国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (4): 453-461.doi: 10.7518/gjkq.2022062

• 综述 • 上一篇    下一篇

唇腭裂患者鼻通气功能的研究进展

黄艺璇(),石冰,李精韬()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院唇腭裂外科 成都 610041
  • 收稿日期:2021-11-10 修回日期:2022-02-14 出版日期:2022-07-01 发布日期:2022-06-28
  • 通讯作者: 李精韬
  • 作者简介:黄艺璇，硕士， Email：hyxnoemie96@126.com
  • 基金资助:
    年底，中共中央宣传部、中国科协、科技部、中国科学院、中国工程院、国防科工局六部门向全社会发布了2021年“最美科技工作者”的先进事迹

Research progress on nasal airway among patients with cleft lip and palate

Huang Yixuan(),Shi Bing,Li Jingtao.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2021-11-10 Revised:2022-02-14 Online:2022-07-01 Published:2022-06-28
  • Contact: Jingtao. Li

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摘要：

先天性唇腭裂畸形影响患者颌面部包括呼吸在内的诸多重要生理功能。然而，现行的序列治疗关注重点集中在外观、语音及咬合功能的恢复，治疗内容往往缺乏对鼻通气功能的考量。事实上，唇腭裂患者的鼻通气道存在显著的结构异常，鼻通气功能情况是影响患者生存质量的重要因素。因此，本文在明确唇腭裂患者鼻通气相关结构异常的基础上，综述序列治疗各项内容对鼻通气功能的影响规律，介绍常用鼻通气功能的评估手段，并针对如何更好地将鼻通气功能考量纳入唇腭裂治疗方案设计提供建议和参考。

关键词: 唇腭裂, 序列治疗, 呼吸, 鼻通气道

Abstract:

The congenital deformities of cleft lip and palate have significant effects on various physiological functions of the maxillofacial region including breathing. The team approach protocol mainly focuses on restoring appearance, speech, and occlusal function, instead of nasal breathing. In fact, there are significant structural anomalies in the nasal airway of patients with cleft lip and palate, which exert critical impacts on the patient ’ s quality of life. Therefore, on the basis of elucidating the anatomical anomalies associated with nasal breathing in patients with cleft lip and palate, this article reviews the influence of sequential treatment on nasal breathing, introduces commonly used assessment tools for nasal breathing, and provides references on how to better incorporate nasal breathing into the treatment planning for cleft lip and palate.

Key words: cleft lip and palate, team approach, breathing, nasal airway

中图分类号: 

