腭帆提肌重建联合岛状颊黏膜肌瓣在先天性腭裂中的应用

目的:探讨一种对上颌骨发育影响较小且具有良好腭咽闭合功能的腭裂修补术的临床应用。方法:采用腭帆提肌重建联合岛状颊黏膜肌瓣术,共修补37例腭裂患者。结果:所有患者均一期愈合,随诊1～3年,语音清晰度满意,无腭瘘发生。结论:腭帆提肌重建联合岛状颊黏膜肌瓣术较好地恢复了腭帆提肌正常的解剖结构和位置,获得了良好的腭咽闭合,有效降低了腭瘘的发生率,是一种值得推荐的功能性腭裂修复术。     

双颊肌黏膜瓣修复大龄宽大腭裂患者的远期效果评价

目的对采用双颊肌黏膜瓣修复的大龄宽大腭裂患者的语音效果和上颌骨发育情况进行分析,评价手术的远期效果。方法选择12例大龄宽大腭裂患者为试验组,采用软腭后退双颊肌黏膜瓣修复;同期选择20例腭裂患者为传统手术组,采用常规双瓣法加软腭肌功能修整术进行整复;另外选择30例非唇腭裂患者作为对照组。应用专业语音和临床语音评价方法比较腭裂患者术前和术后5年的语音效果;拍摄头颅定位侧位片,应用头影测量方法评价患者术前和术后5年的上颌骨发育情况;并将2组腭裂患者术后5年的语音和上颌骨发育情况与对照组进行比较。结果试验组患者术后伤口均达到一期愈合;随访5年,张口度正常,硬软腭部无继发穿孔,原手术区域组织松软,组织瓣较腭部组织色泽红润。试验组术后语音效果优于术前,也优于传统手术组（P<0.05）;术后上颌骨发育情况优于传统手术组（P<0.05）,但与对照组相比无明显差异（P>0.05）。结论采用软腭后退双颊肌黏膜瓣法修复大龄宽大腭裂患者,术后语音改善效果较好,对上颌骨发育的影响较小,是一种较好的手术方式。     

大龄腭裂患者治疗模式的初步研究

目的改进大龄腭裂患者的治疗模式,提高大龄腭裂患者术后的腭咽闭合率和语音清晰度。方法对37例年龄大于6岁（含6岁）的腭裂患者进行同期腭裂与腭咽肌瓣咽成形整复术,并对其术后10~15个月的效果进行了随访和语音评估。结果22例患者术后腭咽闭合完全,15例术后虽仍有腭咽闭合不全,但在鼻咽纤维镜下腭咽闭合度达85%以上;所有患者X线侧位咽腔造影显示软腭与咽后壁贴合;语音检测显示,高鼻音和鼻漏气程度显著下降,辅音清晰度提高。结论本研究中建立的大龄腭裂患者治疗模式可以显著提高腭裂患者术后的腭咽闭合率和语音清晰度,为改善其生存质量创造了条件。     

腭裂手术的新概念

一、手术年龄1 .5岁左右修复腭裂有利于正常语音功能 ,因为在学习语音以前 ,建立了正常的腭部解剖位。二、为什么早期腭裂修复术 ,采用兰氏法 ?早期腭裂手术有利于语音的发育 ,但手术过多干绕颌骨 ,无疑会造成日后颌骨发育障碍 ,兰氏手术未后退软腭 ,仅封闭裂隙 ,在腭部所遗留骨创面极小 ,从而手术对颌骨干扰小。三、腭帆提肌功能位的重建是获得软腭上提功能的关键腭咽闭合的机理是腭帆提肌构成的前半园向上后收缩及咽上缩肌构成的后半园向前收缩来达到腭咽闭合。一些患者 ,有足够的软腭长度 ,但腭帆提肌上提功能差 ,也无法达到腭咽闭合。因…     

