体现在减小手术的难度和提高术后的效果上,而矫治器的种类繁多,目的和效果也不尽相同。本文就唇腭裂婴儿术前正畸的研究进展作一综述。     

单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化

目的 探讨单侧完全性唇腭裂患儿术前正畸及手术前后的上腭裂隙变化.方法 对18例单侧完全性唇腭裂患儿先用上颌腭托矫治器(PNAM)术前正畸治疗后,再进行唇裂修补手术.采用模型测量方法,比较患儿初诊时、手术前1个月和手术后2个月时的上腭裂隙变化.结果 治疗后患儿唇部外形明显改善,腭部裂隙减小,患侧塌陷的鼻翼穹隆高度恢复.结...     

唇腭裂婴儿术前正畸治疗的优势附85例病例报告

目的：研究唇腭裂婴儿术前正畸治疗的方法,评估春对手术及患儿发育的影响。方法：Ｃ地患儿正畸治疗前后的变化进行分析对比。结果：患儿上唇及前颌骨在治疗后２－３个月内可基本复位,腭裂呈明显缩窄。结论：术前正畸治疗可改善喂养状况;有利于手术年龄提前和缩小瘢痕,并有助于语言的正常发育。     

婴儿期单侧完全性唇腭裂术前颌骨矫治器的应用

目的：为了提高唇裂修复的效果，在16例婴儿期完全性唇腭裂术前采用Latham颌骨矫治器，关闭婴儿单侧唇腭裂的牙槽嵴裂隙，为唇鼻整形奠定基础。方法：采用Latham颌骨矫治器方法，个体化制作矫制器，用骨内针固定矫治器。用螺旋式加力法将错位的各骨段移位到较为理想的排列位置。结果：经过2～4周矫治后可使患侧鼻翼基底部升高，两侧牙槽嵴裂隙显著缩小。结论：对婴儿期完全性唇腭裂术前颌骨裂隙的矫治，为初期的整形手术奠定了较好基础。     

婴儿期唇腭裂的术前正畸治疗

作者对婴儿期单侧完全性唇腭裂患者进行了术前正畸治疗,与不进行术前正畸治疗的患者,比较患者手术前唇腭部裂隙的变化,观察术前正畸对婴儿唇腭裂治疗的作用。 一、临床资料 选择48例单侧完全性唇腭裂患者,均为上颌骨异常前     

Presurgical Orthopaedic Nasoalveolar Molding in Cleft Lip and Palate Infants: A Comparative Evaluation of Cases Done With and Without Nasal Stents

Addressing the craniofacial anomaly of cleft lip and palate presurgically has been done since more than 50 years now, with a constant improvisation of the treatment protocols from time to time. The present study deals with a modification of the technique devised 16 years ago. The effect of nasal stents attached to a pre-surgical naso-alveolar molding (PNAM) appliance on the nasal morphology achieved prior to primary surgical correction of the cleft lip was to be evaluated. Twenty subjects, infants with cleft lip and palate, less than 2 months of age were selected for presurgical nasoalveolar molding treatment. Impressions were recorded, casts made and PNAM appliance fabricated. Ten infants were given the appliance without nasal stents and to the other ten appliances nasal stents were added. The patients were recalled every 2–3 weeks and a series of 9 measurements were recorded every visit along with adjustments made to the appliance for desirable effects on the lip, alveolus and nose. This was carried out till the patient was taken up for lip repair. The final measurements obtained at the end of the presurgical treatment were recorded. Mann-Whitney test, between study and control group showed that the increase in the columella length was statistically significant (p = 0.0001 and p = 0.033) in the study group as compared to the control group. Also the increase of the nasal tip projection (mean = 1.30 mm) in the study group was found to be statistically significant (p = 0.006) as compared to the control group. We concluded that nasal stents attached to the alveolar molding appliance, yield significant improvement of the nasal morphology and better nasal aesthetics presurgically.     

