小年龄唇腭裂住院患儿术前发生呼吸道感染的高危因素分析与预防策略

目的 分析唇腭裂住院患儿术前发生呼吸道感染的危险因素,探讨预防呼吸道感染的措施,提高唇腭裂住院患儿的治疗质量。方法 选取2017年6—12月四川大学华西口腔医院唇腭裂外科收治的年龄≤3岁的先天性唇腭裂住院患儿510例。其中,入院后术前发生医院感染的呼吸道感染患儿50例,为观察组;入院后术前未发生呼吸道感染的460例患儿,为对照组;采用t检验及多因素logistic分析,分析唇腭裂住院患儿发生呼吸道感染的相关危险因素,探讨预防控制唇腭裂患儿入院后术前发生呼吸道感染的对策及措施。结果 2组患儿在喂养方式、住院期间陪伴人员有无感染以及夜间有无开窗通风方面有差异,其中喂养方式及住院期间陪伴人员有无感染是年龄≤3岁的唇腭裂住院患儿入院后术前发生呼吸道感染的独立风险因素。结论 年龄≤3岁唇腭裂住院患儿术前发生呼吸道感染的危险因素包括喂养方式、住院期间陪伴人员有感染以及夜间未开窗通风,尤其前两者是重要的影响因素。医护人员应加强相应的健康教育与护理措施进行控制。     

宁夏地区非综合征型唇腭裂环境因素的研究

目的 探讨宁夏地区非综合征型唇腭裂（NSCL/P）发病相关环境因素。方法 采用病例对照研究方法纳入NSCL/P患者453例,正常新生儿452例。对研究对象进行问卷调查,利用SPSS 16.0统计软件对数据进行卡方检验和Logistic回归分析。结果 NSCL/P患病类型构成比为唇裂︰唇裂合并腭裂︰腭裂=1︰2.02︰1.51。Logistic回归分析显示妊娠期发生异常、妊娠期感染、流产史、孕前孕中服用药物、饮茶、吸烟、饮酒、居住地附近工厂为危险因素（P<0.05）。单胎、早孕反应、食用豆制品食物、水果为保护因素（P<0.05）。结论 加强母亲孕期饮食均衡,避免感染、流产、服用药物以及不良生活习惯对降低NSCL/P的发生具有重要意义。     

先天性颌下腺导管扩张症的临床诊治

目的 探讨先天性颌下腺导管扩张症的临床特点及治疗方法。方法 2008年1月—2018年3月共收治7例先天性颌下腺导管扩张患儿,平均年龄5月22天;临床上表现为单侧的口底膨隆肿胀。7例患儿均在全麻下行患侧舌下腺腺体切除、颌下腺扩张部分导管切除及导管改道术,术中可见颌下腺导管口狭窄,部分导管呈扩张状态。结果 7例患者术后口底创口均愈合良好,无肿胀及囊肿发生。结论 先天性颌下腺导管扩张症患儿的发生年龄小,早期诊断与治疗有助于防止导管扩张加重,避免腺体萎缩、喂养困难以及阻塞呼吸;舌下腺腺体的同期切除可以避免术后舌下腺囊肿的发生。     

先天性颌下腺导管扩张症的临床诊治

目的 探讨先天性颌下腺导管扩张症的临床特点及治疗方法。方法 2008年1月—2018年3月共收治7例先天性颌下腺导管扩张患儿,平均年龄5月22天;临床上表现为单侧的口底膨隆肿胀。7例患儿均在全麻下行患侧舌下腺腺体切除、颌下腺扩张部分导管切除及导管改道术,术中可见颌下腺导管口狭窄,部分导管呈扩张状态。结果 7例患者术后口底创口均愈合良好,无肿胀及囊肿发生。结论 先天性颌下腺导管扩张症患儿的发生年龄小,早期诊断与治疗有助于防止导管扩张加重,避免腺体萎缩、喂养困难以及阻塞呼吸;舌下腺腺体的同期切除可以避免术后舌下腺囊肿的发生。     