  • R 782.2
1 Worley ML, Patel KG, Kilpatrick LA. Cleft lip and palate[J]. Clin Perinatol, 2018, 45(4): 661-678.
2 Dai L, Zhu J, Mao M, et al. Time trends in oral clefts in Chinese newborns: data from the Chinese National Birth Defects Monitoring Network[J]. Birth Defects Res A Clin Mol Teratol, 2010, 88(1): 41-47.
3 Warren D, Duany L, Fischer N. Nasal pathway resistance in normal and cleft palate subjects[J]. Cleft Palate J, 1969, 6: 134-40.
4 MacLean JE, Waters K, Fitzsimons D, et al. Scree-ning for obstructive sleep apnea in preschool children with cleft palate[J]. Cleft Palate Craniofac J, 2009, 46(2): 117-123.
5 MacLean JE, Hayward P, Fitzgerald DA, et al. Cleft lip and/or palate and breathing during sleep[J]. Sleep Med Rev, 2009, 13(5): 345-354.
6 Magliulo G, Iannella G, Ciofalo A, et al. Nasal pathologies in patients with obstructive sleep apnoea[J]. Acta Otorhinolaryngol Ital, 2019, 39(4): 250-256.
7 Garg RK, Afifi AM, Garland CB, et al. Pediatric obstructive sleep apnea: consensus, controversy, and craniofacial considerations[J]. Plast Reconstr Surg, 2017, 140(5): 987-997.
8 Rundo JV. Obstructive sleep apnea basics[J]. Cleve Clin J Med, 2019, 86(9 ): 2-9.
9 Keeler J, Most SP. Measuring nasal obstruction[J]. Facial Plast Surg Clin North Am, 2016, 24(3): 315-322.
10 Hsu DW, Suh JD. Anatomy and physiology of nasal obstruction[J]. Otolaryngol Clin North Am, 2018, 51(5): 853-865.
11 Glade RS, Deal R. Diagnosis and management of velopharyngeal dysfunction[J]. Oral Maxillofac Surg Clin North Am, 2016, 28(2): 181-188.
12 Robison JG, Otteson TD. Increased prevalence of obstructive sleep apnea in patients with cleft palate[J]. Arch Otolaryngol Head Neck Surg, 2011, 137(3): 269-274.
13 Hansen L, Skovgaard LT, Nolting D, et al. Human prenatal nasal bone lengths: normal standards and length values in fetuses with cleft lip and cleft palate[J]. Cleft Palate Craniofac J, 2005, 42(2): 165-170.
14 Cuzalina A, Jung C. Rhinoplasty for the cleft lip and palate patient[J]. Oral Maxillofac Surg Clin North Am, 2016, 28(2): 189-202.
15 Sykes JM, Tasman AJ, Suárez GA. Cleft lip nose[J]. Clin Plast Surg, 2016, 43(1): 223-235.
16 Losee JE, Kirschner RE. Comprehensive cleft care[M]. 2nd ed. New York: Thieme Medical Publi-shers, 2016.
17 Khansa I, Hall C, Madhoun LL, et al. Airway and feeding outcomes of mandibular distraction, tongue-lip adhesion, and conservative management in Pierre robin sequence: a prospective study[J]. Plast Reconstr Surg, 2017, 139(4): 975e-983e.
18 Wang X, Xu Z, Xiao Y, et al. Successful management of anesthesia complications in a child with Crouzon syndrome[J]. Anaesthesist, 2020, 69(6): 432-435.
19 Starbuck JM, Friel MT, Ghoneima A, et al. Nasal airway and septal variation in unilateral and bilate-ral cleft lip and palate[J]. Clin Anat, 2014, 27(7): 999-1008.
20 Aras I, Olmez S, Dogan S. Comparative evaluation of nasopharyngeal airways of unilateral cleft lip and palate patients using three-dimensional and two-dimensional methods[J]. Cleft Palate Craniofac J, 2012, 49(6): e75-e81.
21 Trindade IE, Gomes Ade O, Fernandes Mde B, et al. Nasal airway dimensions of children with repaired unilateral cleft lip and palate[J]. Cleft Palate Craniofac J, 2015, 52(5): 512-516.
22 Iwasaki T, Suga H, Minami-Yanagisawa A, et al. Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics[J]. Am J Orthod Dentofacial Orthop, 2019, 156(2): 257-265.
23 Sobol DL, Allori AC, Carlson AR, et al. Nasal airway dysfunction in children with cleft lip and cleft palate: results of a cross-sectional population-based study, with anatomical and surgical considerations[J]. Plast Reconstr Surg, 2016, 138(6): 1275-1285.
24 Zhang RS, Lin LO, Hoppe IC, et al. Nasal obstruction in children with cleft lip and palate: results of a cross-sectional study utilizing the NOSE scale[J]. Cleft Palate Craniofac J, 2019, 56(2): 177-186.
25 Warren DW, Drake AF, Davis JU. Nasal airway in breathing and speech[J]. Cleft Palate Craniofac J, 1992, 29(6): 511-519.
26 Fukushiro AP, Trindade IE. Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types[J]. Cleft Palate Craniofac J, 2005, 42(4): 396-402.
27 Pawar SS, Wang TD. Secondary cleft rhinoplasty[J]. JAMA Facial Plast Surg, 2014, 16(1): 58-63.