Nasoalveolar Molding with Active Columellar Lengthening in Severe Bilateral Cleft Lip/Palate: A Clinical Report

Severe bilateral cleft‐lip/palate patients are difficult to manage even if nasoalveolar molding therapy is advocated before surgical repair. A 5‐day‐old male infant with bilateral cleft‐lip‐palate was managed with the nasoalveolar molding technique. Periodic adjustments of the appliance were continued every week to mold the nasoalveolar complex into the desired shape for the 5 months of infancy. The cleft width of 12 mm on the right and 14 mm on the left side was completely reduced, and the absent columella was lengthened to 6 mm with the active molding appliance. The horizontal bar of the nasal stent of the appliance was modified by adding an additional 1 mm layer of resilient liner on the tissue surface to achieve rapid columellar lengthening. In severe bilateral cleft‐lip/palate cases, simple modifications in the appliance can achieve rapid results.     

Modified Presurgical Nasoalveolar Molding in the Infants with Complete Unilateral Cleft Lip and Palate: A Stepwise Approach

Presurgical orthopedics in one or the other form has been an important part of the multidisciplinary approach towards the better cleft care. Presurgical nasoalveolar molding (PNAM) was described as a modified approach to the conventional form of orthopedics. PNAM not only reduces the severity of the alveolar defect before surgery, it also reduces the nasal deformity bringing it near to the normal. Nonsurgical nasal correction forms an important adjunct to the primary nasal repair at the time of primary lip repair. However, acceptance of nasoalveolar molding in Indian set-up has not been wide spread due to various reasons such as lack of the resources and inability of the parents to comply with the frequent adjustment schedule. At the Nitte Meenakshi Institute of Craniofacial surgery at the Nitte University, Mangalore, authors have developed a modification of the PNAM appliance previously described in the literature. The key modification is done at the time of fabrication of the occlusal prosthesis. This modification has made the overall procedure simpler and at the same time helped to reduce the recall visits by half of the originally required. This article describes the fabrication procedure of the modified nasal alveolar molding appliance and the modified treatment protocol in a stepwise manner.     

双侧唇裂或唇腭裂患者唇裂术后鼻唇畸形的Ⅱ期整复治疗

目的：介绍双侧唇裂／唇腭裂患者术后鼻唇畸形的Ⅱ期整复方法及效果。方法：将50例患者按鼻畸形、唇畸形的不同，分别采用三种不同的术式治疗。对上唇组织较多者，采用鼻底叉形瓣延长鼻小柱，上唇创缘直接缝合法；对鼻及上唇畸形较轻者，采用Noordhoff整复法治疗；对鼻唇畸形严重并有上唇过紧者，采用前唇组织瓣延长鼻小柱，下唇Abbe瓣旋转修复上唇正中缺损。结果：50例患者中，30例Ⅱ期修复后鼻形态正常，鼻孔大小对称，有良好的鼻堤，鼻小柱长度适中；恢复了上唇的高度和宽度，有明显的人中嵴、唇峰及唇珠，上下唇和谐。11例患者一般。结论：本文介绍的三种术式适用于不同类型双侧唇裂术后鼻唇畸形的患者。     

Effect of Cleft Lip and Palate Repair on Craniofacial Morphology in Patients with Unilateral Complete Cleft Lip and Palate

目的通过对替牙期正常儿童及单侧完全唇腭裂(UCLP)患者X线头影测量侧位片进行比较研究,了解唇腭裂及其手术对颌骨发育的影响,探索继发畸形的发病机制.方法将替牙期的正常儿童及UCLP患者分为四组①正常对照组(Normal),本组包括48名替牙期正常湖北地区儿童;②未手术组(NO),本组10名UCLP患者未经任何手术治疗;③唇裂修复组(OL),34名UCLP患者已行唇裂修复,腭裂暂未手术;④唇腭裂修复组(OLP),16名UCLP患者已行唇、腭裂修复.各受试对象拍摄X线头影测量侧位片,测量描述颌骨的形态特征及生长方向,对各组之间测量结果进行统计学分析.结果未行手术治疗的UCLP患者颌骨形态除腭部先天性发育不足外,颌骨侧位头影测量与正常无显著性差异;OL和OLP组较正常存在严重的颌骨畸形,主要表现为上颌后缩、位置后移,同时下颌骨向后下旋转移位;OL和OLP组上颌后缩的程度无显著性差异.结论UCLP患者颌骨具有趋于发育正常的生长能力;手术是导致颌骨继发畸形的主要因素;对于单侧完全唇腭裂患者,唇裂修复术对颌骨发育的影响较腭裂修复术更严重.     

