腭裂上颌骨牵张成骨对腭帆提肌及腭咽功能的影响。

The effect of cleft maxillary distraction osteogenesis on the levator veli palatini and velopharyngeal function.

作者信息

Chen Philip Kuo-Ting, Por Yong-Chen, Liou Eric Jein-Wein, Chang Frank Chun-Shin

机构信息

*Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan †Cleft and Craniofacial Center, Department of Plastic, Reconstructive and Aesthetic Surgery, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore ‡Department of Orthodontics and Craniofacial Dentistry, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

出版信息

J Craniofac Surg. 2015 May;26(3):687-90. doi: 10.1097/SCS.0000000000001586.

DOI:10.1097/SCS.0000000000001586

PMID:25974774

Abstract

BACKGROUND

Le Fort I maxillary distraction with the rigid external distraction (RED) device is performed to correct severe midface retrusion in cleft patients, but it may adversely affect velopharyngeal function.

OBJECTIVES

This study aims to investigate the angular changes in the levator veli palatini (LVP) and its influence on velopharyngeal function after maxillary distraction using 3-dimensional computed tomography (3D CT) scan volume rendered images.

METHODS

This was a retrospective study of 12 patients. Group 1 had no velopharyngeal function deterioration and group 2 had velopharyngeal function deterioration. Preoperative and 1 year postoperative CT scans were analyzed with Mimics v10 software. Segmentation of the LVP and the nasopharyngeal airway was performed and volumetric images were obtained. Six measurements were made: (1) the angle between the levator plane and the Frankfort horizontal, (2) the angle between the levator plane and the soft palate plane, (3) the angle between the 2 LVP muscles, (4) the pharyngeal depth, and (5, 6) the movement of the inferior pharyngeal point with respect to the horizontal and vertical planes. The independent samples t test, Mann-Whitney test, and paired t tests were used for statistical analyses (P < 0.05).

RESULTS

Group 2 had statistically significant reduction in the angle between the levator plane and Frankfort horizontal as well as the soft palate plane. Group 1 had a statistically significant increase in the pharyngeal depth and movement of the inferior pharyngeal point with respect to the horizontal plane.

CONCLUSION

A decrease in the angle between the levator plane and the Frankfort horizontal or the soft palate plane was associated with velopharyngeal function deterioration.

摘要

背景

采用坚固外部牵张（RED）装置进行勒福Ⅰ型上颌骨牵张，用于矫正腭裂患者严重的面中部后缩，但可能对腭咽功能产生不利影响。

目的

本研究旨在利用三维计算机断层扫描（3D CT）扫描容积再现图像，研究上颌骨牵张后腭帆提肌（LVP）的角度变化及其对腭咽功能的影响。

方法

这是一项对12例患者的回顾性研究。第1组无腭咽功能恶化，第2组有腭咽功能恶化。使用Mimics v10软件分析术前和术后1年的CT扫描图像。对LVP和鼻咽气道进行分割并获得容积图像。进行六项测量：（1）提肌平面与法兰克福水平面之间夹角；（2）提肌平面与软腭平面之间夹角；（3）两侧LVP肌肉之间夹角；（4）咽深度；（5、6）下咽点相对于水平面和垂直面的移动。采用独立样本t检验、曼-惠特尼检验和配对t检验进行统计学分析（P < 0.05）。