Shi Bing, Losee Joseph E
State Key Laboratory of Oral Diseases, Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
University Cleft-Craniofacial Center, Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, USA.
Int J Oral Sci. 2015 Mar 23;7(1):14-7. doi: 10.1038/ijos.2014.59.
Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau's pushback palatoplasty and Langenbeck's palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.
手术矫正是当前团队式腭裂治疗的核心。腭裂外科医生一直关注其手术操作对上颌骨生长的影响。腭裂治疗后，上颌骨发育不全、面中部凹陷和牙弓畸形屡有报道。目前的手术方案很难完全避免这些术后并发症。在本文中，我们讨论了影响腭裂患者颌面生长的因素。这些因素包括术前干预、腭裂和牙槽突修复的时机、手术设计和治疗方案。此外，我们还综述了未手术腭裂患者上颌骨生长的影响。基于以往的研究，我们可以得出结论，大多数学者在这些方面观点一致：早期腭裂修复术会导致上颌骨各维度生长受限；二期牙槽骨植骨对上颌骨矢状向生长无影响；唇裂修复术会抑制唇腭裂患者上颌骨矢状长度；Veau后推腭裂修复术和带松弛切口的Langenbeck腭裂修复术对生长最为不利；Furlow腭裂修复术对上颌骨生长的不利影响较小；硬腭关闭的时机而非硬腭或软腭修复的顺序决定术后生长。不过，学者们在一些问题上仍存在争议观点，例如，未手术腭裂是否具有正常生长潜力、术前干预和咽成形术是否抑制颌面生长。
