Hirano A, Suzuki H
Department of Plastic and Reconstructive Surgery, Nagasaki University School of Medicine, Japan.
Cleft Palate Craniofac J. 2001 Jan;38(1):1-10. doi: 10.1597/1545-1569_2001_038_0001_frtral_2.0.co_2.
To identify factors associated with relapse after maxillary advancement in cleft lip and palate patient.
Seventy-one cleft lip and palate patients underwent Le Fort I maxillary advancement osteotomy between 1988 and 1998, and 58 patients (42 unilateral cleft and 16 bilateral cleft) with complete data were investigated for relapse by clinical and cephalometric analysis. The clinical follow-up period ranged from 1.5 to 8.5 years (mean 2.5 years).
Horizontal advancement averaged 6.9 mm. There was a significant correlation between surgical movement and postoperative relapse in both the horizontal and vertical planes. In vertical repositioning, 15 patients had maxillary intrusion and 31 had inferior repositioning. There was a significant difference between the intrusion group and the inferior repositioning group. There was a significant correlation between surgical and postoperative rotation regardless of the direction. Other factors were evaluated by the horizontal relapse rate. Type of cleft and the rate of relapse were statistically associated. A relapse was more likely to occur in patients with bilateral cleft. There were no significant associations with the rate of relapse in type of operations or previous alveolar bone grafting. There was no significant correlation between the rate of relapse and the number of missing anterior teeth, postoperative overbite and overjet, and age at operation. Four of 71 patients experienced major relapse, and 3 of them underwent jaw surgery again.
Based on clinical and cephalometric analysis, two-jaw surgery should be performed in cases of severe maxillary hypoplasia, and overcorrection may be useful in inferior repositioning or surgical rotation. Special attention should be paid to the patient with bilateral cleft, multiple missing teeth, or shallow postoperative overbite.
确定唇腭裂患者上颌前徙术后复发的相关因素。
1988年至1998年间，71例唇腭裂患者接受了Le Fort I型上颌前徙截骨术，对其中58例（42例单侧唇腭裂和16例双侧唇腭裂）有完整数据的患者进行了临床和头影测量分析以评估复发情况。临床随访期为1.5至8.5年（平均2.5年）。
水平前徙平均为6.9毫米。手术移动与术后在水平和垂直平面上的复发之间存在显著相关性。在垂直复位方面，15例患者上颌骨有后缩，31例有向下复位。后缩组和向下复位组之间存在显著差异。无论方向如何，手术与术后旋转之间存在显著相关性。通过水平复发率评估其他因素。腭裂类型与复发率在统计学上相关。双侧唇腭裂患者更易复发。手术类型或既往牙槽骨植骨与复发率无显著相关性。复发率与缺失前牙数量、术后覆合覆盖及手术年龄之间无显著相关性。71例患者中有4例出现严重复发，其中3例再次接受颌骨手术。
基于临床和头影测量分析，对于严重上颌骨发育不全的病例应行双颌手术，对于向下复位或手术旋转，过度矫正可能有效。应特别关注双侧唇腭裂、多颗牙齿缺失或术后覆合浅的患者。
