Dec Wojciech, Shetye Pradip R, Grayson Barry H, Brecht Lawrence E, Cutting Court B, Warren Stephen M
Department of Plastic Surgery, New York University School of Medicine, New York, NY 10016, USA.
J Craniofac Surg. 2013 Jan;24(1):57-61. doi: 10.1097/SCS.0b013e31826d09b5.
The incidence of postoperative complications in cleft care is low. In this 19-year retrospective analysis of cleft lip and palate patients treated with preoperative nasoalveolar molding, we examine the incidence of postoperative oronasal fistulae. The charts of 178 patients who underwent preoperative nasoalveolar molding by the same orthodontist/prosthodontist team and primary cleft lip/palate repair by the same surgeon over a 19-year period were reviewed. Millard, Mohler, Cutting, or Mulliken-type techniques were used for cleft lip repairs. Oxford-, Bardach-, or von Langenbeck-type techniques were used for cleft palate repairs. One nasolabial fistula occurred after primary cleft lip repair (0.56% incidence) and was repaired surgically. Four palatal fistulae (3 at the junction between soft and hard palate and 1 at the right anterior palate near the incisive foramen) occurred, but 3 healed spontaneously. Only 1 palatal fistula (0.71%) required surgical repair. All 5 fistulae occurred within the first 8 years of the study period, with 4 (80%) of 5 occurring within the first 3 years. Although fistula rate may be related to surgeon experience and the evolution of presurgical techniques, nasoalveolar molding in conjunction with nasal floor closure contributes to a low incidence of oronasal fistulae.
腭裂治疗术后并发症的发生率较低。在这项对接受术前鼻牙槽塑形治疗的唇腭裂患者进行的19年回顾性分析中，我们研究了术后口鼻瘘的发生率。回顾了178例患者的病历，这些患者在19年期间由同一正畸医生/修复医生团队进行术前鼻牙槽塑形，并由同一位外科医生进行一期唇腭裂修复。唇裂修复采用Millard、Mohler、Cutting或Mulliken型技术。腭裂修复采用牛津、Bardach或von Langenbeck型技术。一期唇裂修复后出现1例鼻唇瘘（发生率0.56%），并进行了手术修复。出现4例腭瘘（3例位于软硬腭交界处，1例位于切牙孔附近的右前腭），但3例自行愈合。仅1例腭瘘（0.71%）需要手术修复。所有5例瘘均发生在研究期的前8年内，其中5例中的4例（80%）发生在头3年内。尽管瘘的发生率可能与外科医生的经验和术前技术的发展有关，但鼻牙槽塑形结合鼻底封闭有助于降低口鼻瘘的发生率。