华西Sommerlad-Furlow腭裂修复术后腭瘘率的研究

目的 探索华西Sommerlad-Furlow （SF）腭裂修复术后的腭瘘发生率及影响因素。方法 随访四川大学华西口腔医院唇腭裂外科2017年4—12月的385例一期腭裂病例,观察华西SF腭裂修复术后的腭瘘率,并分析可能影响伤口愈合的因素,包括性别、体重、手术年龄、裂隙类型、手术医生资历、术前白细胞计数、术前是否预防性使用抗生素、术后体温。结果 采用华西SF腭裂修复术的总瘘孔率为3.9%（15/385）;在15例腭瘘患者中,1例瘘孔位于牙槽近硬腭,12例位于硬腭,2例位于硬软腭交界。腭瘘的发生与性别、体重、手术年龄、术前是否预防性使用抗生素、术前白细胞计数、术后体温均无关（P>0.05）。在手术医生资历这一影响因素中,正高级职称（3.03%）与副高级职称（2.23%）的瘘孔率之间的差异无统计学意义（P>0.05）,但中级职称的瘘孔率为14.29%,明显高于正高级职称和副高级职称（P<0.05）。双侧完全性腭裂的瘘孔率（20.6%）大于单侧完全性腭裂（3.6%）及硬软腭裂（2.6%）（P<0.05）。结论 华西SF腭裂修复术不做松弛切口,可避免上颌骨的生长抑制,同时并未增加腭裂术后的瘘孔率,其瘘孔发生率与患儿性别、体重、手术年龄、术前是否预防性使用抗生素、术前感染、术后体温等因素关联不大,与术者的年资和腭裂的不同类型有一定相关性。     

PRDM16基因及母亲孕期环境暴露因素与非综合征型唇腭裂相关性研究

目的 探究PRDM16基因rs7525173、rs2236518、rs2493264及母亲孕早期吸烟饮酒与非综合征型唇腭裂（NSCL/P）发生的相关性。方法 收集157个患者-父母核心家系,采用连接酶检测反应（LDR）和直接测序两种方法进行基因分型,使用传递不平衡检验（TDT）、连锁不平衡检验（LD）等对数据进行统计分析。收集1 710例唇腭裂患者及956例健康新生儿,填写《唇腭裂患者流行病学调查问卷》,对孕期父母吸烟饮酒暴露因素进行分析。结果 rs2236518位点C等位基因在腭裂组中存在过传递（P<0.05）,其余位点在各组中均无明显统计学意义。母亲吸烟、母亲被动吸烟及母亲饮酒3个因素存在统计学差异（P<0.05）。结论 PRDM16基因rs2236518多态性与NSCL/P存在相关性,母亲吸烟、母亲被动吸烟及母亲饮酒与唇腭裂的发生存在密切联系。     

正畸患者上颌侧切牙和尖牙区骨缺损影响因素的锥形束CT研究

目的: 利用锥形束CT(cone beam computed tomography,CBCT)研究上颌侧切牙和尖牙区骨开裂和骨开窗的危险因素。方法: 实验对象选自2014~2016年就诊于中国医科大学附属口腔医院正畸一科患者治疗前的CBCT,存在骨开裂或骨开窗的上颌侧切牙44例和上颌尖牙43例为实验组,不存在骨开裂和骨开窗的上颌侧切牙43例和上颌尖牙41例为对照组。结果: 牙体倾斜度、牙体长轴与牙槽突长轴的角度、牙槽骨曲度、牙槽骨宽度、牙根宽度与牙槽骨宽度差、牙齿在牙槽骨中的位置有统计学差异(P<0.05),牙根长度、根尖距牙槽骨最凹点的距离无统计学差异(P>0.05)。结论: 牙齿舌倾、牙体长轴与牙槽突长轴角度大、牙槽骨薄、牙槽骨弯曲大、牙齿位置偏离牙槽骨中心(偏唇侧或舌侧)等是上颌侧切牙和尖牙区发生骨开裂与骨开窗的危险因素。     

