Department of Oral and Maxillofacial Plastic Surgery, Rostock University Hospitals, Rostock, Germany.
J Craniomaxillofac Surg. 2013 Jan;41(1):62-70. doi: 10.1016/j.jcms.2012.05.013. Epub 2012 Jul 12.
Speech development is of utmost importance and requires early closure of a palatal cleft. On the other hand, it is well known that all types and timings of surgical repair of facial clefts are detrimental to maxillary growth. Nevertheless, these days one is more and more confronted with a world-wide tendency in favour of the one-in-all operation to close clefts of the lip, alveolus, and palate. Therefore, a three-centre study was performed for testing - once more - the value of two-stage palatoplasty as a means to reduce the detrimental effects of surgery on palatal growth and at the same time to also enable early speech development.
Plaster casts from 85 patients have been re-evaluated. All of them had a complete unilateral cleft of lip, alveolus, and palate. They had been treated according to the old therapy protocols followed in either one of the three different cleft centres many years ago, namely in Hamburg, (Western) Germany, Iowa City, IO, USA, and Rostock, (in those days still Eastern) Germany. The impressions had been taken already in 1987 from patients being either 8 years (36 pts.) or 16 years of age (49 pts.). Three different treatment protocols had been followed for these patients in those centres in those days: The main difference was that in centres A and B the palates were closed in two stages whilst in centre C palatoplasty was performed in just one operation.
The most interesting results regarding the palatal growth were that: 1. In centre C (one-stage palatoplasty) the patients had more constricted palates. 2. In centre A (two-stage palatoplasty) the patients had least often an anterior cross-bite.
It appears that it was possible to show once more that closing the palate in one stage at age 1 year or less is interfering most with maxillary growth. This study leads us to conclude that two-stage palatoplasty is still a valuable treatment protocol for patients with a complete unilateral cleft of lip, alveolus, and palate, especially as apparently good guidance of speech development can lead to satisfactory speech for cleft patients in whom the hard palate was closed at a later age.
言语发展至关重要，需要尽早关闭腭裂。另一方面，众所周知，所有类型和时间的面部裂隙修复手术都不利于上颌骨生长。然而，如今人们越来越面临着一种在全球范围内倾向于一次性手术关闭唇裂、牙槽裂和腭裂的趋势。因此，进行了一项三中心研究，再次测试两阶段腭裂修复术作为减少手术对上颌生长的不利影响的方法，同时也使早期言语发展成为可能。
对 85 名患者的石膏模型进行了重新评估。他们均患有单侧完全唇裂、牙槽裂和腭裂。他们根据多年前在三个不同的裂隙中心之一遵循的旧治疗方案进行治疗，即德国汉堡、美国爱荷华市和德国罗斯托克（当时仍为东德）。这些印模是在 1987 年从年龄分别为 8 岁（36 例）和 16 岁（49 例）的患者中获得的。这些患者在当时的中心遵循了三种不同的治疗方案：主要区别在于，中心 A 和 B 的腭裂分两阶段关闭，而中心 C 的腭裂则在一个手术中完成。
关于腭部生长的最有趣的结果是：1. 在中心 C（一次性腭裂修复术）中，患者的腭部更为狭窄。2. 在中心 A（两阶段腭裂修复术）中，患者最常发生的是前交叉咬合。
似乎再次证明，在 1 岁或更小年龄时一次性关闭腭裂最干扰上颌骨生长。这项研究使我们得出结论，两阶段腭裂修复术仍然是完全单侧唇裂、牙槽裂和腭裂患者的有价值的治疗方案，特别是因为良好的言语指导似乎可以使腭裂患者的言语发育良好，而这些患者的硬腭在较晚的年龄才被关闭。