同期咽后壁组织瓣转移修复后大龄腭裂患者语音改善效果的评价

目的探讨咽后壁瓣转移修复术对大龄腭裂患者语音效果的影响。方法选择2006年8月～2008年8月就诊于青岛大学医学院附属医院口腔颌面外科的大龄腭裂患者37例,20例采用两瓣法关闭裂隙并同期行咽后壁瓣转移修复术;17例单纯关闭裂隙。比较手术前后腭咽闭合不全率（RVPI）,单元音[i]三个共振峰频率,辅音[ka]、[pa]、[si]、[qi]冲直条和擦音乱纹及语音清晰度变化,并与健康儿童20例对照。结果所有患者均达到临床Ⅰ期愈合,两手术组术后RVPI均显著降低,语音也有不同程度改善,且关闭裂隙同期行咽后壁瓣转移修复术组明显优于单纯关闭裂隙组。结论大龄腭裂患者同期行腭裂修复术和咽后壁瓣转移修复术能显著改善患者的腭咽闭合功能,可作为大龄腭裂患者常规术式。     

腭裂植骨对上颌骨生长发育的影响

目的 为了寻找拮抗腭裂及腭裂修复术后上颌骨生长抑制的方法。本研究观察了早期延期全裂隙植骨修复动物腭裂模型后，对上颌骨生长发育的影响。方法 本研究用４０只狗作实验动物，分成正常对照组和３个实验组，实验组Ｉ外科手术造成右侧完全性腭裂，实验组Ⅱ手术造成右侧完全性腭裂后用两瓣法修补裂隙，实验组Ⅲ手术造成右侧完全性腭裂后用自体肋骨移植并用两瓣法修复裂隙。观察了上颌骨长，宽，高、后面长、宽及鼻中缝与额骨中垂线     

腭裂手术的点滴体会

先天性腭裂手术目的在于恢复腭咽闭合功能。通过对78例腭裂患者术后伤口愈合情况进行分析。一期愈合率约97％;最小手术年龄为2.5岁。手术在口腔插管全麻下进行。手术方法,不完全腭裂采用兰氏法,单侧完全性采用4瓣法,双例完全性采用5瓣法。     

颞肌瓣修复上颌骨及腭部缺损的语音功能评价

目的　分析颞肌瓣即刻修复上颌骨及腭部术后缺损患者的语音功能恢复情况。方法　通过对 19例应用颞肌瓣修复上颌骨及腭部缺损的患者进行腭咽闭合功能、头颅腭咽侧位X线片测量和语音清晰度测定 ,分析评价颞肌瓣即刻修复上颌骨及软腭部术后缺损患者的语音功能恢复情况。结果　 19例患者中 ,有 15例 (78.0 0 % )为完全腭咽闭合 ,3例 (15 80 % )为边缘性腭咽闭合 ,1例 (5 2 6 % )为腭咽闭合不全 ,平均语音清晰度为 94 3% ,接近正常人语音清晰水平。结论　颞肌瓣修复上颌骨及腭部缺损能够较好地重建口腔发音结构 ,维持腭部功能 ,较好地恢复术后语音功能     

腭裂植骨对上颌骨生长发育的影响(动物实验研究)

目的为了寻找拮抗腭裂及腭裂修复术后上颌骨生长抑制的方法，本研究观察了早期延期全裂隙植骨修复动物腭裂模型后，对上颌骨生长发育的影响。方法本研究用４０只狗作实验动物，分成正常对照组和３个实验组，实验组Ｉ外科手术造成右侧完全性腭裂，实验组Ⅱ手术造成右侧完全性腭裂后用两瓣法修补裂隙，实验组Ⅲ手术造成右侧完全性腭裂后用自体肋骨移植并用两瓣法修复裂隙。观察了上颌骨长、宽、高、后面长、宽及鼻中缝与额骨中垂线的夹角变化等指标，并进行统计学分析。结果早期的延期腭裂全裂隙骨移植修复术在拮抗裂隙和裸露骨面对上颌骨横向生长致畸作用的同时，可以诱发新的上颌骨畸形。结论提示临床选用这一修复方法时应采取谨慎的态度     