头颈部肿瘤患者放射性龋相关性因素分析

目的 通过构建多元线性回归方程探讨放射性龋相关危险因素,为有效预防放射性龋提供依据。方法 收集166例头颈部肿瘤放射治疗后患者,记录其患龋情况（龋失补牙面数）及个人相关信息（包括年龄、性别、放射治疗的方式和剂量等）,并进行多元逐步回归分析。结果 放射性龋的危险因素依次为：菌斑指数、放射治疗的方式、放射治疗后时间和放射治疗的剂量。结论 增强头颈部肿瘤患者的口腔卫生保健意识,尽量采用适形调强放射治疗技术,在有效控制肿瘤的情况下尽可能降低头颈部的放射治疗剂量等措施可减少放射性龋的发生。     

苏州两所幼儿园儿童感染幽门螺杆菌的危险因素及口腔清洁措施对降低口腔幽门螺杆菌感染的作用

目的 了解学龄前儿童口腔幽门螺杆菌感染的危险因素,为幽门螺杆菌感染的预防提供积极有效的口腔清洁措施,降低幽门螺杆菌感染率。方法 选择苏州市两所幼儿园的儿童204例,进行问卷调查,通过单因素配对资料卡方检验及多因素Logistic回归分析筛选出危险因素;采用幽门螺杆菌唾液检测试剂（HPS）方法和 ¹³C-尿素呼气试验（ ¹³C-UBT）检测口腔和胃幽门螺杆菌感染;选择抑制幽门螺杆菌的专用牙膏进行口腔清洁,2个月后用HPS方法复查口腔幽门螺杆菌感染。结果 儿童的个人卫生如爱啃手指、爱啃玩具、饭前便后不常洗手;照养人的带养方式如咀嚼食物喂养、使用自己的筷子喂食、经常亲吻幼儿、饭前不常洗手;父母胃病史等为学龄前儿童幽门螺杆菌感染的危险因素。204例儿童中HPS阳性158例（占77.45%）, ¹³C-UBT阳性37例（占18.14%）,HPS与 ¹³C-UBT均阳性28例（占13.73%）,口腔幽门螺杆菌感染显著高于胃内幽门螺杆菌感染（P<0.01）。接受口腔清洁措施干预后,口腔幽门螺杆菌转阴率显著增高,表明干预有效（P<0.01）。结论 教育儿童从小养成良好的卫生习惯,实行家庭分餐制或应用公筷,尽早发现幽门螺杆菌感染并定期选择专用牙膏进行口腔清洁,对预防幽门螺杆菌感染具有重要意义。     

青少年唇腭裂患者自我意识与父母教养方式的相关性研究

目的 调查青少年唇腭裂患者自我意识和父母教养方式的现状,分析二者之间的相关性,为青少年唇腭裂患者的心理干预提供证据支持。方法 以11~25周岁的400例青少年唇腭裂患者为研究对象,采用青少年唇腭裂患者自我意识量表、父母教养方式量表进行问卷调查,了解青少年唇腭裂患者的自我意识和家庭的教养方式,分析二者之间的相关性。结果 有效问卷380份。青少年唇腭裂患者的自我意识与父母教养方式间存在相关关系。青少年唇腭裂患者的自我评价、自信心、他人评价与心理承受力、人际关系及亲子关系得分与父母亲的情感关爱得分呈正相关关系,自信心与父母亲拒绝否认、惩罚与严厉得分呈负相关关系。结论 父母良好的教养方式对青少年唇腭裂患者自信心的建立、社会适应能力的提高、人际关系和亲子关系的维护有重要影响。父母应给予更多的情感关爱,避免一再的拒绝否认、惩罚与严厉。     

Longitudinal study of body height, radius length and skeletal maturity in Danish boys with cleft lip and palate

