Anastassov G E, Joos U
Department of Maxillofacial Surgery, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, NY 11737, USA.
J Oral Maxillofac Surg. 2001 Sep;59(9):1062-75; discussion 1075-7. doi: 10.1053/joms.2001.25852.
The controversy regarding the timing of repair of the deformities associated with cleft lip and palate still exists. The goal of this article is to present a versatile, universal philosophy of management of these deformities involving early repair.
Over 20 years, 2,698 new patients with cleft lip and palate deformities were treated. These included 1,298 unilateral and 320 bilateral cleft lip and palate patients. The remaining patients (1,018) had isolated palatal clefts. All patients were operated according to the same protocol and the same surgical procedure. The treatment philosophy was based on early, wide myoperiosteal-periosteo-sutural reconstruction by a modified Delaire functional cheilorhinoplasty and alveolar gingivoperiosteoplasty at 3 months, followed by soft and hard functional palatoplasty at 9 months.
All patients were followed longitudinally and retrospectively. The parameters investigated were facial symmetry, presence or absence of growth retardation, and oropharyngeal and nasal function. The parameters studied indicated that when this treatment schedule was followed and the procedures were performed on time and according to the protocol, there was minimal growth retardation of the maxilla. When early gingivoperiosteoplasty was performed in 25% of the patients there was a sufficient amount of alveolar bone for eruption of the primary and permanent dentition. This negated the need for secondary alveolar bone grafting. The development of the upper lip was harmonious, and usually no further corrective procedures were necessary. The nose was usually well developed and functionally normal.
Optimal rehabilitation of the patients was achieved by following the principles and treatment strategies described. If the treatment principles are not incorporated in the functional repair (ie, joining of the primary and the secondary growth centers during corrective procedures), compromised results are to be expected.
唇腭裂相关畸形修复时机的争议依然存在。本文的目的是提出一种涉及早期修复的、通用的唇腭裂畸形处理理念。
在20多年间，共治疗了2698例新的唇腭裂畸形患者。其中包括1298例单侧唇腭裂患者和320例双侧唇腭裂患者。其余患者（1018例）为单纯腭裂患者。所有患者均按照相同的方案和相同的手术步骤进行手术。治疗理念基于在3个月时通过改良的德莱尔功能性唇鼻成形术和牙槽嵴牙龈骨膜成形术进行早期、广泛的肌骨膜-骨膜-缝线重建，随后在9个月时进行软硬功能性腭裂修复术。
对所有患者进行了纵向和回顾性随访。所研究的参数包括面部对称性、生长发育迟缓的有无以及口咽和鼻腔功能。研究参数表明，当遵循该治疗方案并按时按规程进行手术时，上颌骨的生长发育迟缓最小。当25%的患者早期进行牙龈骨膜成形术时，有足够的牙槽骨供乳牙和恒牙萌出。这消除了二次牙槽骨植骨的必要性。上唇发育协调，通常无需进一步的矫正手术。鼻子通常发育良好且功能正常。
遵循所述的原则和治疗策略可实现患者的最佳康复。如果在功能性修复中不纳入治疗原则（即矫正手术期间连接原发和继发生长中心），则预期会出现不理想的结果。
