Geraedts C T M, Borstlap W A, Groenewoud J M M, Borstlap-Engels V M F, Stoelinga P J W
Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Int J Oral Maxillofac Surg. 2007 Sep;36(9):788-96. doi: 10.1016/j.ijom.2007.04.010. Epub 2007 Jul 6.
The aim of this retrospective, mixed longitudinal study was to assess the long-term outcome of early secondary closure and premaxilla osteotomy in 40 bilateral cleft lip and palate patients who underwent early secondary osteotomy of the premaxilla and bone grafting at the age of 8-12 years. Clinical and cephalometric evaluations of profile, lip relation, nasolabial angle and position of the maxilla preoperatively, postoperatively and at adolescence were compared to normal values of non-cleft individuals and the reported data of 90 bilateral cleft lip and palate patients treated in Oslo. In 68% of patients the profile was considered acceptable, but in 26 maxillary growth appeared to be impaired by cephalometric standards. In four patients a Le Fort I osteotomy was carried out and nine patients would have benefited from such a procedure. This study reveals a trend towards maxillary growth retardation partially compensated by orthodontic and dental treatment. Since the results are comparable to those reported for the Oslo group with regard to maxillary growth, the surgical protocol followed does not require revision. Considering the benefits, i.e. closure of alveolo-palatal cleft, continuity of dental arch, eruption of canine in the graft and closure of oro-nasal communications, this mode of treatment should be continued.
这项回顾性混合纵向研究的目的是评估40例双侧唇腭裂患者早期二期关闭和前颌骨截骨术的长期效果，这些患者在8至12岁时接受了早期前颌骨二期截骨术和植骨术。将术前、术后及青春期时的侧面轮廓、唇部关系、鼻唇角和上颌位置的临床及头影测量评估结果与非腭裂个体的正常值以及在奥斯陆接受治疗的90例双侧唇腭裂患者的报告数据进行比较。68%的患者侧面轮廓被认为可接受，但根据头影测量标准，26例患者的上颌生长似乎受到了影响。4例患者接受了Le Fort I截骨术，9例患者本可从该手术中获益。这项研究揭示了上颌生长发育迟缓的趋势，不过可通过正畸和牙科治疗得到部分补偿。由于在上颌生长方面的结果与奥斯陆组报告的结果相当，因此所遵循的手术方案无需修订。考虑到其益处，即牙槽腭裂的关闭、牙弓的连续性、植骨区尖牙的萌出以及口鼻通道的闭合，这种治疗方式应继续采用。