28 Fisher MD, Fisher DM, Marcus JR. Correction of the cleft nasal deformity: from infancy to maturity[J]. Clin Plast Surg, 2014, 41(2): 283-299.
29 Huempfner-Hierl H, Hemprich A, Hierl T. Results of a prospective anthropometric and functional study about aesthetics and nasal respiration after secondary rhinoplasty in cleft lip and palate patients[J]. J Craniofac Surg, 2009, 20(): 1863-1875.
30 Rautio J, Vento S, Malmberg H. Rhinoplasty and nasal function in patients with cleft lips[J]. Scand J Plast Reconstr Surg Hand Surg, 2002, 36(5): 268-272.
31 van Zijl FVWJ, Versnel S, van der Poel EF, et al. Use of routine prospective functional and aesthetic patient satisfaction measurements in secondary cleft lip rhinoplasty[J]. JAMA Facial Plast Surg, 2018, 20(6): 488-494.
32 Sawyer AR, Robinson S, Cadier M. Prospective patient-related outcome evaluation of secondary cleft rhinoplasty using a validated questionnaire[J]. Cleft Palate Craniofac J, 2017, 54(4): 436-441.
33 Vass G, Mohos G, Bere Z, et al. Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation[J]. Head Face Med, 2016, 12(1): 34.
34 Friel MT, Starbuck JM, Ghoneima AM, et al. Airway obstruction and the unilateral cleft lip and pa-late deformity: contributions by the bony septum[J]. Ann Plast Surg, 2015, 75(1): 37-43.
35 Massie JP, Runyan CM, Stern MJ, et al. Nasal septal anatomy in skeletally mature patients with cleft lip and palate[J]. JAMA Facial Plast Surg, 2016, 18(5): 347-353.
36 石冰. 腭裂的个体化整复[J]. 国际口腔医学杂志, 2015, 42(6): 621-623.
Shi B. Individualized surgical management of cleft palate[J]. Int J Stomatol, 2015, 42(6): 621-623.
37 Scott AR, Moldan MM, Tibesar RJ, et al. A theoretical cause of nasal obstruction in patients with repaired cleft palate[J]. Am J Rhinol Allergy, 2011, 25(1): 58-60.
38 Yamaguchi K, Lonic D, Lee CH, et al. Modified furlow palatoplasty using small double-opposing Z-plasty: surgical technique and outcome[J]. Plast Reconstr Surg, 2016, 137(6): 1825-1831.
39 Kharbanda O, Rana S, Duggal R. Area and volume of the pharyngeal airway in surgically treated unila-teral cleft lip and palate patient: a cone beam computed tomography study[J]. J Cleft Lip Palate Craniofac Anomal, 2015, 2(1): 27.
40 Gandedkar NH, Chng CK, Basheer MA, et al. Comparative evaluation of the pharyngeal airway space in unilateral and bilateral cleft lip and palate indivi-duals with noncleft individuals: a cone beam computed tomography study[J]. Cleft Palate Craniofac J, 2017, 54(5): 509-516.
41 Karia H, Shrivastav S, Karia AK. Three-dimensio-nal evaluation of the airway spaces in patients with and without cleft lip and palate: a digital volume tomographic study[J]. Am J Orthod Dentofacial Orthop, 2017, 152(3): 371-381.
42 Akarsu-Guven B, Karakaya J, Ozgur F, et al. Growth-related changes of skeletal and upper-airway features in bilateral cleft lip and palate patients[J]. Am J Orthod Dentofacial Orthop, 2015, 148(4): 576-586.
43 Yamaguchi K, Lonic D, Lee CH, et al. A treatment protocol for velopharyngeal insufficiency and the outcome[J]. Plast Reconstr Surg, 2016, 138(2): 290e-299e.
44 Grover R, Barnett A, Rampazzo A, et al. Outcomes of sphincter pharyngoplasty in the cleft population[J]. J Craniofac Surg, 2018, 29(4): 908-913.
45 Horton JD, Gnagi SH, Atwood CM, et al. Pharyn-geal flap versus sphincter pharyngoplasty for velopharyngeal insufficiency: a review of the 2014 and 2015 American college of surgeons national surgical quality improvement project-pediatrics data[J]. J Craniofac Surg, 2019, 30(2): 554-556.
46 Meier JD, Muntz HR. Velopharyngeal dysfunction evaluation and treatment[J]. Facial Plast Surg Clin North Am, 2016, 24(4): 477-485.
47 Abdel-Aziz M, Hussien A, Kamel A, et al. The impact of velopharyngeal surgery on the polysomnographic parameters after cleft palate repair[J]. J Craniofac Surg, 2018, 29(3): 717-719.
48 Luo X, Guo C, Yin H, et al. Comparison of Hogan pharyngeal flap and sphincter pharyngoplasty in postoperative velopharyngeal function[J]. Br J Oral Maxillofac Surg, 2020, 58(3): 291-295.
49 Sullivan SR, Marrinan EM, Mulliken JB. Pharyn-geal flap outcomes in nonsyndromic children with repaired cleft palate and velopharyngeal insufficiency[J]. Plast Reconstr Surg, 2010, 125(1): 290-298.
