Schultz R C
Division of Plastic Surgery, University of Illinois, College of Medicine, Chicago.
Arch Otolaryngol Head Neck Surg. 1989 Jan;115(1):65-7. doi: 10.1001/archotol.1989.01860250067029.
The treatment of cleft palate fistulas is currently unstandardized, and the outcome is often unsuccessful. Conventional surgical techniques for the repair of such fistulas involving bony defects have essentially been abandoned by the author. Current protocol calls for their repair in early adolescence (before the age of 10 years) following completion of any required orthodontic expansion of the maxillary dental arch. At the time of fistula repair, all scar tissue is excised between the maxillary segments. Both palatal and gingival soft-tissue flaps are developed to cover either free cancellous bone grafts or free periosteal grafts used to bridge the maxillary defect. This change in technique has resulted in osteogenic filling of the maxillary bony defect and has markedly improved the success rate of fistula repair. Furthermore, it has enhanced the aesthetic correction of the nasal alar base cleft stigmas.
目前腭裂瘘管的治疗尚无标准化方案，且治疗结果往往不理想。作者基本上已摒弃了用于修复此类伴有骨缺损的瘘管的传统手术技术。当前方案要求在完成上颌牙弓所需的任何正畸扩弓后，于青春期早期（10岁之前）进行修复。在瘘管修复时，切除上颌骨段之间的所有瘢痕组织。制作腭部和牙龈软组织瓣以覆盖用于桥接上颌骨缺损的游离松质骨移植片或游离骨膜移植片。这种技术改变已使上颌骨缺损实现成骨填充，并显著提高了瘘管修复的成功率。此外，它还增强了鼻翼基部腭裂瘢痕的美学矫正效果。
