鼻-牙槽塑形矫治器在完全性唇腭裂修复中的应用

The repairing application of presurgical nasoalveolar molding used for infants with complete cleft lip and palate

目的：观察鼻－牙槽突塑形矫治器（PNAM）在术前矫治完全性唇腭裂患儿中的作用。方法对20例完全性唇腭裂患者（平均年龄为18 d）采用 PNAM进行术前矫治，其中双侧唇腭裂8例，单侧12例。测量患儿治疗前后鼻小柱长度、病变侧鼻孔宽度、上唇裂隙宽度及牙槽突裂隙宽度的变化，用 SPSS 13．0软件进行统计分析。结果患儿应用 PNAM治疗后病变侧鼻孔宽度[双侧组：（9．01±1．04）mm、（8．87±1．62）mm；单侧组：（12．32±1．91）mm]、上唇裂隙[双侧组：（9．86±3．05）mm、（9．45±2．78）mm；单侧组：（8．76±2．7）mm]及牙槽突裂隙宽度[双侧组：（4．39±2．23）mm、（4．06±2．41）mm；单侧组：（6．49±1．15）mm]明显缩小，鼻小柱长度[双侧组：（3．36±1．98）mm；单侧组：（5．06±2．03）mm]增加，与治疗前[双侧组：（12．43±2．02）mm，（11．91±1．55）mm，（12．95±2．39）mm，（12．31±1．92）mm，（8．45±2．67）mm，（8．05±2．48）mm，（1．03±0．51）mm；单侧组：（16．89±2．36）mm，（13．85±2．52）mm，（9．23±2．37）mm，（1．78±0．61）mm]相比差异有统计学意义（t 值：双侧组：9．286、8．847、6．659、5．672、8．596、6．121、6．896，单侧组：10．537、11．497、10．001、9．391；均 P ＜0．05）。结论PNAM术前矫治能有效改善患儿的唇腭裂原发畸形和鼻部形态，为Ⅰ期手术创造良好的条件，有助于患儿建立正常的吮吸、呼吸及语言功能，同时缓解患儿家长的焦虑，使之对治疗充满信心并积极配合，进一步完善临床整复效果。

Objective To analyze the effect of presurgical nasoalveolar molding（PNAM）used for infants with complete cleft lip and palate in preoperative orthopedics.Methods 20 infants of complete cleft lip and palate （with an average age of 18 days）,including 8 infants of bilateral and 12 infants of unilateral,were treated with PNAM in preoperative orthopedics.The nasal columella length,width of malformed nostril,width of cleft lip and alveolar cleft were measured before and after operation of PNAM.The data were analyzed by SPSS 13.0.Results The width of malformed nostril[bilateral group：（9.01 ±1.04）mm,（8.87 ±1.62）mm;unilateral group：（12.32 ±1.91）mm], width of cleft lip[bilateral group：（9.86 ±3.05）mm,（9.45 ±2.78）mm;unilateral group：（8.76 ±2.7）mm]and alveolar cleft[bilateral group：（4.39 ±2.23）mm,（4.06 ±2.41 ）mm;unilateral group：（6.49 ±1.15）mm]were remarkably decreased,and nasal columella length[bilateral group：（3.36 ±1.98）mm;unilateral group：（5.06 ± 2.03）mm]was extended after PNAM treatment compared with those before treatment[bilateral group：（12.43 ± 2.02）mm,（11.91 ±1.55）mm,（12.95 ±2.39）mm,（12.31 ±1.92）mm,（8.45 ±2.67）mm,（8.05 ±2.48）mm, （1.03 ±0.51）mm;unilateral group：（16.89 ±2.36）mm,（13.85 ±2.52）mm,（9.23 ±2.37）mm,（1.78 ±0.61）mm],in addition,changes of data were statistically significant（t value bilateral group：9.286,8.847,6.659,5.672,8.596, 6.121,6.896;unilateral group：10.537,11.497,10.001,9.391;all P ＆lt;0.05）.Conclusion The primary deformity of cleft lip and palate and nasal profile of complete cleft lip and palate infants could be improved by PNAMtreatment, which is favorable for first stage surgery of complete cleft lip and palate;improving functions of sucking,respiratory and language and relieving anxiety of parents who would be full of confidence in treatment.Furthermore,all these advantages will perfect the clinical effect of restoration.