Abstract – Body height, radius length and skeletal maturity were registered longitudinally in 48 boys with combined cleft lip and palate (CLP) and compared with measurements in a non-cleft control group. Age range was from 6 to 20 yr. Skeletal maturity was evaluated according to the TW2 method. Distance and velocity curves for radius length and body height were determined by means of a computer program which for each month calculated the median and percentiles of the distribution. Compared to the control group the CLP boys were slightly shorter from 6 to 18 yr of age. The velocity curves revealed that pubertal growth maximum occurred on an average 6 months later in the CLP boys and that the pubertal growth spurt was less marked. However, the total growth period was prolonged thus enabling the CLP group to catch up with the control group. Skeletal maturity was retarded during the whole period when compared to normal children. It is suggested that the early feeding problems and recurrent infections of the upper airways combined with the surgical procedures account for an essential part of the delay in the present CLP group.     

Early childhood caries — a synopsis

All the papers presented at the conference are reviewed and comparisons are made with past beliefs on the topic. Early childhood caries (ECC) is a serious public health problem in disadvantaged communities in both developing and industrialized countries in which under-nutrition is common. ECC involves the maxillary primary incisors within months after their eruption and spreads rapidly to involve other primary teeth. The early implantation of mutans streptococci, the use of a feeding bottle containing sugary solutions and prolonged breast-feeding, especially at night, are important predisposing factors. Attention is drawn to the need for more research into the factors which determine the resistance of the enamel and particularly the elucidation of the relationship established in several countries between early enamel caries, enamel hypoplasia, and perinatal under- or malnutrition. Primary preventive measures should be applied during the ante- and immediate post-natal periods. Secondary preventive measures include the use of chemotherapeutic agents such as fluoride, and antimicrobials. The most appropriate tertiary preventive measure is the atraumatic restorative technique (ART). Broadly based committees should be established by governments to address the issues of caries risk in young children. Parents and all personnel involved in infant health and welfare should be shown how to recognize early signs of the condition, as well as to promote early intervention and referral.     

The electrical activity of the masticatory muscles in children with cleft lip and palate

Background

Information regarding masticatory muscle function in children with cleft lip and palate (CLP) is limited. As a consequence, research on masticatory muscle activity in cleft subjects is needed.

Aim

To assess masticatory muscle activity in children surgically treated for CLP as well as identify the possible factors associated with this activity.

Design

The sample comprised 82 children with mixed dentition and Class I occlusions (25 children with unilateral CLP and 57 subjects with no cleft abnormalities). A DAB‐Bluetooth Instrument (Zebris Medical GmbH, Germany) was used to take electromyographical (EMG) recordings of the temporal and masseter muscles both in the mandibular rest position and during maximum voluntary contraction (MVC).

Results

Patients with clefts showed a significant increase in temporal muscle activity at rest compared with the controls. The presence of clefts and unilateral posterior crossbites are factors strongly associated with increased temporal muscle EMG potentials during rest position.

Conclusions

Children with clefts have altered temporal muscle function. The presence of posterior crossbites affects the temporal muscle activity in cleft subjects. Early diagnosis and orthodontic treatment of malocclusions are necessary to achieve functional improvement in these patients.     

Correlation of factors associated with postoperative infection in patients with malignant oral and maxillofacial tumours: a logistic regression analysis

Patients with oral and maxillofacial malignant tumours have a relatively high incidence of postoperative infections. We have analysed the risk factors and the distribution of pathogens in infected patients to try and find out how to prevent them. We recruited 312 patients over 60 years old with malignant oral and maxillofacial tumours and investigated their incidence of postoperative infection between January 2007 and December 2017. Some factors were included in one way and multifactorial logistic analyses to find out which risk factors were likely to be associated with postoperative infections. Thirty-nine of the 312 (12.5%) developed postoperative infections, mainly at the surgical site (n = 21) and in the lower respiratory tract (n = 14). Pathogens were isolated from all patients and comprised aerobic (n = 4) and anaerobic (n = 5) bacteria, together with mixed infections (n = 30). Univariate analysis showed that age, size and site of tumour, body-mass index (BMI), diabetes, and duration of operation were risk factors. Multivariate logistic analyses, however, showed that BMI, the presence of diabetes, duration of operation, and American Society of Anesthesiologists (ASA) score were the main independent risk factors for postoperative infection. We conclude that there are abundant risk factors for postoperative infection in these patients, and it is important that they are evaluated preoperatively so that suitable postoperative treatments can be given.     

