伴与不伴有腭裂的单侧唇牙槽突裂患者的鼻气道结构对比_高明.pdf

临床研究*基金项目:陕西省重点研发计划(2018SF-118)*通信作者:任战平，E-mail:zhanpingmailxjtueducn伴与不伴有腭裂的单侧唇牙槽突裂患者的鼻气道结构对比*高明1，2，3，陶永炜1，2，3，毕思思1，2，3，李锦峰1，2，3，任战平1，2，3*(西安交通大学口腔医院 1陕西省颅颌面精准医学研究重点实验室;2陕西省牙颌疾病临床研究中心;3唇腭裂外科陕西西安710004)摘要 目的:利用 CBCT 三维重建对比分析伴与不伴有腭裂的单侧唇牙槽突裂继发鼻畸形患者的健侧、患侧鼻气道横截面积及鼻中隔偏曲情况。方法:收集 22 例已行唇腭裂手术的单侧完全性唇腭牙槽突裂患者(完全裂组)及 20 例已行唇裂手术的单侧唇牙槽突裂患者(唇牙槽突裂组)的 CBCT 数据。利用 Mimics 21.0 软件进行三维重建。从前、中、后 3 个冠状面上测量健侧、患侧的鼻气道横截面积及鼻中隔偏曲情况，进行对比分析。结果:完全裂组较唇牙槽突裂组中、后冠状面的鼻中隔偏曲程度大(P0.05)。组间比较，3 个冠状面的健、患侧鼻气道横截面积差异均无统计学意义(P0.05)。组内分析，两组 3 个冠状面上健侧鼻气道的横截面积均较患侧大(P0.05)。两组中与后两个冠状面健、患侧鼻气道的横截面积及鼻中隔偏曲程度均无统计学意义(P0.05)。唇牙槽突裂组前与中两个冠状面的患侧鼻气道横截面积差异无统计学意义(P0.05)。3 个冠状面间的鼻中隔偏曲角度差异无统计学意义(P0.05)。结论:腭裂和腭裂手术是导致已行唇裂手术的单侧唇腭牙槽突患者中、后两个冠状面鼻中隔偏曲程度增大的重要因素，其对前、中、后 3 个冠状面上的鼻气道横截面积无明显影响。无论是否伴有腭裂，3 个冠状面的健侧鼻气道横截面积一般均大于患侧，中与后两个冠状面上健侧及患侧鼻气道的横截面积及鼻中隔偏曲程度差异一般较小。关键词 单侧唇腭牙槽突裂;单侧唇牙槽突裂;鼻气道;CBCT 三维重建 中图分类号 816987822 文献标识码 Adoi:10.3969/jissn1003-1634.2023.06.004Comparison of nasal airways structure in patients with unilateral cleft labial alveolar with and without cleft pal-ateGAO Ming1，2，3，TAO Yong-wei1，2，3，BI Si-si1，2，3，LI Jin-feng1，2，3，EN Zhan-ping1，2，3*1Key Laboratory of ShaanxiProvince for Craniofacial Precision Medicine esearch，Xi an Jiaotong University;2Clinical esearch Center of Shaanxi Prov-ince for Dental and Maxillofacial Diseases，Xi an Jiaotong University;3Department of Cleft Palate-Craniofacial Surgery，Hos-pital of Stomatology，Xi an Jiaotong University，Shaanxi Xi an 710004，China Abstract Objective:To compare the cross-sectional area of the healthy and affected nasal airway and the deviationof nasal septum in patients with secondary unilateral cleft lip nasal deformity with and without cleft palate using CBCT three-dimensional reconstructionMethods:The CBCT data of 22 patients with unilateral complete cleft lip and palate(completecleft group)and 20 patients with unilateral cleft lip and palate(cleft lip group)were collectedMimics 21.0 software was usedfor 3D reconstructionThe cross-sectional area of the nasal airway on the healthy and affected sides and the deviation of nasalseptum were measured on the anterior，middle and posterior coronal planesesults:The degree of deviation of nasal septumin the complete cleft group were larger than those in the labial alveolar cleft group(P0.05)Comparison between the twogroups，there was no significant difference in the cross-sectional area of the healthy and affected sides of the nasal airway inthe three coronal planes(P0.05)Intra-group analysis，the cross-sectional area of