Hohoff Ariane, Rabe Heike, Ehmer Ulrike, Harms Erik
Poliklinik für Kieferorthopädie, Universitätsklinikum, Westfälische Wilhelms-Universität, Münster, Germany.
Head Face Med. 2005 Oct 28;1:9. doi: 10.1186/1746-160X-1-9.
Well-designed clinical studies on the palatal development in preterm and low birthweight infants are desirable because the literature is characterized by contradictory results. It could be shown that knowledge about 'normal' palatal development is still weak as well (Part 1). The objective of this review is therefore to contribute a fundamental analysis of methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants.
An electronic literature search as well as hand searches were performed based on Cochrane search strategies including sources of more than a century in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered for comparison.
Seventy-eight out of 155 included articles were analyzed for palatal morphology of preterm infants. Intubation, feeding tubes, feeding mode, tube characteristics, restriction of oral functions, kind of diet, cranial form and birthweight were seen as causes contributing to altered palatal morphology. Changes associated with intubation concern length, depth, width, asymmetry, crossbite, and contour of the palate. The phenomenon 'grooving' has also been described as a complication associated with oral intubation. However, this phenomenon suffers from lack of a clear-cut definition. Head flattening, pressure from the oral tube, pathologic or impaired tongue function, and broadening of the alveolar ridges adjacent to the tube have been raised as causes of 'grooving'. Metrically, the palates of intubated preterm infants remain narrower, which has been examined up to the age of the late mixed dentition.
There is no evidence that would justify the exclusion of any of the raised causes contributing to palatal alteration. Thus, early orthodontic and logopedic control of formerly orally intubated preterm infants is recommended, as opposed to non-intubated infants. From the orthodontic point of view, nasal intubation should be favored. The role that palatal protection plates and pressure-dispersing pads for the head have in palatal development remains unclear.
由于现有文献结果相互矛盾，因此需要针对早产儿和低体重儿的腭部发育开展设计完善的临床研究。同时也表明，关于“正常”腭部发育的认知依然薄弱（第一部分）。因此，本综述的目的是对早产儿和低体重儿腭部发育研究的方法、混杂因素及结果进行基础分析。
根据Cochrane检索策略进行电子文献检索及手工检索，检索来源包括一个多世纪以来的英文、德文和法文资料。对主要涉及早产儿和足月儿的研究重新计算原始数据。提取的数据，尤其是非英文文献来源的数据，未经筛选直接提供以供比较。
对155篇纳入文章中的78篇进行了早产儿腭部形态分析。插管、喂食管、喂养方式、导管特性、口腔功能受限、饮食种类、颅骨形态和出生体重被视为导致腭部形态改变的原因。与插管相关的变化涉及腭部的长度、深度、宽度、不对称性、反咬合及轮廓。“沟纹”现象也被描述为与口腔插管相关的并发症。然而，这一现象缺乏明确的定义。头部扁平、口腔导管的压力、病理性或受损的舌功能以及导管附近牙槽嵴变宽被认为是“沟纹”产生的原因。从测量角度来看，插管早产儿的腭部在混合牙列晚期之前一直较窄。
没有证据表明可以排除任何已提出的导致腭部改变的原因。因此，与未插管婴儿相比，建议对曾接受口腔插管的早产儿进行早期正畸和言语治疗控制。从正畸角度来看，应优先选择鼻插管。腭部保护板和头部压力分散垫在腭部发育中的作用尚不清楚。
