摘要
目的：研究颊粘膜瓣封闭法牙槽嵴裂修复术后的软组织形态学改变，比较移植颊粘膜瓣与正常颊粘膜、牙龈粘膜的异同，并探讨移植颊粘膜瓣术后能否形成类似正常的牙周形态。
方法：选取中南大学湘雅医院口腔科颊粘膜瓣封闭法牙槽嵴裂修复术后患者9例(10侧)及正常颊粘膜、正常牙龈粘膜对照组各10例。测量牙槽嵴裂患者术后患侧尖牙的龈沟深度并与正常人进行对照，拍摄上颌前部(牙合)片和测量其牙槽嵴高度。分别切取上颌尖牙唇侧附着龈位置粘膜组织(病例组和正常牙龈粘膜对照组)、上颌第1前磨牙相对处颊粘膜(正常颊粘膜对照组)并测量其龈沟深度。标本制成石蜡切片后行HE染色，显微镜下观察形态特点。数据进行相应的统计学分析。
结果：(1)颊粘膜瓣封闭法牙槽嵴裂修复术后患者裂隙处软组织形态与正常对照组相比存在差异；(2)与正常对照组相比，其龈沟深度没有显著性差异；(3)本实验中所有患者植骨结果均为临床成功，可以排除手术失败对观察结果的影响；(4)与正常颊粘膜相比，移植颊粘膜瓣上皮出现角化层，上皮钉突较长而且数量增多，但与正常牙龈相比钉突长度和排列不规则，且数量较少。
结论：(1)颊粘膜瓣可以作为宽的牙槽嵴裂植骨时封闭裂隙的软组织来源；(2)移植的颊粘膜瓣随移植时间推移可以演变为类似正常牙龈粘膜的组织结构；(3)颊粘膜瓣封闭法牙槽嵴裂植骨术后，裂隙侧尖牙可以从牙槽嵴中萌出，萌出的牙齿具有牙周结构和龈沟，有近似牙龈的组织形态结构。
Objective: The purpose of this study was to investigate the morphologic changes of soft tissue after alveolar cleft repair with buccal mucosal flap closure and compare the differences and similarities of transplanted buccal mucosa (TBM) with normal buccal mucosa (NBM) and normal attached gingival mucosa (NGM) respectively, and to explore whether TBM can form normal periodontal structures postoperatively or not and its morphological features.
Methods: 10 samples of 9 patients who had undergone alveolar cleft (AC) repair with buccal mucosal flap closure in the Department of Stomatology, Xiangya Hospital of Central South University, and 10 controls of normal buccal and gingival mucosa each were recruited. Probing depth of the canine gingival sulcus in the cleft side was measured and compared with normal controls. An anterior maxillary occlusal X-ray film of each patient was taken and the alveolar height of the cleft was recorded. Labial attached gingival mucosa of maxillary canine (TBM and NGM group) and buccal mucosa opposite to the 1st premolar (NBM group) were harvested, then formalin-fixed and paraffin-embedded (FFPE). Paraffin-embedded tissue samples were sectioned and hematoxylin-eosin stained, and light microscope (LM) was utilized to determine histomorphologic changes.
Results: (1)Soft tissue overview differences existed between patients after AC repair and normal controls. (2)The depth of canine gingival sulcus was of no significant differences between subjects who had undergone alveolar cleft repair with buccal mucosal flap closure and normal controls. (3)All patients recruited in the experiment demonstrated successful bone grafting results so odds caused by this matter can be excluded. (4)There was a cuticular layer in the epithelium of the transplanted flap buccal mucosa like normal gingival mucosa, when compared with normal buccal mucosa. The rete pegs in the epithelium of TBM were longer than normal buccal mucosa, and larger in quantity. But they were shorter in length, less regular in arrangement and smaller in quantity when compared with normal gingival mucosa.
Conclusion: (1) Buccal mucosal flap is a proper source for soft tissue coverage in wide cleft alveolus bone grafting. (2) The transplanted buccal mucosal flap can gradually develop into a structure similar to normal gingiva postoperatively as time lasts. (3) Canines can erupt in the impaired side after alveolar bone grafting with buccal mucosal flap closure and possess approximately normal gingival sulci and periodontal structures.
引文
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