双侧唇腭裂婴幼儿正畸及外科治疗新技术.doc

双侧唇腭裂婴幼儿正畸及外科治疗新技术[摘要]目的：探索双侧唇腭裂婴幼儿术前鼻-牙槽骨塑形及同期唇-鼻-牙槽整复术的时机、方法、特点，并进行其疗效的初步观察。方法：对21例双侧唇腭裂婴幼儿进行了术前鼻-牙槽骨塑形和同期唇-鼻-牙槽整复术。术前鼻－牙槽骨塑形主要包括前颌后退、牙槽骨间隙的关闭、唇的牵张及鼻的矫形；同期唇-鼻-牙槽整复术包括牙龈-牙周膜-牙槽骨整形术及改良长庚式双侧唇裂唇鼻同期整复术。结果：21例行术前鼻-牙槽骨塑形的患者前唇后退充分；唇裂隙宽度变窄，裂隙两侧唇组织适度牵张；鼻小柱延长及鼻塌陷畸形明显改善；牙槽裂隙变窄为1～2mm。19例术后患者经1～5年随访，结果表明：唇鼻形态良好；前庭沟连续；口-鼻腔瘘封闭； 16例上牙槽连续、稳定，但部分病例牙槽高度、宽度稍嫌不足,其中13例患者在原牙槽裂隙处长出乳齿。结论：双侧唇裂患者为了获得理想的唇鼻形态及完整稳定的牙槽骨，术前进行正畸鼻-牙槽突塑形和早期同期唇-鼻-牙槽整复术是一种实用、无创、安全、可行、经济、值得借鉴的序列治疗方法。 [关键词]婴幼儿；双侧唇腭裂；术前正畸；鼻-牙槽骨塑形；唇-鼻-牙槽整复术；唇腭裂序列治疗 [中图分类号]R782.2.1[文献编码]A [文章编号]1008-6455（2009）02-0172-04 An innovative orthodontic and surgical technique for bilateral complete cleft lip- presurgicalnoso-alveolar molding and early simultaneous lip-nose-alveolar repairs LI Jin-feng1, ZHOU Hong2, CHEN Guo-ding3，REN Zhan-ping1, ZHANG Zhi-yong2,WEN Yi-xi1, LIU Jian-hua1 （1.Department of Oral Maxillofacial Surgery,Stomatological Hospital,Xi’an Jiaotong University, Xi’an 710004, Shaanxi, China; 2.Department of Orthodontics, Stomatological Hospital, Xi’an Jiaotong University, Xi’an 710004, Shaanxi, China; 3 Craniofacial Center,Chang Gung Memorial Hospital,Taipei,Taiwan，China） Abstract： Objective Presurgical nose-alveolar molding for infants with cleft lip and palate has been one of new methods and techniques of the cleft lip and palate team approach. The purpose of this paper was to study the effects of presurgical nasoalveolar molding in bilateral complete cleft lip/palate and early simultaneous lip-nose-alveolar repairs and to discuss the optimum time, methods, skills, characteristics of using the technique.Methods 21 cases with bilateral complete cleft lip/palate were underwentpresurgical noso-alveolar molding which including the premaxillo-backward, the gap-closing of cleft alveolar in two sides, lip taping and nosa-stent until he age of approximately 6～9 months at which time the surgery was performed. All cases with presurgical nosoalveolar molding have been operated early simultaneous lip-nose-alveolar repair