新生儿唇腭裂术前鼻部矫正效果的初步评价

A preliminary study of nasoalveolar molding for infants born with cleft lip and palate

目的:应用鼻翼-牙槽改建矫治器对唇腭裂新生儿进行早期鼻部治疗,观察该矫治器对鼻翼、鼻小柱的矫治效果。方法:10例在早期行鼻翼-牙槽改建的唇腭裂患儿作为治疗组,10例未经任何术前矫正者作为对照组。在矫正前(T0)、唇裂术前(T1)、术后2周(T2)、术后半年(T3)分别拍摄鼻部照片,用配对t检验分析比较鼻翼、鼻小柱的对称性。结果:治疗组T0-T1、T1-T2,两侧鼻不对称率减小(P<0.05),T2-T3两侧鼻不对称率增大(P<0.05)。治疗组与对照组手术前后鼻不对称率的改变值在垂直方向上有显著差异(P<0.01),水平方向上差异无统计学意义(P>0.05)。结论:鼻翼-牙槽改建矫治器可明显改善鼻部对称性;术后半年,患侧鼻部有复发趋势,但其鼻翼拱形仍较理想。

PURPOSE： The purpose of this study was to apply nasoalveolar molding appliance in infants with cleft lip and plate and to observe the preliminary effects on nasal cartilage and columella. METHODS： Ten infants were treated with nasoalveolar molding. The other ten infants without any presurgical orthopedic treatment were chosen as the control group. Each patient was photographed at the initial visit（T0）, after nasoalveolar molding （T1）, 2 weeks （T2）, and half a year （T3） after cheiloplasty. Six measurements were made on the photographs and the nasal symmetry was analyzed with paired t test. RESULTS： The percentage of the deviation from perfect symmetry was significantly improved at T0-T1, T1-T2 stage （P〈 0.05）, and the improvement relapsed at T2-T3 （P〈0.05）. There was significant difference between the orthopedic group and the control group with the changes in nasal symmetry in vertical dimension （P〈0.01）, and there was no significant difference in horizontal dimension （P〉0.05）. CONCLUSIONS： Nasal asymmetry was significantly improved after nasoalveolar molding. Half a year after the primary cheiloplasty, although there was a relapse tendency of nasal asymmetry, the shape of the nasal dome was ideal. Supported by Shanghai Leading Academic Discipline Project （Grant No.Y0203）.