Modified Activation Technique for Nasal Stent of Nasoalveolar Molding Appliance for Columellar Lengthening in Bilateral Cleft Lip/Palate

Bilateral cleft lip/cleft palate is associated with nasal deformities typified by a short columella. The presurgical nasoalveolar molding (NAM) therapy approach includes reduction of the size of the intraoral alveolar cleft as well as positioning of the surrounding deformed soft tissues and cartilages. In a bilateral cleft patient, NAM, along with columellar elongation, eliminates the need for columellar lengthening surgery. Thus the frequent surgical intervention to achieve the desired esthetic results can be avoided. This article proposes a modified activation technique of the nasal stent for a NAM appliance for columellar lengthening in bilateral cleft lip/palate patients. The design highlights relining of the columellar portion of the nasal stent and the wire‐bending of the nasal stent to achieve desirable results within the limited span of plasticity of the nasal cartilages. With this technique the vertical taping of the premaxilla to the oral plate can be avoided.     

双侧唇裂/唇腭裂术后继发畸形的临床分类研究

目的：对双侧唇裂／唇腭裂术后继发畸形进行临床分类研究。方法：选中南大学湘雅医院口腔颌面外科双侧唇裂／唇腭裂术后继发畸形患者50例作为研究对象，观察鼻部、唇部、He／颌骨畸形等19项内容，它们分别是：鼻尖低平、鼻翼塌陷、双侧鼻孔不对称、鼻堤缺失、鼻小柱短小；上唇过紧、上唇过松、人中及唇峰不显、唇珠缺如、口哨畸形、红唇不显；前牙反He、313移位或缺失、牙槽嵴裂、牙弓小、牙列不齐、前牙槽嵴缺失和上颌后缩。结果：50例双侧唇裂／唇腭裂术后畸形患者均有鼻尖低平、鼻翼塌陷、双侧鼻孔不对称、鼻堤缺失、鼻小柱短小、人中不显、唇峰不显、唇珠缺如。50例患者中，42例有牙槽嵴裂和牙列不齐；33例行加长法Ⅱ期修复双侧唇裂者均有前牙反He、牙列不齐和上颌后缩；28例有口哨畸形存在。结论：双侧唇裂／唇腭裂I期修复后仍有鼻、唇及He或颌畸形存在，对这些畸形必须讲行Ⅱ期整复治疗．     

Presurgical Nasoalveolar Molding (PNAM) for a Unilateral Cleft Lip and Palate: A Clinical Report

Cleft lip and palate deformity is a congenital defect of the middle third of the face. Incidence varies from 1:500 to 1:2500 live births. Etiology depends upon hereditary and environmental factors. Restoration of these defects is important not only for functional and esthetic reasons, but also because there may be a positive psychological impact for the patient and parents. The goal of primary closure of the lip for unilateral cleft lip is to ensure a normal and symmetrical lip and nose. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. Presurgical nasoalveolar molding (PNAM) represents a paradigm shift from the traditional methods of presurgical infant orthopedics. PNAM consists of active molding of the alveolar segments as well as the surrounding soft tissues. This clinical report describes a new approach of PNAM therapy for an infant with complete unilateral cleft lip and palate showing significant reduction in cleft defect size and improved contour and topography of deformed surrounding soft tissues.     

Nasoalveolar Moulding for Children with Unilateral Cleft Lip and Palate

Introduction

Cleft lip and palate represents the most frequently occurring congenital deformity second only to club foot deformity in our country. Wide alveolar clefts if not preceded by pre surgical orthodontic adjuncts like nasoalveolar moulding, may affect the final outcome of the primary surgery. Presurgical nasoalveolar moulding is to align and approximate the alveolar cleft segments while at the same time achieving correction of the nasal cartilage and soft tissue deformity.

Materials and methods

The device we used is designed by Barry Grayson. It is simple to fabricate, causes less discomfort to the patient and optimum results are achieved in three months of time, compared to other complicated appliances like Latham’s which are more invasive. A child of 3 months presented with a complaint of unilateral cleft deformity on one side of the face.

Conclusion

After three months of nasoalveolar moulding considerable changes were observed. The widths of the cleft alveolus were reduced and the nasal contours of columella on the cleft side showed considerable improvement.