Stein Silke, Dunsche Anton, Gellrich Nils-Claudius, Härle Franz, Jonas Irmtrud
Department of Orthodontics, University of Freiburg, Germany.
Cleft Palate Craniofac J. 2007 Jan;44(1):13-22. doi: 10.1597/05-160.
To assess facial growth and dentoalveolar development in two groups of patients with complete unilateral cleft lip and palate. Primary surgical treatment differed in the timing of hard palate closure.
Forty-three patients with unilateral cleft lip and palate were examined. Twenty-two patients underwent early one-stage closure of the hard and soft palate cleft (mean age 23.0 +/- 4.7 months); in 21 patients, the hard palate closure was delayed to 86.3 +/- 39.2 months of age. Lateral cephalograms and dental casts were consecutively analyzed at four stages between 6 and 18 years of age.
Lateral cephalometric analysis revealed no significant intergroup differences in the sagittal and vertical craniofacial dimensions at any time. Dental cast analysis showed constriction of the upper anterior arch width at the ages of 6 and 10 years in patients with one-stage surgical palate closure, but a difference could no longer be verified at the ages of 15 and 18 years.
The transverse distances in the upper jaw developed initially more positively in the group with delayed hard palate closure, but it became apparent later that the transverse deficiency after one-stage palate closure could be compensated for. When considering surgical treatment in general, the advantages of the delayed hard palate closure must be weighed against criteria favoring the early one-stage closure of the hard and soft palate.
评估两组完全性单侧唇腭裂患者的面部生长及牙牙槽发育情况。初次手术治疗在硬腭关闭时间上存在差异。
对43例单侧唇腭裂患者进行检查。22例患者接受早期硬腭和软腭裂一期关闭术（平均年龄23.0±4.7个月）；21例患者的硬腭关闭延迟至86.3±39.2个月龄。在6至18岁之间的四个阶段连续分析头颅侧位片和石膏模型。
头颅侧位片分析显示，在任何时间，矢状和垂直颅面尺寸方面两组间均无显著差异。石膏模型分析显示，一期手术关闭腭部的患者在6岁和10岁时上颌前牙弓宽度变窄，但在15岁和18岁时差异不再明显。
硬腭关闭延迟组上颌的横向距离最初发育得更积极，但后来明显发现一期腭部关闭后的横向不足可以得到补偿。在总体考虑手术治疗时，必须权衡硬腭关闭延迟的优点与支持早期硬腭和软腭一期关闭的标准。
