唇腭裂患者上颌前移对腭咽部结构影响的研究

发布时间：2018-04-13 00:29

  本文选题：唇腭裂 + 上颌发育不足　； 参考：《青岛大学》2014年硕士论文

【摘要】：目的：唇腭裂是口腔颌面部最常见的先天发育畸形,常伴有上颌发育不足。为改变患者面型,对乳牙列和混合牙列尚处于生长发育快速期的患者可采用正畸前方牵引促进面中部的生长发育,对已处于生长发育稳定期的患者采用正颌手术来矫正患者牙颌面畸形。无论何种方式前移上颌骨,由于软腭附丽随上颌骨前移而前移,造成咽腔深度增大,可能会导致腭咽部结构的变化,继发腭咽闭合功能不全或加重已有的腭咽闭合不全。临床上应用上颌前移矫治唇腭裂患者上颌发育不足能改变患者面型及恢复咬合功能已成为常规治疗方法,而上颌前移对患者腭咽部结构的影响尚待探讨。本研究试探讨两种方法前移上颌骨前后腭咽部结构的变化,为唇腭裂患者的序列治疗提供了理论依据。 方法：本研究就20例上颌发育不足患者其中10例行上颌骨LeFort Ⅰ型截骨术(正颌组),唇腭裂5例,非唇腭裂5例；10例行正畸前方牵引矫治(牵引组),唇腭裂5例,非唇腭裂5例。每位患者治疗前,治疗后一月分别拍摄头颅定位侧位片,并进行投影测量分析对腭咽部组织的形态进行评价。 结果：两组患者上颌分别平均前移5.28±2.32m.4.39±2.15mm。正颌组X线投影测量结果显示：术后咽腔深度明显增大(p0.05),同时软腭长度及软硬腭夹角较术前明显增大(p0.05),软腭厚度减小。牵引组X线投影测量结果显示：软腭厚度小于术前(p0.05),唇腭裂骨性咽腔深度明显增大(p0.05),腭咽间隙无明显变化,软硬腭夹角、软腭长轻度增加(p0.05)。 结论：上颌前移造成患者咽腔深度显著增加,对腭咽闭合功能可能有不利影响；但术后腭咽部软组织发生适应性变化,这种代偿性改变会在一定程度上减轻腭咽闭合不全。前方牵引可在青少年早期矫治上颌发育不足,X线头颅定位侧位片显示牵引组腭咽部软组织较正颌组有良好的适应性变化。
[Abstract]:Objective: cleft lip and palate is the most common congenital malformation in oral and maxillofacial region.In order to change the facial shape of the patients, patients with primary dentition and mixed dentition in the period of rapid growth and development can use orthodontic anterior traction to promote the growth and development of the middle face.Orthognathic surgery was used to correct maxillofacial malformations in patients with stable growth and development.No matter how the maxilla is moved forward, the depth of pharynx cavity increases because the soft palate appuration moves forward with the maxilla, which may lead to the change of palatopharynx structure, secondary velopharyngeal insufficiency or exacerbation of the existing palatopharynx insufficiency.The effect of maxillary anterior displacement on the palatopharynx structure in patients with cleft lip and palate has become a routine treatment method, which can change the facial shape and restore the occlusal function in patients with cleft lip and palate, but the effect of maxillary anterior displacement on the structure of palatopharynx remains to be explored.In this study, the changes of palatopharynx structure before and after maxillary anterior displacement were studied, which provided a theoretical basis for the sequence therapy of cleft lip and palate.Methods: in this study, 10 patients with maxillary hypoplasia were treated with maxillary LeFort type 鈪，

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