腭裂手术年龄对腭咽闭合功能影响的研究

目的通过回顾性调查,研究在不同年龄修复腭裂后腭咽闭合功能恢复的规律。方法将102例年龄在10岁以上,腭裂术后2年以上的单侧完全性唇腭裂患者,根据接受腭裂手术的年龄分为三组,A组:0~3.00岁手术组(n=37)、B组:3.01~6.00岁手术组(n=36)和C组:6.01岁以上手术组(n=29)。随访时进行鼻咽纤维镜检查,对其最大腭咽闭合程度进行等级评价。并对不同手术年龄组间的腭咽闭合程度进行统计学检验。结果统计学检验显示腭咽闭合程度在A组与B组以及A组与C组间差异有显著性(P<0.05),B组与C组间差异有显著性趋势(P=0.051)。说明0~3.00岁接受腭裂修复术患者术后腭咽闭合功能的恢复要明显优于3.01岁以上接受腭裂修复术的患者,而3.01~6.00岁接受腭裂修复术患者术后腭咽闭合功能的恢复要优于6.01岁以上接受腭裂修复术的患者。结论在不同年龄进行腭裂修复术其术后腭咽闭合功能恢复的程度不同。手术年龄越小,恢复程度越好。     

改良腭黏膜瓣整复软腭裂的临床观察

目的:探讨整复软腭裂的新术式,重建腭咽闭合的效果。方法:采用腭黏膜瓣后推术对25例软腭裂患者进行整复治疗,并对其进行随访,以了解术后腭咽闭合的情况。结果:所有患者术后腭部创口愈合良好,瘢痕不明显,软腭的活动度良好,且均有良好的腭咽闭合功能。结论:对先天性软腭裂的患者实施该术式整复,能较好地恢复腭咽闭合功能,是较为理想的手术整复方法之一。     

复合人工骨修复腭裂腭板缺损

目的 :在动物实验的基础上 ,实施以HA Bonecement复合人工骨作为植骨材料应用于临床腭板骨缺损的修复。方法 :就诊的有腭板骨缺损的先天性 Ⅱ°腭裂患者 4 0人 ,随机分为对照组和植骨组 ,植骨组腭板骨缺损利用HA Bonecement复合人工骨修复 ,术后 3个月复诊 ,植骨组患者行腭部CT扫描检查。结果 :腭部CT扫描显示植入人工骨愈合良好 ,植骨组语音改善明显优于对照组 (x2 =6 4 6,p <0 0 5 )。结论 :HA Bonecement复合人工骨可以作为临床腭板骨缺损修复材料 ;初步研究认为腭板骨缺损修复能改善腭咽闭合。     

腭板植骨术后5年腭咽闭合功能分析

目的 :探讨腭板骨缺损修复对腭咽闭合功能的影响。方法 :腭板骨缺损的先天性Ⅱ°腭裂患者 4 0例 ,随机分为对照组和植骨组 ,植骨组腭板骨缺损利用HA -Bonecement复合人工骨修复 ,术后 5年复诊 ,所有患者行鼻咽纤维镜腭咽闭合功能定量对比分析检测 ,植骨组患者加腭部CT扫描检查。结果 :植入的人工骨在植骨床固定牢固 ,未见移位、未见塌陷、未见断裂 ;植骨组软腭活动度和腭咽闭合的比例明显高于对照组 ,但术后 5年腭咽闭合功能定量分析结果与术后 3个月比较没有统计学意义。结论 :腭板骨缺损修复远期效果显示能改进腭咽闭合 ,但腭板骨缺损修复改进腭咽闭合的程度随植骨时间的延长无明显提高     

Laryngeal airway resistance in cleft palate children with complete and incomplete velopharyngeal closure.

