裂隙顶端黏膜瓣在宽大型Ⅱ度腭裂修复中的应用

Oral mucosa flap in the top of fissure for nasal side mucosa repair of wide incomplete cleft palate

目的探讨在裂隙宽大的Ⅱ度腭裂修复术中,利用裂隙顶端口腔黏膜瓣修复鼻侧黏膜、降低缝合后张力的术式的临床应用效果。方法选择27例宽大型Ⅱ度腭裂患者为研究对象,在常规两瓣法的基础上,将裂隙顶端三角形口腔黏膜瓣翻转,与两侧鼻侧黏膜缝合修复裂隙宽大的Ⅱ度腭裂鼻侧黏膜。结果27例患者均手术顺利,术后无活动性出血、呼吸道阻塞及伤口感染发生。随访1～3个月,伤口愈合良好,无伤口裂开及腭漏发生,上腭瘢痕不明显。结论应用裂隙顶端口腔黏膜瓣修复宽大型Ⅱ度腭裂鼻侧黏膜,可以降低鼻侧黏膜缝合时的张力,相应增加两侧黏骨膜瓣宽度,降低术后腭漏的发生及减轻腭部瘢痕的形成。

Objective To explore a method to repair nasal side mucosa of wide incomplete cleft palate and reduce the tension of wound by using oral mucosa flap in the top of fissure. Methods 27 cases of wide incomplete cleft palatal were included in the study. On the basis of two-flap palatoplasty, the triangular oral mucosa flap in the top of fissure was turned and sewed with side mueosa to repair nasal side mucosa of wide palatal cleft. Results Without postoperative active bleeding, airway obstruction and wound infection, 27 cases had been repaired satisfactorily by this procedure. 1-3 months followed up demonstrated that all the wounds healed well without wound dehiscence or fistulas and the scars in the palate were not severe. Conclusion Using oral mucosa flap in the top of fissure to repair nasal side mucosa of wide palatal cleft can get a reduced tension and correspondingly increase the width of mucoperiosteal flaps so as to decrease incidence rate of palatal fistulas and reduce formation of scars.