唇腭裂继发上颌骨发育不足牵引成骨后腭咽部功能变化

目的　通过颅外支架式上颌骨牵引成骨术 (RigidExternalDistraction ,RED)前后唇腭裂患者静止位和i]发音位头颅定位侧位片腭咽部结构变化 ,拟评价上颌骨牵引成骨术对唇腭裂患者腭咽部结构功能的影响及其相关因素。方法　 1999～ 2 0 0 1年行颅外支架式上颌骨牵引成骨术的唇腭裂术后上颌发育不足患者 2 1名 ,平均年龄15 .0 5岁。所有患者RED术前后拍摄静止位及 i]位头颅定位片 ,然后对腭咽部结构功能指标测量分析。结果　(1)RED术后PNS A、PNS PPW、NR、ASPHP、RVCR、EASP和MSP具有显著性变化 ;(2 )RVCR的变化与上颌骨前移幅度、PNS PPW增加幅度和NR增大程度呈正相关。上颌前移幅度还与软硬腭夹角增加呈正相关。结论　 (1)上颌骨牵引成骨术后腭咽腔深度增加 ,对唇腭裂患者腭咽闭合功能仍有一定负面影响 ,但同时腭咽部软组织有代偿性改变 ;(2 )上颌骨前移幅度与RED术后腭咽闭合功能变化有关 ;(3)咽后壁瓣的存在对防止和减少RED术后腭咽闭合功能不全产生有积极作用。

VELOPHARYNGEAL STRUCTURE AND FUNCTION CHANGES IN CLEFT LIP AND PALATE PATIENTS AFTER MAXILLARY DISTRACTION OSTEOGENESIS

Objective This study was conducted to evaluate the velopharyngeal structure and function changes after maxillary distraction osteogenesis by using a Rigid External Distraction Device (RED) in cleft lip and palate patients with maxillary dysplasia. Methods Twenty one cleft lip and palate patients with maxillary dysplasia were included in this study. There were 13 male and 8 female patients, with average age 15.05 years. All the patients underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. Pretreatment and posttreatment lateral cephalograms at rest and position were compared, and paired T test was used to evaluate the changes of velopharyngeal structure and function.Results (1)The differences of PNS A?PNS-PPW?NR?ASPHP?RVCR?EASP and MSP after RED were significant; (2)The changes of RVPC is relative to the deyree of maxillary advancement, increase of PNS PPW and NR. The degree of maxillary advancement is also relative to the increase of ASPHP.Conclusion (1)In cleft lip and / or palate population, the risk for velopharyngeal insufficiency following maxillary distraction leading to increase of velopharyngeal depth can be found, in despite of compensatory changes of soft tissue in the velopharyngeal area observed; (2)The change of velopharyngeal function is relative to the degree of maxillary advancement; (3)The existence of pharyngeal flap is beneficial to preventing or diminishing the increase of RVCR.