OBJECTIVE: This study investigated the effect of velopharyngeal insufficiency on aerodynamic measures of laryngeal function in children with cleft palate. DESIGN: Data were analyzed using analysis of covariance. The independent variable was velopharyngeal closure, and the dependent variables were laryngeal resistance, laryngeal airflow, and transglottal pressure. Age and gender were covariates. SETTING: The data were collected at The Craniofacial Center, University of Illinois, a tertiary health care center located in Chicago. PATIENTS: Thirty-six children with cleft palate were recruited from among the patients at The Craniofacial Center. Ten children with velopharyngeal areas >5 mm2 during oral speech were placed in the incomplete closure group, while 26 children with areas <1 mm2 were placed in the complete closure group. OUTCOME MEASURES: The three dependent variables (transglottal pressure, transglottal airflow, and laryngeal resistance) were measured. RESULTS: Laryngeal resistance and transglottal pressure were significantly higher, and transglottal airflow was significantly lower in the group with complete closure. CONCLUSIONS: In summary, cleft palate patients with complete velopharyngeal closure exhibited higher laryngeal resistances than those with incomplete closure.     

频谱分析技术在腭裂语音研究中的应用

目的用语音共振峰的原理建立腭裂语音研究的客观方法。方法对正常儿童、腭裂术前儿童、腭裂术后儿童分别进行单元音[a]、[o]、[e]、[ī]、[u]、[ü]的录音及语音频谱分析,计算各组儿童的第一、二、三共振峰数值,对腭裂术后儿童的腭咽闭合不全率及语音清晰度进行测量,并评价其与共振峰的对应关系。结果正常儿童的第一、二、三共振峰数值是比较恒定的,腭裂术前儿童的共振峰数值明显下降,腭裂术后儿童的共振峰数值随腭咽闭合程度和语音清晰度的改善而显著提高。腭咽闭合完全者发[i]时,F3值明显大于腭咽闭合不全者。结论语音共振峰可以客观地反映腭咽闭合状况,单元音[i]可以作为此种检测的标准音素。     

单侧完全性唇腭裂患儿唇裂修复同期硬腭裂隙封闭的临床观察

目的　探讨单侧完全性唇腭裂患儿时唇裂修复同期硬腭裂隙封闭的可行性及临床效果。方法　47例年龄为3·0~7·5月龄的单侧唇腭裂患儿在唇裂修复同期行硬腭裂隙封闭,分析手术时间、术中出血、术后恢复、创口愈合及腭部裂隙变化情况。结果　所有患儿的手术均顺利完成。手术时间与单纯唇裂修复术相比平均延长13 min , 术中出血平均增加5 ml,术后恢复好,无创口感染及裂开。至患儿9~18月龄二期手术时腭部裂隙比行单纯唇裂修复术平均小0·28 cm,使二期手术时软腭后退充分,腭咽闭合良好。结论　单侧完全性唇腭裂患儿唇裂修复同期行硬腭裂隙封闭是安全和可行的。     

幼儿腭裂术后语言发育与腭咽闭合功能恢复关系的研究

目的 探讨幼儿腭裂患者术后口语语言发育对腭咽闭合功能恢复的影响.方法 普通话腭裂术后患者78例,腭裂手术年龄平均14.9个月,对其手术后(30±3)个月时的录音资料整理、转译判听及分析.分别统计平均发音次数(mean utterance count,MUC)和平均特定口辅音正确发生次数(mean special consonant correct count,MSCC).应用统计学方法分析MUC和MSCC的相关性.结果 本组78例的MUC:5.5～54.4次/min,平均26.8次/min;MSCC:0～8.4次/min,平均1.1次/min.MUC和MSCC呈正相关关系,相关系数为0.360(P＜0.01).结论 患者发音频数越高越有助于腭裂术后腭咽闭合功能的恢复.     

