Taipei and Taoyuan, Taiwan From the Craniofacial Center, Chang-Gung Memorial Hospital, and the College of Medicine, Chang Gung University.
Plast Reconstr Surg. 2010 May;125(5):1503-1510. doi: 10.1097/PRS.0b013e3181d5132a.
Two-stage palate repair with delayed hard palate closure is generally advocated because it allows the best possible postoperative maxillary growth. Nevertheless, in the literature, it has been questioned whether maxillary growth is better following use of this protocol. The authors therefore aimed to investigate whether stage of palate repair, one-stage versus two-stage, had a significant effect on facial growth in patients with unilateral cleft lip and palate.
Seventy-two patients with nonsyndromic complete unilateral cleft lip and palate operated on by two different protocols for palate repair, one-stage versus two-stage with delayed hard palate closure, and their 223 cephalometric radiographs were available in the retrospective longitudinal study. Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. Generalized estimating equations analysis was performed to assess the relationship between (1) facial morphology at age 20 and (2) facial growth rate, and the stage of palate repair.
Stage of palate repair had a significant effect on the length and protrusion of the maxilla and the anteroposterior jaw relation at age 20, but not on their growth rates.
The data suggest that in patients with unilateral cleft lip and palate, two-stage palate repair has a smaller adverse effect than one-stage palate repair on the growth of the maxilla. This stage effect is on the anteroposterior development of the maxilla and is attributable to the development being undisturbed before closure of the hard palate (i.e., hard palate repair timing specific).
两阶段腭裂修复术伴硬腭裂延迟关闭通常被提倡，因为它可以实现术后上颌最佳的生长。然而，文献中质疑使用该方案是否能更好地促进上颌生长。因此，作者旨在研究腭裂修复术的阶段，即一期修复与两阶段修复伴硬腭裂延迟关闭，是否对上颌裂患者的面部生长有显著影响。
72 例非综合征性完全单侧唇腭裂患者，采用两种不同的腭裂修复术方案进行手术，即一期修复术与两阶段修复术伴硬腭裂延迟关闭术，对其 223 张头颅侧位片进行回顾性纵向研究。回顾临床记录以记录治疗史。通过头影测量法确定面部形态和生长速度。采用广义估计方程分析评估（1）20 岁时的面部形态和（2）面部生长速度与腭裂修复术阶段之间的关系。
腭裂修复术阶段对上颌的长度和突出度以及下颌的前后向颌关系有显著影响，但对上颌的生长速度没有影响。
数据表明，在单侧唇腭裂患者中，两阶段腭裂修复术对上颌生长的不良影响小于一期腭裂修复术。这种阶段效应主要表现在上颌的前后向发育上，这归因于硬腭裂关闭前（即硬腭裂修复时机）上颌发育不受干扰。
