Noordhoff手术联合PNAM正畸治疗唇腭裂患儿的疗效评价

doi:10.19438/j.cjoms.2020.04.013

摘要/Abstract

摘要： 目的: 评价罗氏手术（Noordhoff）联合鼻-牙塑形（PNAM）正畸治疗唇腭裂（CLP）患儿的疗效及安全性。方法: 回顾2014年7月—2019年1月漯河市中心医院与郑州大学第一附属医院收治的80例CLP患儿临床资料,根据治疗方式,将患儿分为联合组（PNAM正畸+Noordhoff手术,61例）与Noordhoff组（单纯Noordhoff手术,19例）,比较2组的治疗效果及安全性。采用SPSS 19.0软件包对数据进行统计学分析。结果: 与相同唇裂程度患儿相比,联合组患儿手术时间显著短于Noordhoff组,术中出血量显著少于Noordhoff组（P<0.05）,2组不同唇裂患儿术后住院时间无显著差异（P>0.05）;2组手术相关并发症无显著差异（P>0.05）。联合组61例患儿PNAM正畸治疗过程中,18例患儿软腭、上颌结节及患侧穹隆内衬黏膜处出现黏膜溃疡及出血,42例患儿双侧颊部皮肤防水胶布粘连处出现接触性皮疹。2组术后6个月患侧唇高、健侧唇长及患侧唇长均较同组初诊时显著增加（P<0.05）,术后6个月患侧唇高、健侧唇长及患侧唇长均较同组初诊时显著增加（P<0.05）,且联合组术后6个月患侧唇高、健侧唇长及患侧唇长均显大于Noordhoff组（P<0.05）;2组手术前、后健侧唇高均无显著变化（P>0.05）。治疗后,联合组鼻部外形优良率显著高于Noordhoff组（P<0.05）。2组术后6个月BK横向距离、BK矢状线距离、矢状线长度及MG-矢状线均较同组初诊时显著下降（P<0.05）,J-（F-G）均较同组初诊时显著上升（P<0.05）,且联合组术后6个月BK横向距离、BK矢状线距离、矢状线长度及MG-矢状线均显著小于Noordhoff组（P<0.05）,2组术后6个月J-（F-G）无显著差异（P>0.05）。结论: Noordhoff术前应用PNAM正畸治疗能有效减轻手术难度,缩短手术时间,减少术中出血量,改善CLP患儿鼻唇部形态,提高间隙关闭效果,但PNAM治疗期间并发症较多,建议在矫治过程中对患儿痛点、溃疡处进行充分润滑及打磨,减少防水胶布更换次数,以减轻患儿治疗痛苦。

关键词: Noordhoff手术, PNAM正畸, 唇腭裂

Abstract: PURPOSE: To investigate the efficacy and safety of Noordhoff surgery combined with presurgical nasoalveolar molding (PNAM) orthodontics for children with cleft lip and palate (CLP). METHODS: The clinical data of 80 CLP children admitted to Luohe Central Hospital and The First Affiliated Hospital of Zhengzhou University from July 2014 to January 2019 were reviewed and analyzed. The children were divided into two groups according to different treatment methods. Patients in the combined group (n=61) received Noordhoff surgery combined with PNAM orthodontics, while patients in Noordhoff group (n=19) received Noordhoff surgery alone. The efficacy and safety of the two groups were compared. SPSS 19.0 software package was used for data analysis. RESULTS: The operation time of the combined group was significantly shorter than that of the Noordhoff group, and the intraoperative blood loss was significantly less than that of the Noordhoff group (P<0.05). There was no significant difference in surgical complications between the two groups (P>0.05). During the orthodontic treatment of PNAM in the combined group, mucosal ulcer and bleeding symptoms in the soft palate, maxillary nodule and lining mucosa of the affected side were observed in 18 cases, and contact rash at the adhesion of waterproof adhesive tape on bilateral buccal skin was observed in 42 cases. The height of the lateral lip, the length of the healthy lip and the length of the affected lip were significantly increased in the two groups 3 months after operation (P<0.05), and significantly higher in combined group than in the Noordhoff group (P<0.05). The width of the affected nostrils was decreased in both groups after treatment (P<0.05), and were significantly lower in the combined group than in Noordhoff group(P<0.05). BK horizontal distance, BK sagittal line distance, sagittal line length and MG sagittal line distance were significantly decreased in both groups 3 months after operation (P<0.05), and significantly lower in the combined group than in Noordhoff group (P<0.05). J-(F-G) was increased in both groups after treatment (P<0.05), while no significant difference was found between the two groups 3 months after treatment(P>0.05). CONCLUSIONS: PNAM orthodontic treatment before Noordhoff surgery can effectively alleviate operation difficulty and shorten operation time, with less intraoperative blood loss and better nasolabial morphology; however, there are many complications during the treatment of PNAM. It is recommended that the area of pain and ulcers be fully lubricated and polished during the correction process, and the number of waterproof tape replacements should be reduced to alleviate the pain of the child.