腭裂畸形程度对腭裂语音影响的研究

目的研究腭裂畸形程度与腭裂语音之间的关联性。方法选择102例行腭帆提肌重建术的非综合征型腭裂患者为研究对象,其中完全性腭裂56例（CCP组）,不完全性腭裂46例（ICCP组）。在语音频谱仪上测定患者在手术前及术后发[i]音时共振峰F1、F2、F3的数值,并与30例正常对照组（C组）的测定结果进行比较。患者的术后复诊时间为3～6个月。结果①C组、ICCP组术前和CCP组术前的F1值无统计学差异（P>0.05）,F2、F3值有统计学差异（P<0.05）,C组高于ICCP组,ICCP组高于CCP组;②C组、ICCP组术后和CCP组术后的F1值无统计学差异（P>0.05）,F2、F3值有统计学差异（P<0.05）,C组高于ICCP组,ICCP组高于CCP组;③ICCP组和CCP组进行组内自身比较,术前、术后的F1值无统计学差异,术后F2、F3值均高于术前（P<0.05）。结论腭裂畸形程度对腭裂患者的语音有影响,畸形越严重,患者舌位后缩越明显,术后软腭上抬动度越差,语音状况越不理想。     

Palate re-repair revisited.

OBJECTIVE: To analyze the results of a consecutive series of palate re-repairs performed using the operating microscope and identify predictive factors for outcome. DESIGN: Prospective data collection, with blind assessment of randomized recordings of speech and velar function on lateral videofluoroscopy and nasendoscopy. PATIENTS: One hundred twenty-nine consecutive patients with previously repaired cleft palates and symptomatic velopharyngeal incompetence (VPI) and evidence of anterior insertion of the levator veli palatini underwent palate re-repairs by a single surgeon from 1992 to 1998. Syndromic patients, those who had significant additional surgical procedures at the time of re-repair (23 patients), and all patients with inadequate pre- or postoperative speech recordings were excluded, leaving a total of 85 patients in the study. INTERVENTIONS: Palate re-repairs, with radical dissection and retropositioning of the velar muscles, were performed using the operating microscope with intraoperative grading of anatomical and surgical findings. MAIN OUTCOME MEASURES: Pre- and postoperative perceptual speech assessments using the Cleft Audit Protocol for Speech (CAPS) score, measurement of velar function on lateral videofluoroscopy, and assessment of nasendoscopy recordings. RESULTS: There were significant improvements in hypernasality, nasal emission, and nasal turbulence and measures of velar function on lateral videofluoroscopy, with improvement in the closure ratio, velopharyngeal gap at closure, velar excursion, velar movement angle, and velar velocity. CONCLUSIONS: Palate re-repair has been shown to be effective in treating VPI following cleft palate repair, both in patients who have not had an intravelar veloplasty and those who have had a previous attempt at muscle dissection and retropositioning. Palate re-repair has a lower morbidity and is more physiological than a pharyngoplasty or pharyngeal flap.     

Cleft palate repair using a marginal musculo-mucosal flap.

OBJECTIVE: To describe a modified procedure consisting of a mucoso-periosteal flap palatoplasty with a marginal musculo-mucosal flap (3M flap). This is also the first report of a primary repair for complete cleft palate using the 3M flap. We describe the lengthening effect of the nasal mucous layer of the soft palate and evaluate the fistula formation rate associated with this method. METHODS: This procedure has been performed on 21 patients with unilateral complete clefts and on 27 patients with incomplete clefts. A mucoso-periosteal flap raised from the hard palate was used mainly for closure of the cleft and not for the push-back. The 3M flap repaired the deficit of the nasal mucosa, making sure that the soft palate was lengthened. Intravelar veloplasty was performed also. RESULTS: The dimension of the nasal mucosal defect that can be filled with the 3M flap is 10 to 12 mm in length, oriented anterior-posterior, and 15 to 20 mm wide. Oronasal fistula formation was recognized in only 3 of 48 cases (2 of 21 complete clefts, 1 of 27 incomplete clefts) and were located at the hard-soft palate junction at the anterior portion of the 3M flap. CONCLUSIONS: This method has the theoretical advantages of (1) preventing fistula formation by filling the tissue deficiency with the 3M flap; (2) achieving better velopharyngeal function due to elongation of the soft palate and retropulsion of the muscular bundle, utilizing the 3M flap; and (3) minimizing maxillary growth retardation by adopting a non-push-back method of hard palate repair.