口腔医学研究

口腔医学研究 ›› 2020, Vol. 36 ›› Issue (2): 148-151.DOI: 10.13701/j.cnki.kqyxyj.2020.02.014

• 口腔颌面外科学研究 • 上一篇    下一篇

两种腭裂修复方式治疗过宽不完全腭裂的临床效果比较

李天一1,2, 徐明耀3, 万延俊1,2*, 张阳1,2, 成雨生1,2, 张红闯1,2, 王超1,2, 张扬1,2   

  1. 1. 徐州医科大学口腔医学院颌面外科 江苏 徐州 221000;
    2. 徐州医科大学附属徐州市立医院口腔科 江苏 徐州 221000;
    3. 南京大学附属南京市口腔医院口腔颌面外科 江苏 南京 210000
  • 收稿日期:2019-08-18 出版日期:2020-02-28 发布日期:2020-04-24
  • 通讯作者: 万延俊,E-mail:XZYYKQK@163.com
  • 作者简介:李天一(1993~ ),男,江苏徐州人,口腔医师,硕士在读,主要从事颌面外科研究。
  • 基金资助:
    徐州市科技计划项目(编号:KC19142)

Clinical Comparison of Two Kinds of Cleft Palate Repair Methods in Treatment of Over-wide Incomplete Cleft Palate

LI Tianyi1,2, XU Mingyao3, WAN Yanjun1,2*, ZHANG Yang1,2, CHENG Yusheng1,2, ZHANG Hongchuang1,2, WANG Chao1,2, ZHANG Yang1,2   

  1. 1. School of Stomatology, Xuzhou Medical University, Xuzhou 221000, China;
    2. Department of Stomatology, Xuzhou State Hospital, Xuzhou Medical University, Xuzhou 221000, China;
    3. Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital, Nanjing University, Nanjing 210000, China
  • Received:2019-08-18 Online:2020-02-28 Published:2020-04-24

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摘要： 目的:比较兰氏法和改良兰氏法修复过宽不完全腭裂的临床效果。方法:选取2012年1月~2014年12月于徐州医科大学附属徐州市立医院接受腭裂修复术的不完全腭裂患儿40例,年龄2~5岁,裂隙宽度均大于2.5 cm,按接受腭裂修复的不同方式分为2组,实验组:20例,行改良兰氏法(兰氏法联合颊肌黏膜瓣)修复腭裂,对照组:20例,行兰氏法修复腭裂。2017年1月~2019年9月(术后5~7年)进行随访,此时两组患者年龄7~9岁,平均年龄为8岁。分别观察两组患者术区恢复状态,应用锥形束CT(CBCT)观察比较上颌骨发育情况,使用头颅侧位片评价腭咽闭合功能,并且进行语音清晰度评估。结果:相比于对照组,实验组的患者恢复较好,术区瘢痕轻微,上颌骨发育好,腭咽闭合完全,语音清晰度高。结论:对于裂隙过宽的腭裂患者,使用联合颊黏膜瓣的兰氏法可有效避免裸露的骨面,减轻了瘢痕增生,有利于上颌骨发育,增进腭咽闭合,提高了语音清晰度是一种更为值得推广的腭裂新手术方法。

关键词: 腭裂, CBCT, 兰氏法, 颊肌黏膜瓣, 上颌骨发育

Abstract: Objective: To compare the clinical effects of Langenbeck and modified Langenbeck methods in repairing over-wide incomplete cleft palate. Methods: Forty children with incomplete cleft palate who underwent palatoplasty in Xuzhou State Hospital Affiliated to Xuzhou Medical University from January 2012 to December 2014 were selected. The age ranged from 2 to 5 years and the width of cleft was more than 2.5 cm. The recovery status of two groups was observed. Cone beam CT was used to observe and measure postoperative maxillary development. Lateral cranial radiographs were used to evaluate velopharyngeal function. Speech intelligibility evaluation was also carried out. Results: Compared with the control group, the patients in the experimental group recovered better with slight scar and good maxillary development, a well-developed maxilla, velopharyngeal closure, and high articulation clarity. Conclusion: For too wide cleft palate patients, the operation of Langenbeck combined with buccal mucous membrane flap can effectively avoid the bare bone surface, reduce scar hyperplasia, and improve velopharyngeal closure and speech function. It is a new functional cleft palate repair method and worthy to be recommended.

Key words: cleft palate, CBCT, levator veli palatini retro positioning, buccal mucous membrane flap, maxillary development