Kumar Anand, Gabbay Joubin S, Nikjoo Rabin, Heller Justin B, O'Hara Catherine M, Sisodia Manisha, Garri J I, Wilson Libby S, Kawamoto Henry K, Bradley James P
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California, USA.
Plast Reconstr Surg. 2006 Apr 15;117(5):1499-509. doi: 10.1097/01.prs.0000206308.86089.86.
BACKGROUND: Correction of severe maxillary deficiency in cleft lip-cleft palate patients often results in undercorrection, relapse, and need for secondary corrective procedures. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients. METHODS: Patients with cleft lip-cleft palate deformities and maxillary deficiency were divided into three groups treated by Le Fort I advancement: group 1, mild to moderate deficiency (< 10 mm) with conventional orthognathic procedure; group 2, severe deficiency (> or = 10 mm) with conventional orthognathic procedure; and group 3, distraction procedure for severe deficiency (> or = 10 mm) (n = 51). Preoperative, postoperative, and follow-up (> 1 year) lateral cephalogram measurements were compared including angular (SNA and SNB) and linear (Deltax = horizontal and Deltay = vertical) changes. The Pittsburgh Speech Score was used to assess for velopharyngeal insufficiency (score > 3). RESULTS: Results demonstrated that group 1 patients had a mean SNA change from preoperatively (78.7) to postoperatively (83.8), and a horizontal change of 5.0 mm, with no relapse. Group 2 patients had a mean SNA change from preoperatively (76.3) to postoperatively (82.0) and a horizontal change of 7.2 mm, with 63 percent relapse. Group 3 patients had a mean SNA change from preoperatively (74.1) to postoperatively (84.9) and a horizontal change of 16.5 mm, with 15 percent relapse. Thus, for severe maxillary deficiency, the distraction group had 48 percent less relapse than the conventional Le Fort I group. Postoperative speech evaluation showed velopharyngeal insufficiency in the following: group 1, four of 20 patients (20 percent); group 2, nine of 11 patients (82 percent); and group 3, nine of 20 patients (45 percent). CONCLUSION: These data suggest that Le Fort I internal distraction for severe cleft maxillary deficiency leads to better dental occlusion, less relapse, and better speech results.
背景：唇腭裂患者严重上颌骨缺损的矫正常导致矫正不足、复发以及需要二次矫正手术。勒福 I 型内牵张成骨术为一次性正颌前徙术提供了一种替代方法，具有通过瘢痕逐渐延长以及对生长发育期患者进行早期治疗的优势。 方法：唇腭裂畸形和上颌骨缺损患者被分为三组，接受勒福 I 型前徙术治疗：第 1 组，轻度至中度缺损（<10 毫米），采用传统正颌手术；第 2 组，严重缺损（≥10 毫米），采用传统正颌手术；第 3 组，严重缺损（≥10 毫米）采用牵张手术（n = 51）。比较术前、术后及随访（>1 年）的头颅侧位片测量结果，包括角度（SNA 和 SNB）和线性（Δx = 水平方向和 Δy = 垂直方向）变化。采用匹兹堡语音评分评估腭咽闭合不全（评分>3）。 结果：结果表明，第 1 组患者术前平均 SNA 为 78.7，术后为 83.8，水平变化为 5.0 毫米，无复发。第 2 组患者术前平均 SNA 为 76.3，术后为 82.0，水平变化为 7.2 毫米，复发率为 63%。第 3 组患者术前平均 SNA 为 74.1，术后为 84.9，水平变化为 16.5 毫米，复发率为 15%。因此，对于严重上颌骨缺损，牵张组的复发率比传统勒福 I 型组低 48%。术后语音评估显示腭咽闭合不全情况如下：第 1 组，20 例患者中有 4 例（20%）；第 2 组，11 例患者中有 9 例（82%）；第 3 组，20 例患者中有 9 例（45%）。 结论：这些数据表明，勒福 I 型内牵张术治疗严重腭裂上颌骨缺损可获得更好的牙合关系、更少的复发以及更好的语音效果。
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