Doucet J-C, Herlin C, Bigorre M, Bäumler C, Subsol G, Captier G
Département de Chirurgie Orthopédique et Plastique Pédiatrique, Hôpital Lapeyronie, CHRU Montpellier, France; Department of Oral and Maxillofacial Surgery, Dalhousie University, Halifax, Canada.
Département de Chirurgie Orthopédique et Plastique Pédiatrique, Hôpital Lapeyronie, CHRU Montpellier, France.
Int J Oral Maxillofac Surg. 2014 Jun;43(6):702-7. doi: 10.1016/j.ijom.2014.01.017. Epub 2014 Mar 13.
Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6-12 months postoperative (T1), and ≥ 4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the mandible demonstrated a minimal counter-clockwise rotation of the body (mandibular plane = -0.2 ± 3.2°) and ramus (-0.6 ± 4.3°). Maxillary DO in CLP had no significant effect on the shape or rotation of the mandible. The maxillary advancement remained stable after 1 year.
上颌骨牵张成骨术（DO）是治疗唇腭裂（CLP）患者严重上颌骨发育不足的可靠方法。本研究旨在分析其对下颌骨的长期影响。对24例采用波利和菲格罗亚技术进行上颌骨DO治疗的CLP患者进行回顾性研究；对患者进行了4年以上的随访。评估术前（T0）、术后6 - 12个月（T1）和术后≥4年（T2）的头颅侧位X线片。采用经典的头影测量分析法评估治疗稳定性，采用普洛透斯叠加法评估下颌骨形态的局部变化。患者在T0时的平均年龄为15.4±4.1岁。SNA在T1和T2时增加（P < 0.001），T1和T2之间无明显复发，表明治疗后1年稳定（T0 = 72.4±5.3°；T1 = 81.3±6.2°；T2 = 79.9±6.1°）。SNB、面角、下颌角和颏角保持稳定。下颌骨的长期分析显示，下颌体有轻微逆时针旋转（下颌平面 = -0.2±3.2°），下颌升支有轻微逆时针旋转（-0.6±4.3°）。CLP患者的上颌骨DO对下颌骨的形状或旋转无显著影响。上颌骨前移在1年后保持稳定。