Etiology of nursing caries

Some etiological factors believed to play a role in the genesis of nursing caries (i. e. prolonged bottle-feeding, prolonged breast feeding, illnesses, drug intake and hospitalization) were analyzed and evaluated. A group of 179 pre-school children with a clinical picture of nursing caries were examined. Prolonged bottle--and breast-feeding were recorded in 54% and 72% of the children, respectively. Allergy, respiratory, infections and other diseases were observed in 71% of the children. Drugs were frequently taken by 57%, and hospitalization was recorded in 32% of the children examined. Prolonged bottle- and breast-feeding were found to significantly influence the occurrence of nursing caries (p less than 0.001.) No significant relationship was found between illnesses, drug usage or hospitalization, and the occurrence of nursing caries. The prevalence of nursing caries as assessed in a sample of the children from Zagreb was 15%.     

婴幼儿口腔变形链球菌群感染的相关因素研究

目的　研究7~36个月婴幼儿唾液中变形链球菌群（Mutans Streptococci, MS）感染的相关因素。方法　研究青岛市112例7～36个月的婴幼儿唾液中MS的感染状况。检查并记录婴幼儿口腔中牙齿萌出情况、母亲的龋齿情况,对家长进行问卷调查并统计分析影响婴幼儿口腔变形链球菌群感染的因素。结果　 与MS感染率有关的因素包括：婴幼儿的年龄、牙齿萌出的数目、含糖食品的摄入和夜间喂养习惯。运用Logistic回归分析,牙齿萌出的数目和夜间喂养习惯的WALD值分别18.04和8.47,OR值分别为3.506和6.258。结论　 婴幼儿口腔MS的感染与婴幼儿的年龄、牙齿萌出的数目、含糖食品的摄入和入睡、夜间喂养习惯等因素有关。牙齿萌出的数目和不良入睡及夜间喂养习惯是影响MS感染的主要因素。     

Tongue structure, position and function in cleft lip and palate children assessed by ultrasound examination

The aim of the study was to examine the position and function of the tongue in cleft lip and palate (CLP) patients and to reveal their impact on alveolar bone development. Two hundred and fifty-eight CLP children and 50 healthy children as control group were included in the study. Tongue function and position were assessed by ultrasound examination. In CLP patients the dorsum of the tongue was deformed and the asymmetry of some tongue structures was also found out (mainly the massive of the tongue muscles). Low tip and high dorsum position were specific for CLP children as well as discoordinated tongue movements. Both in static and dynamic condition the tongue was pressed to the lower alveolar bone thus disturbing its development. The obtained data showed tongue position and function to be one of the causes for lower promacrognathy and lingual inclination of incisors in CLP patients. The absence of tongue impact on the upper alveolar bone should be seen as one of the factors for upper retromicrognathy.     

孕期环境因素与新生儿唇腭裂畸形相关性研究

目的 探讨孕期内环境中的危险因素与新生儿唇腭裂畸形的相关性。方法 采用102例唇腭患儿的母亲与非唇腭裂患儿的母亲1：1配对的方法。回顾性调查孕期前3个月接触的8种危险因素：包括病毒感染、嗜好烟酒、饲养宠物、化学药物、工业、农业毒物、X线照射和精神创伤，进行统计学分析。结果 其中6种环境因素与对照组有统计学差异。结论 环境因素是先天性唇腭裂畸形的重要致病因素。