自体髂软骨及松质骨移植在牙槽突裂同期行鼻畸形整复术中的应用

Application of iliac cancellous and chondral bone to repair the cleft of alveolar process and the nasal deformity at the same time

目的 探索牙槽突裂与鼻畸形同期整复的新方法。方法 对 4 2例牙槽突裂患者采用自体髂骨及松质骨充填牙槽裂隙 ,髂嵴软骨片覆盖并充垫塌陷的梨状孔外缘及鼻侧区 ,同时利用鼻前庭黏膜软骨复合组织瓣V Y推进法整复鼻畸形。结果 9～ 11岁患者牙槽突高度恢复平均为86 7% ,厚度恢复平均为 89 6 % ,牙槽突外形和功能为Ⅰ、Ⅱ级 ,尖牙在骨移植区萌出 ,梨状孔外缘鼻侧区低陷处高度恢复 ,鼻翼塌陷畸形恢复 ,鼻孔形态对称 ;12岁以上患者牙槽突高度恢复平均为70 1% ,厚度恢复平均为 71 7% ,牙槽突外形和功能为Ⅱ级、Ⅲ级 ;2例 18岁患者鼻背长轴、鼻端偏斜未能改善。结论 利用自体松质骨和软骨来修复牙槽突裂并同时进行鼻畸形整复 ,既能保证牙槽突高度、牙弓连续性的恢复 ,鼻畸形的改善 ,又能防止鼻背、鼻端长期畸形发展而造成难以矫正的偏斜 ,同时也能尽早消除因畸形给患者带来的心理障碍 。

Objective To study a new method of simultaneous repair of alveolar cleft and the deformity of the nose and lip. Methods\ 42 patients with cleft of alveolar process were included in this study.We filled the cleft of alveolar process with iliac cancellous bone and covered the depression of piriform aperture and the nasal side with iliac cartilage.Simultaneously,we corrected the nasal deformity using V\|Y plasty of a mucosa\|cartilage compound flap at the nasal vestibule. Results\ In the patients aged 9～11 years,the mean height of the repaired alveolar process was 86\^7%; the mean thickness was 89\^6%; the contour and function of the alveolar process was grade Ⅰ or Ⅱ.The canine erupted at the place of bone grafting.The depression of the piriform aperture and alae nasi was repaired.The contour of the nares was symmetrical.In the patients over 12 years,the mean height of the alveolar process was 70\^1%; the mean thickness was 71\^7%; the contour and function of the alveolar process was grade Ⅱ or Ⅲ. The deflexion of nasal dorsum and nasal dome was not ameliorated in 2 patients of 18 years old. Conclusions\ The application of iliac cancellous and chondral bone to simultaneously repair cleft of alveolar process and the nasal deformity is an ideal plastic method. It can recover the height of alveolar process and the continuity of dental arch, ameliorate the nasal deformity, and redress the deflexion of nasal dorsum and nasal end. It can also eliminate the psychological obstacle of the patients at an early stage.