the healthy side was larger than that of theaffected side on the three coronal planes in the two groups(P0.05)There was no significant difference in the cross-section-al area of nasal airway in the healthy and affected sides and in the degree of deviation of nasal septum of the two groups(P0.05)There was no significant difference in the cross-sectional area of the affected nasal airway on the anterior and middlecoronal planes in the labial alveolar cleft group(P0.05)There was no significant difference in the deviation angle of nasalseptum between the three coronal planes In the labial alveolar cleft group(P0.05)Conclusion:Cleft palate and cleft palate233临床口腔医学杂志 2023 年 6 月第 39 卷第 6 期J Clin Stomatol，Jun.2023，Vol.39，No.6surgery are important factors leading to the increase of nasal septum deviation in the middle and posterior coronal planes ofpatients with unilateral cleft labial-palatal alveolar who have undergone cleft lip surgeryIt has no significant effect on thecross-sectional area of the nasal airway in the anterior，middle and posterior coronal planesNo matter whether there is cleftpalate or not，the cross-sectional area of the healthy side of the nasal airway on the three coronal planes was generally largerthan that of the affected sideThere was generally no significant difference in the cross-sectional area of the nasal airway andthe degree of nasal septum deviation between the healthy side and the affected side on the middle and posterior coronalplanes Key words Unilateral labial palatal alveolar cleft;Unilateral labial alveolar cleft;Nasal airway;CBCT three-dimen-sional reconstruction唇腭裂患者常伴有明显的鼻部畸形1。不仅表现在解剖结构方面，其在生理功能方面也存在各种缺陷2。结构方面的缺陷主要有鼻中隔偏曲以及鼻气道的阻塞等3。功能方面的缺陷可能包括口呼吸、鼻窦炎、打鼾，严重的甚至会伴有阻塞性呼吸睡眠暂停4。目前唇腭裂伴发鼻畸形的整复重点多集中于外形，即使同期行鼻中隔偏曲矫正术也是为了更好地改善外观，而对鼻腔内部更加细化的畸形关注较少5。然而，随着健康意识的提高，唇腭裂患者对生活质量也有了更高的要求6，治疗唇腭裂继发鼻畸形时要有更加深入的理解。鼻气道的阻力约占整个呼吸道阻力的 50%以上7。而鼻气道的横截面积及鼻中隔偏曲是影响鼻气道阻力的最重要因素8。提示唇腭裂继发鼻畸形的鼻气道横截面积及鼻中隔偏曲情况研究的重要性。CBCT 具有成本低、比传统 CT 辐射量小等优点9，10。本研究利用 CBCT 三维重建对比分析已行唇腭裂手术的单侧完全性唇腭牙槽突裂及已行唇裂手术的单侧唇牙槽突裂患者健侧、患侧鼻气道的横截面积及鼻中隔偏曲情况，以期为此类患者的继发鼻畸形修复及后期深入研究提供参考。资料和方法1研究对象选择 2017 年 1 月2021 年 9 月间在西安交通大学口腔医院就诊的 22 例已行唇腭裂手术的单侧完全性牙槽突裂患者定义为完全裂组，20 例已行唇裂手术的单侧完全性牙槽突裂患者定义为唇牙槽突裂组。所有入组患者均因欲行牙槽突裂植骨而在术前行 CBCT 检查。本研究经医院伦理委员会批准通过，患者知情同意。完全裂组男 15 例，女 7 例，年龄 7 13 岁，平均(10.451.55)岁，其中左侧裂 15 例，右侧裂7 例;唇牙槽突裂组男 10 例，女 10 例，年龄 714 岁，平均(10.552.01)岁，其中左侧裂 13 例，右侧裂 7 例。纳入标准:已行唇裂或唇腭裂手术的单侧完全性牙槽突裂患者;植骨术前拍摄 CBCT;影像清晰、完整、无伪影。排除标准:颅颌面综合征;腭瘘;既往行扩弓手术;既往行前牵引治疗者。2影像学资料获取方法术前拍摄 CBCT，设备信息为(KaVo 3D eXam i，imaging Sci-ence International