单侧唇腭裂鼻-牙槽骨塑形后同期唇-鼻-牙槽骨整复术

目的:探讨唇腭裂婴幼儿术前鼻-牙槽骨塑形后的同期唇-鼻-牙槽骨整复术的方法与技术,并进行初步疗效评价。方法:对31例单侧完全性唇腭裂婴幼儿进行术前鼻-牙槽骨塑形及同期唇-鼻-牙槽骨整复术。术前鼻-牙槽骨塑形主要包括关闭牙槽骨间隙、唇牵张及鼻矫形;早期同期唇-鼻-牙槽骨整复术,即牙龈-牙周膜-牙槽骨整形术和改良Mohler法单侧唇裂唇鼻畸形同期整复术。采用SPSS10.0统计软件包对所得数据进行t检验。结果:31例唇腭裂婴幼儿经2～3个月术前鼻-牙槽骨塑形,唇裂隙宽度显著变窄(P<0.01),裂隙两侧唇组织适度牵张;鼻小柱延长及鼻塌陷畸形显著改善(P<0.05);牙槽裂隙显著变窄(P<0.01)。术后2例失访,29例患者随访6～30个月,结果显示:上唇和鼻形态俱佳,鼻小柱端正,鼻尖形态改善,双鼻孔、鼻底堤状隆起对称;口腔前庭-鼻腔瘘封闭;27例患者牙槽突裂隙关闭,牙槽骨连续性及稳定性增强并在原牙槽裂隙处有牙萌出,其中13例牙槽嵴高度、宽度及厚度不足;2例仍有1～2mm的牙槽裂隙。结论:单侧完全性唇腭裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨,术前进行鼻-牙槽骨塑形和同期唇-鼻-牙槽骨整复术是值得采用的序列治疗方法。

Early simultaneous lip-nose-alveolar repair following presurgical nasoalveolar molding for infants with unilateral cleft lip and palate

PURPOSE: To apply a new technique of early simultaneous lip-nose-alveolar repair after presurgical nasoalveolar molding in infants with unilateral complete cleft lip and palate and evaluate its outcome. METHODS: 31 cases with unilateral complete cleft lip and palate underwent early simultaneous lip-nose-alveolar repair following presurgical nasoalveolar molding. The nasoalveolar molding included gap-closing of alveolar cleft, lip taping and nose-stent until the age of approximately 3-5 months when the surgery was performed. Unilateral gingivoperiosteoplasty as well as the lip and nose repair were performed in these patients. Student's t test was used for data analysis with SPSS10.0 software package. RESULTS: After nonsurgical nose-alveolar molding in 31 infants with cleft lip and palate about 2-3 months, the width of the cleft lips in all cases was significantly narrowed (P<0.01), the soft tissue of both sides of the clefts grew and expanded. The deformity of the columella, the dome, and the wide alar of the nose was significantly reduced following nonsurgical nasoalveolar molding (P<0.05). The width of the alveolar cleft became significantly narrower in these patients (P<0.01). 29 operated cases with simultaneous lip-nose-alveolar repair were followed up for 6-30 months. These cases had satisfactory lip-nose contour and closed fistulas between the nose and the oral cavity. After 15-30 months of follow up,27 cases gained a whole uninterrupted alveoli and the deciduous teeth erupted at the previous clefts. But there were still deficiencies of height, width, and thickness of the alveolar ridge in 13 cases, and 1-2 mm gaps of alveolar clefts in 2 cases. CONCLUSIONS: In order to obtain satisfactory lip-nose configuration and uninterrupted alveolar bone for unilateral complete cleft lip and alveolus,the presurgical nasoalveolar molding and early simultaneous lip-nose-alveolar repair are useful in cleft lip and palate team approach.