新生儿单侧唇腭裂术前外贴式鼻牙槽矫治器的研制及应用

A Novel Presurgical Extraoral Orthopedic Appliance and Treatment Approach for Newborns with Unilateral Cleft Lip and Palate

目的自行研制口腔外粘贴式鼻牙槽矫治装置并初步探讨其对新生单侧完全性唇腭裂患儿手术前矫治的效果。方法自行研制外贴式鼻牙槽矫治器,对1例出生12d的单侧完全性唇腭裂患儿进行术前矫治,利用上唇粘贴技术恢复口唇张力,并以其为支抗粘接固位预制的鼻孔支撑装置对裂隙侧塌陷鼻孔进行塑形,疗程为3个月。结果患儿矫治3周后牙槽突裂隙缩小3mm,3个月后裂隙完全关闭;鼻小柱明显直立,塌陷的鼻翼上抬呈圆拱状,患侧鼻孔形态接近未裂侧鼻孔。结论北京协和医院口腔科研制的外贴式鼻牙槽矫治器可以有效地缩窄单侧完全性唇腭裂患儿的软硬组织裂隙,改善鼻孔外形,为Ⅰ期唇裂修复手术创造良好的条件。

Objective To introduce a novel presurgical extraoral orthopedic appliance and treatment ap- proach for the newborns with unilateral cleft lip and palate. Methods A novel presurgical extraoral orthopedic appliance was self-designed. In a 12-day-old male newborn presented with complete unilateral cleft lip and pal- ate, an adhesive taped lip supported the novel preformed nasal stent without any oral appliance was used to de- crease the alveolar gap and improve the symetry of the nose. The treatment course was 3 months. Results The intraoral cleft gap was decreased by 3 mm after 3 weeks and closed at the 14th week by the gradual activations with a rounding nostril on the cleft side. The shape of the cartilaginous septum, alar cartilage tip, medial and lateral crus, and alveolar segments were molded to resemble the normal shape of these structures. Conclusion The novel extraoral orthopedic appliance can effectively decrease the intraoral cleft gap and mold the oronasal tissues into normal form, and therefore can be helpful for the cleft lip and palate repair surgery in the newborns with unilateral cleft lip and palate.