唇腭裂术前鼻牙槽塑形：数字化设计模具的应用
Presurgical nasoalveolar molding for cleft lip and palate: the application of digitally designed molds.
作者信息
Shen Congcong, Yao Caroline A, Magee William, Chai Gang, Zhang Yan
机构信息
Shanghai, China; and Los Angeles, Calif. From the Department of Plastic and Reconstructive Surgery, 9th People's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine; and Division of Plastic and Reconstructive Surgery, University of Southern California Keck School of Medicine.
出版信息
Plast Reconstr Surg. 2015 Jun;135(6):1007e-1015e. doi: 10.1097/PRS.0000000000001286.
BACKGROUND
The authors present a novel nasoalveolar molding protocol by prefabricating sets of nasoalveolar molding appliances using three-dimensional technology.
METHODS
Prospectively, 17 infants with unilateral complete cleft lip and palate underwent the authors' protocol before primary cheiloplasty. An initial nasoalveolar molding appliance was created based on the patient's first and only in-person maxillary cast, produced from a traditional intraoral dental impression. Thereafter, each patient's molding course was simulated using computer software that aimed to narrow the alveolar gap by 1 mm each week by rotating the greater alveolar segment. A maxillary cast of each predicted molding stage was created using three-dimensional printing. Subsequent appliances were constructed in advance, based on the series of computer-generated casts. Each patient had a total three clinic visits spaced 1 month apart. Anthropometric measurements and bony segment volumes were recorded before and after treatment.
RESULTS
Alveolar cleft widths narrowed significantly (p < 0.01), soft-tissue volume of each segment expanded (p < 0.01), and the arc of the alveolus became more contiguous across the cleft (p < 0.01). One patient required a new appliance at the second visit because of bleeding and discomfort. Eleven patients had mucosal irritation and two experienced minor mucosal ulceration.
CONCLUSIONS
Three-dimensional technology can precisely represent anatomic structures in pediatric clefts. Results from the authors' algorithm are equivalent to those of traditional nasoalveolar molding therapies; however, the number of required clinic visits and appliance adjustments decreased. As three-dimensional technology costs decrease, multidisciplinary teams may design customized nasoalveolar molding treatment with improved efficiency and less burden to medical staff, patients, and families.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
作者提出了一种新颖的鼻牙槽塑形方案，即使用三维技术预制鼻牙槽塑形矫治器套装。
方法
前瞻性地，17名单侧完全性唇腭裂婴儿在初次唇裂修复术前接受了作者的方案。基于患者通过传统口腔内牙印模制作的首个也是唯一的上颌石膏模型，制作初始鼻牙槽塑形矫治器。此后，使用计算机软件模拟每位患者的塑形过程，该软件旨在通过旋转较大牙槽段每周将牙槽间隙缩小1毫米。使用三维打印制作每个预测塑形阶段的上颌石膏模型。后续矫治器根据一系列计算机生成的石膏模型提前制作。每位患者共进行3次门诊就诊，间隔1个月。记录治疗前后的人体测量数据和骨段体积。
结果
牙槽裂宽度显著变窄（p < 0.01），各段软组织体积增大（p < 0.01），牙槽弓在裂隙处变得更连续（p < 0.01）。1名患者在第二次就诊时因出血和不适需要更换新的矫治器。11名患者出现黏膜刺激，2名患者出现轻微黏膜溃疡。
结论
三维技术可以精确呈现小儿腭裂的解剖结构。作者算法的结果与传统鼻牙槽塑形疗法相当；然而，所需的门诊就诊次数和矫治器调整次数减少了。随着三维技术成本的降低，多学科团队可以设计定制的鼻牙槽塑形治疗方案，提高效率，减轻医护人员、患者及其家庭的负担。
临床问题/证据水平：治疗性，IV级。
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