50 Li JT, Shi B, Liu K, et al. A photogrammetric study of the effects of alveolar bone graft on nose symmetry among unilateral cleft patients[J]. J Plast Reconstr Aesthet Surg, 2011, 64(11): 1436-1443.
51 Chang CS, Wallace CG, Hsiao YC, et al. Patient and parent reported outcome measures in cleft lip and palate patients before and after secondary alveolar bone grafting[J]. Medicine (Baltimore), 2017, 96(52): e9541.
52 Roy AA, Rtshiladze MA, Stevens K, et al. Orthognathic surgery for patients with cleft lip and palate[J]. Clin Plast Surg, 2019, 46(2): 157-171.
53 Trindade IE, Yamashita RP, Suguimoto RM, et al. Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: acoustic and aerodynamic assessment[J]. Cleft Palate Craniofac J, 2003, 40(1): 54-64.
54 Chang CS, Wallace CG, Hsiao YC, et al. Airway changes after cleft orthognathic surgery evaluated by three-dimensional computed tomography and o-vernight polysomnographic study[J]. Sci Rep, 2017, 7(1): 12260.
55 Kloukos D, Fudalej P, Sequeira-Byron P, et al. Ma-xillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients[J]. Cochrane Database Syst Rev, 2018, 8: CD010403.
56 Yatabe-Ioshida MS, Campos LD, Yaedu RY, et al. Upper airway 3D changes of patients with cleft lip and palate after orthognathic surgery[J]. Cleft Palate Craniofac J, 2019, 56(3): 314-320.
57 Vella JB, Tatum SA. Risk factors for velopharyngeal dysfunction following orthognathic surgery in the cleft population[J]. Curr Opin Otolaryngol Head Neck Surg, 2019, 27(4): 317-323.
58 Spataro E, Most SP. Measuring nasal obstruction outcomes[J]. Otolaryngol Clin North Am, 2018, 51(5): 883-895.
59 Weiss R 2nd, Read-Fuller A. Cone beam computed tomography in oral and maxillofacial surgery: an e-vidence-based review[J]. Dent J (Basel), 2019, 7(2): E52.
60 Shi B, Huang HY. Computational technology for nasal cartilage-related clinical research and application[J]. Int J Oral Sci, 2020, 12(1): 21.
61 Brandon BM, Austin GK, Fleischman G, et al. Comparison of airflow between spreader grafts and butterfly grafts using computational flow dynamics in a cadaveric model[J]. JAMA Facial Plast Surg, 2018, 20(3): 215-221.
62 Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline[J]. J Clin Sleep Med, 2017, 13(3): 479-504.
63 Apon I, van Leeuwen N, Allori AC, et al. Rasch analysis of patient-and parent-reported outcome measures in the international consortium for health outcomes measurement standard set for cleft lip and palate[J]. Value Health, 2021, 24(3): 404-412.
64 Ottaviano G, Pendolino AL, Nardello E, et al. Peak nasal inspiratory flow measurement and visual analogue scale in a large adult population[J]. Clin Otolaryngol, 2019, 44(4): 541-548.
65 Hassan Y, Leveille CF, Gallo L, et al. Reporting outcomes and outcome measures in open rhinoplasty: a systematic review[J]. Aesthet Surg J, 2020, 40(2): 135-146.
66 Peroz R, Holmström M, Mani M. Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and pa-late[J]. J Plast Reconstr Aesthet Surg, 2017, 70(5): 653-658.
67 Gary C, Sykes JM. Intermediate and definitive cleft rhinoplasty[J]. Facial Plast Surg Clin North Am, 2016, 24(4): 487-494.
68 Downs BW. The inferior turbinate in rhinoplasty[J]. Facial Plast Surg Clin North Am, 2017, 25(2): 171-177.
69 Most SP, Rudy SF. Septoplasty: basic and advanced techniques[J]. Facial Plast Surg Clin North Am, 2017, 25(2): 161-169.
70 赵欣然, 蔡鸣. 不同咽成形术式对腭裂术后继发腭咽闭合功能不全合并睡眠呼吸障碍的影响[J]. 中国口腔颌面外科杂志, 2021, 19(1): 76-81.
Zhao XR, Cai M. A retrospective analysis of sleep breathing disordered after pharyngoplasty for velopharyngeal insufficiency secondary to cleft palate[J]. China J Oral Maxillofac Surg, 2021, 19(1): 76-81.
71 Nakajima Y, Hikosaka M, Kuwahara K, et al. The incidence of sleep disordered breathing one week after primary palatoplasty: evaluation with overnight pulse oximetry[J]. J Craniofac Surg, 2019, 30(5): 1565-1567.
72 Ranzer M, Daniele E, Purnell CA. Perioperative management of cleft lip repair: a meta-analysis and clinical practice guideline[J]. Cleft Palate Craniofac J, 2021, 58(10): 1217-1225.
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