Seo Jihee, Kim Sukwha, Yang Il-Hyung, Baek Seung-Hak
*Department of Orthodontics, School of Dentistry †Department of Plastic Surgery, College of Medicine, Seoul National University ‡Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.
J Craniofac Surg. 2015 Oct;26(7):2128-32. doi: 10.1097/SCS.0000000000002133.
The purpose of this study was to investigate the effect of secondary alveolar bone grafting (SABG) on the maxillary growth in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP). The samples consisted of 40 Korean boy cleft patients who had the similar initial skeletal characteristics and were treated with the identical treatment protocol. They were divided into UCLP group (N = 25; mean SABG age, 9.9 years; mean follow-up duration, 42.3 months) and BCLP group (N = 15; mean SABG age, 10.2 years; mean follow-up duration, 40.6 months). In the lateral cephalograms taken 1 month before (T1) and at least 2 years after SABG (T2), cephalometric variables were measured. At T1 stage, the 2 groups did not exhibit significant differences in the cephalometric variables except posterior maxillary height (P-HRP) (P < 0.05). At T2 stage, both groups exhibited the reduced sagittal growth (UCLP, ANB, P < 0.001; AB to facial plane angle (AB-FPA), P < 0.01; BCLP, A to N perpendicular, P < 0.05; ANB and AB-FPA, P < 0.001) and the undisturbed vertical growth (A-HRP and P-HRP, all P < 0.001) of the maxilla. During T1 to T2, BCLP group experienced more aggravation of Class III skeletal pattern than UCLP group (ΔAB-FPA, P < 0.05). There, however, were no differences in the amounts of changes in the maxillary vertical position and mandibular plane angulation between the 2 groups. Two-stage SABG procedure subgroup in patients with BCLP demonstrated a more retrusive maxilla compared with 1-stage SABG procedure subgroup (ΔSNA, P < 0.05). Patients with BCLP, especially who underwent 2-stage SABG procedure, might have a possibility of poor sagittal growth of the maxilla compared with patients having UCLP.
本研究的目的是调查二期牙槽骨植骨术（SABG）对单侧唇腭裂（UCLP）和双侧唇腭裂（BCLP）患者上颌骨生长的影响。样本包括40名韩国腭裂男童患者，他们具有相似的初始骨骼特征，并采用相同的治疗方案进行治疗。他们被分为UCLP组（N = 25；平均SABG年龄9.9岁；平均随访时间42.3个月）和BCLP组（N = 15；平均SABG年龄10.2岁；平均随访时间40.6个月）。在SABG术前1个月（T1）和术后至少2年（T2）拍摄的头颅侧位片中，测量头影测量变量。在T1阶段，除上颌后份高度（P-HRP）外，两组在头影测量变量上无显著差异（P < 0.05）。在T2阶段，两组上颌骨矢状向生长均减少（UCLP组，ANB，P < 0.001；AB与面平面角（AB-FPA），P < 0.01；BCLP组，A到N垂线，P < 0.05；ANB和AB-FPA，P < 0.001），垂直向生长未受干扰（A-HRP和P-HRP，均P < 0.001）。在T1至T2期间，BCLP组比UCLP组Ⅲ类骨骼型加重更明显（ΔAB-FPA，P < 0.05）。然而，两组在上颌垂直位置和下颌平面角度变化量上没有差异。与一期SABG手术亚组相比，BCLP患者的二期SABG手术亚组上颌骨更后缩（ΔSNA，P < 0.05）。与UCLP患者相比，BCLP患者，尤其是接受二期SABG手术的患者，上颌骨矢状向生长可能较差。
