Sommerlad腭帆提肌重建术后松弛切口情况的研究

华西口腔医学杂志

Sommerlad腭帆提肌重建术后松弛切口情况的研究

鲁勇1，2 石冰2 郑谦2

1.南京大学医学院附属口腔医院口腔颌面外科，江苏南京210008；2.四川大学华西口腔医院唇腭裂外科，四川成都610041

收稿日期:2009-08-25 修回日期:2009-08-25 出版日期:2009-08-20 发布日期:2009-08-20
通讯作者: 石冰，Tel：028-61153005
作者简介:鲁勇（1975—），男，湖北人，主治医师，博士

A study on lateral incision after palatoplasty with the levator veli palatini retropositioning according to Sommerlad

LU Yong1，2, SHI Bing2, ZHENG Qian2

1. Dept. of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital, Medical College of Nanjing University, Nanjing 210008, China; 2. Dept. of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China

Received:2009-08-25 Revised:2009-08-25 Online:2009-08-20 Published:2009-08-20
Contact: SHI Bing，Tel：028-61153005

摘要/Abstract

摘要：

目的研究Sommerlad腭帆提肌重建术后两侧松弛切口与裂隙程度之间的关系，探讨使用该术式时不做松弛切口的预测指标。方法选择176例腭裂患者为研究对象，其中不完全性腭裂患者81例，完全性腭裂患者95例（单侧完全性腭裂74例，双侧完全性腭裂21例），均采用Sommerlad腭帆提肌重建术进行腭裂整复。测量其腭裂裂隙宽度（CPW）和上颌结节内侧宽度（IHW），计算腭裂裂隙指数（CPI），CPI=CPW/IHW；记录行松弛切口的例数，并测量术后松弛切口长度。比较不完全性腭裂和完全性腭裂在各指标上的差异，分析CPI与术后松弛切口之间的关系。结果81例不完全性腭裂患者中，45例（55.6%）未做松弛切口，36例（44.4%）行双侧5~30 mm的松弛切口，松弛切口长度为（12.7±10.0）mm；74例单侧完全性腭裂患者中，5例（6.8%）未做松弛切口，28例（37.8%）行单侧兰式松弛切口，41例（55.4%）行双侧兰式松弛切口；21例双侧完全性腭裂中，所有患者（100%）均行双侧兰式松弛切口。完全性腭裂的CPI与松弛切口长度之间无相关性（P>0.05）。不完全性腭裂的CPI与松弛切口长度之间存在相关性（r=0.776，P<0.01），当CPI<0.31或CPW<12.7 mm时，可不做松弛切口。结论不完全性腭裂患者CPW<12.7 mm时，行Sommerlad腭帆提肌重建术修复时可尽量不做松弛切口，避免了硬腭骨面裸露对上颌生长抑制的影响。

关键词: 腭裂, 腭帆提肌重建术, 上颌生长

Abstract:

Objective The aim of this study was to explore the relationships between the lateral incisions（LI） and cleft extent after palatoplasty with the levator veli palatini retropositioning according to Sommerlad, and acquire optimal indication without lateral releasing incisions in the surgical treatment of cleft palate. Methods A total of 176 patients（81 isolated cleft palate, ICP; 74 unilateral completely cleft palate, UCCP; 21 bilateral completely cleft palate, BCCP） underwent Sommerlad palatoplasty. All dental casts evaluated had been obtained after general anaesthesia. Measuring points on the cast were determined as follows: Cleft palate width（CPW）, interhamular width （IHW）, and cleft palate index（CPI） defined as the ratio of CPW to IHW. The following analysis was carried out: The relationship between CPW and CPI, or between CPW and IHW were determined in both ICP, UCCP and BCCP subjects of both sexes together. Correlation analysis of the cleft palate width（CPW and CPI） and lateral incisions was carried out in ICP, UCCP and BCCP subjects. Results Among 81 patients with ICP, 45 patients（55.6%） had no lateral incisions and bilateral incisions with length ranged from 5 mm to 30 mm（averaged 12.7 mm±10.0 mm） were made in 36 patients（44.4%） after palatoplasty. Among 74 patients with UCCP, no lateral incision was made in 5 patients（6.8%）, unilateral incisions were made in 28 patients（37.8%）, and bilateral incisions were made in 41 patients（55.4%）. Moreover, 21 patients（100%） with BCCP had bilateral incisions after palatoplasty. There was a strong correlation between cleft indexes or cleft palate width and lateral incisions in isolated cleft palate subjects（r= 0.776, P<0.01）. Patients with CPI less than 0.31 or CPW less than 12.7 mm were more likely to have no lateral incisions following palatoplasty according to Sommerlad. Conclusion It is suggested that CPW less than 12.7 mm need no lateral incisions for isolated cleft palate re - pair. Sommerlad palatoplasty with levator veli palatini retropositioning leaves few denuded palatal bone is considered to be advantageous for maxillary growth.

Key words: cleft palate, levator veli palatini retropositioning, maxillary growth

鲁勇石冰郑谦. Sommerlad腭帆提肌重建术后松弛切口情况的研究[J]. 华西口腔医学杂志.

LU Yong1，2, SHI Bing2, ZHENG Qian2. A study on lateral incision after palatoplasty with the levator veli palatini retropositioning according to Sommerlad[J]. West China Journal of Stomatology.

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