Key words: Noordhoff surgery, PNAM orthodontics, Cleft lip and palate

中图分类号:

R782.2

张晓敏, 杨雅娴, 宗源, 林鸣. Noordhoff手术联合PNAM正畸治疗唇腭裂患儿的疗效评价[J]. 中国口腔颌面外科杂志, 2020, 18(4): 352-356.

ZHANG Xiao-min, YANG Ya-xian, ZONG Yuan, LIN Ming. Efficacy of Noordhoff surgery combined with PNAM orthodontics for children with cleft lip and palate[J]. China J Oral Maxillofac Surg, 2020, 18(4): 352-356.

参考文献

[1] 李巍然. 唇腭裂的正畸治疗及长期稳定性[J].中华口腔医学杂志, 2018, 53(9): 585-589.
[2] Haque S, Alam MK, Khamis MF.Factors responsible for unfavorable dental arch relationship in non syndromic unilateral cleft lip and palate children[J]. J Clin Pediatr Dent, 2017, 41(3): 236-241.
[3] 白晓峰, 张斌, 田玉楼, 等. 唇腭裂术后继发上颌骨畸形的正颌外科治疗[J]. 中华整形外科杂志, 2019, 35(1): 12-16.
[4] Kato M, Watanabe A, Watanabe S, et al.Cleft lip and palate repair using a surgical microscope[J]. Arch Plast Surg, 2017, 44(6): 490-495.
[5] 韩伟. PNAM矫治器对单侧完全性唇腭裂腭部畸形的矫治效果分析[J]. 临床医学, 2015, 35(1): 38-39, 40.
[6] 于泉, 龚昕, 沈刚, 等. 唇腭裂新生儿术前计算机辅助设计鼻-牙槽骨塑形的疗效评价[J].中华口腔医学杂志, 2015, 50(12): 710-714.
[7] Mariano NCR, Sano MN, Curvêllo VP, et al.Impact of orofacial dysfunction on the quality of life of adult patients with cleft lip and palate[J]. Cleft Palate Craniofacial J, 2018, 55(8): 1055-1067.
[8] 石光, 张肖, 孙莹. PNAM正畸联合Noordhoff手术治疗唇腭裂患儿的效果及对腭部裂隙情况、感染发生率的影响[J]. 中国口腔颌面外科杂志, 2019, 17(4): 319-322.
[9] Akarsu-Guven B, Arisan A, Ozgur F, et al.Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age[J]. Am J Orthod Dentofacial Orthop, 2018, 153(4): 489-495.
[10] Mitropanova MN.Complex rehabilitation of children with congenital cleft lip and palate at stomatological treatment stages[J]. Stomatologiia, 2018, 97(3): 48-56.
[11] 刘颖萍, 张婧, 郭雪松, 等. 鼻-牙槽塑形矫治器在完全性唇腭裂修复中的应用[J].中国基层医药, 2016, 23(23): 3581-3584.
[12] 侯玉霞. 唇腭裂序列治疗中的术前鼻牙槽塑形治疗[J]. 中国实用口腔科杂志, 2015, 8(3): 139-142.
[13] 顾启慧, 王宇婷, 侯伟, 等. 双侧完全性唇腭裂新生儿进行鼻-齿槽塑形治疗的临床研究[J]. 口腔医学, 2016, 36(9): 813-816.
[14] Singh A, Thakur S, Singhal P, et al.A comparative evaluation of efficacy and efficiency of Grayson's presurgical nasoalveolar molding technique in patients with complete unilateral cleft lip and palate with those treated with Figueroa's modified technique[J]. Contemp Clin Dent, 2018, 9(Suppl 1): S28-37.
[15] Kornbluth M, Campbell RE, Daskalogiannakis J, et al.Active presurgical infant orthopedics for unilateral cleft lip and palate: intercenter outcome comparison of Latham, Modified McNeil, and nasoalveolar molding[J]. Cleft Palate Craniofac J, 2018, 55(5): 639-648.