不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究

doi:10.13418/j.issn.1001-165x.2019.05.019

摘要/Abstract

摘要： 目的　研究Millard法（旋转推进法）和改良Tennison法（三角瓣法）治疗单侧完全性唇腭裂的疗效及对患者颌面形态的影响。方法　根据治疗方法的不同，将本院收治的52例单侧完全性唇腭裂患者分为Millard治疗组和改良Tennison治疗组，每组26例。术后6个月，评价2组患者的临床疗效；并于手术治疗前后，采用照片测量法测量患儿的鼻部形态指标，包括Enw（内眦间距）、BAW（鼻部高度）、BADH（双侧鼻翼高度差）、CHW（口角间距）、CL（鼻小柱高度）、CW（鼻小柱宽度）、NBD（鼻背倾斜度）、CD（鼻小柱倾斜度），测量患儿的健侧和患侧唇高。结果　治疗后，改良Tennison组的临床修复优良率为88.46%，高于Millard组（69.23%），P<0.05。改良Tennison组平均BAW、CL、CW均大于对照组，平均BADH、CD均小于对照组（P＜0.05），改良Tennison组健侧-患侧唇高差小于Millard组（P<0.05）。结论　改良Tennison法治疗单侧完全性唇腭裂的整体疗效优于Millard法，能较好地保持鼻部和唇部形态的对称性，更好地控制患者颌面形态，维持颜面美观的形态学机制，值得临床推广应用。

关键词: , 单侧完全性唇腭裂；　Millard法；　改良Tennison法；　颌面形态

Abstract: Objective　To study the effect of Millard (rotating propulsion) and modified Tennison (triangulation) in the treatment of unilateral complete cleft lip and palate and its effect on the shape of maxillofacial. 　Methods　According to the different treatment methods, 52 patients with an unilateral complete cleft lip and palate in our hospital were divided into a Millard treatment group and a modified Tennison treatment group (26 cases). Six months after operation, the clinical efficacy of the two groups was evaluated before and after the operation. The nasal morphological indexes of the children included Enw (medial canthus distance), BAW (nasal height), BADH (bilateral alar height difference), CHW (oral angle distance), CL (nasal columella height), CW (columella width), NBD (nasal dorsal inclination), And CD (tilt of nasal columella) were measured by photogrammetry, and the height of the healthy side and the affected side of the child were measured.　Results　In terms of the excellent rate of clinical repair, the Millard group and the modified Tennison group were 69.23% and 88.46%, respectively, and the modified Tennison group was higher than the Millard group (P<0.05). After treatment, the average BAW, CL and CW of the modified Tennison group were higher than those of the control group, and the average BADH and CD of the modified Tennison group were lower than those of the control group (P<0.05), and the difference of lip height between the healthy side and the affected side of the modified Tennison group was smaller than that of the Millard group (P<0.05).　Conclusions　The modified Tennison method is superior to the Millard method in the treatment of the unilateral complete cleft lip and palate. It can maintain the symmetry of nasal and lip morphology, have a better control the maxillofacial morphology of patients, and maintain the morphological mechanism of facial beauty. It is worthy of clinical application.

Key words: unilateral complete cleft lip and palate;　Millard method;　Modified Tennison method, Maxillofacial morphology

中图分类号:

R782.2

欧邦宾, 刘庭庭, 李迎霞. 不同术式治疗单侧完全性唇腭裂的疗效及颌面形态影响研究[J]. 中国临床解剖学杂志, 2019, 37(5): 578-582.

OU Bang-bin, LIU Ting-ting, LI Ying-xia. Study of the effect of different treatment modalities on unilateral cleft lip and palate and its effect on the maxillofacial morphology[J]. Chinese Journal of Clinical Anatomy, 2019, 37(5): 578-582.

参考文献 17

[1]	冯航, 朱李军, 陈仲伟, 等. 单侧唇裂修复旋转推进法与三角瓣法术后上唇外形及鼻部改变的比较[J]. 南方医科大学学报, 2008, 28(6): 1096-1097.
[2]	周婷, 王同海. Millard法和Tennison法修复单侧完全性唇裂316例比较研究[J]. 中国美容医学, 2014, 23(9): 722-725.
[3]	张锡泽, 邱蔚六. 口腔颌面外科学[M]. 北京: 人民卫生出版社, 2005: 8-15.
[4]	王宏扬, 范存晖, 杨茜, 等. 替牙期单侧完全性唇腭裂病人下颌骨对称性的锥形束CT观察[J]. 青岛大学医学院学报, 2017, 53(2): 174-176.
[5]	杨金龙, 何苇. 单侧完全性唇腭裂手术对上颌骨生长发育的影响[J]. 口腔疾病防治, 2016, 24(4): 247-250.
[6]	李立琪. 改良Mohler法修复单侧唇裂—精准化术式探索及与Tennison-Randall法术后变化趋势的比较[D]. 重庆医科大学, 2016.
[7]	胥毅, 石冰, 杨超, 等. 改进口轮匝肌重建技术对单侧完全性唇裂唇鼻前突度的影响[J]. 北京口腔医学, 2018, 26(2): 83-89.
[8]	徐雪, 陈仁吉, 石冰. 不同的早期治疗模式对单侧完全性唇腭裂患者颌面形态的影响[J]. 北京口腔医学, 2018, 26(2): 95-98.
[9]	沈嬿, 李光早, 徐静. 唇红瓣及口轮匝肌功能性修复在先天性单侧唇裂整复中的应用[J]. 中华全科医学, 2017, 15(5): 742-744.
[10]	Watanabe Hiroshi, Kurita Kenichi, Nakayama Atsushi, et al. Computed tomographic estimation of particulate cancellous bone and marrow weight for successful transplant in unilateral cleft lip and palate patients.[J]. Cleft Palate Craniofacial J, 2017, 54(3): 27-333.
[11]	朱琳, 李薇薇. 应用改良下三角瓣法修复单侧唇裂术后继发畸形临床研究[J].医学研究杂志, 2016, 45(11): 107-111.
[12]	朱云琳, 程新德, 杜金, 等. 改良三角瓣法修复单侧不完全性唇裂25例[J]. 蚌埠医学院学报, 2015, 40(3): 334-336.
[13]	王姗, 杨学财, 刘美霞, 等. 单侧唇裂修复术中唇红三角瓣术前术后定量分析[J]. 口腔医学研究, 2015, 31(10): 1024-1028.
[14]	王秉文, 王映红, 甘晓琴. 改良Tennison术式在单侧Ⅲ°唇裂患者中的临床应用研究[J]. 中国初级卫生保健, 2014, 28(7): 154-155.
[15]	Cazas-Duran EV, Fischer Rubira-Bullen IR, Pagin O, et al. Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography[J]. Acta Otorrinolaringol Esp, 2018, 69(2): 61-66.
[16]	高廷益, 张凯, 杨东昆, 等. 两种改良Millard法修复单侧唇裂的临床对比效果观察[J]. 口腔医学, 2017, 37(12): 1095-1098.
[17]	Willadsen E, Lohmander A, Persson C, et al. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 5. Speech outcomes in 5-year-olds - consonant proficiency and errors.[J]. J Plastic Surg Hand Surg, 2017, 51(1): 38-51.