Dissaux Caroline, Grollemund Bruno, Bodin Frédéric, Picard Arnaud, Vazquez Marie-Paule, Morand Béatrice, James Isabelle, Kauffmann Isabelle, Bruant-Rodier Catherine
Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'Hôpital Civil, 67091 Strasbourg, France.
Maxillofacial and Plastic Surgery Department (Head: Prof. C. Bruant-Rodier), Cleft Competence Center, Strasbourg University Hospital, 1 place de l'Hôpital Civil, 67091 Strasbourg, France.
J Craniomaxillofac Surg. 2016 Feb;44(2):94-103. doi: 10.1016/j.jcms.2015.08.029. Epub 2015 Sep 5.
Cleft surgery is marked by all the controversies and the multiplication of protocols, as it has been shown by the Eurocleft study. The objective of this pilot study is to start a comparison and analyzing procedure between primary surgical protocols in French centers.
Four French centers with different primary surgical protocols for cleft lip and palate repair, have accepted to be involved in this retrospective study. In each center, 20 consecutive patients with complete cleft lip and palate (10 UCLP, 10 BCLP per center), non syndromic, have been evaluated at a mean age of 5 [range, 4-6]. In this second part, maxillary growth and palatine morphology were assessed on clinical examination and on dental casts (Goslon score). Speech was also evaluated clinically (Borel-maisonny classification) and by Aerophonoscope.
Veau-Wardill-Killner palatoplasty involves a higher rate of transversal maxillary deficiency and retromaxillary. The fistula rate is statistically lower with tibial periosteum graft hard palate closure but this technique seems to give retromaxillary. Malek and Talmant two-stage-palatoplasty techniques reach Goslon scores of 1 or 2. Considering speech, Sommerlad intravelar veloplasty got higher outcomes.
Primary results. Extension to other centers required. The two-stage palatoplasty, including a Sommerlad intravelar veloplasty seems to have the less negative impact on maxillary growth, and to give good speech outcomes.
Therapeutic study. Level III/retrospective multicenter comparative study.
如欧洲腭裂研究所示，腭裂手术存在诸多争议且手术方案不断增加。本初步研究的目的是在法国各中心启动一项针对主要手术方案的比较与分析程序。
四个采用不同唇腭裂一期修复手术方案的法国中心同意参与这项回顾性研究。在每个中心，连续纳入20例非综合征性完全性唇腭裂患者（每个中心10例单侧完全性唇腭裂，10例双侧完全性唇腭裂），平均年龄为5岁[范围4 - 6岁]。在第二部分，通过临床检查和石膏模型（戈斯隆评分）评估上颌骨生长和腭部形态。还通过临床评估（博勒 - 梅索尼分类法）和声门分析仪评估语音。
韦 - 瓦 - 基腭成形术导致上颌横向发育不足和上颌后缩的发生率较高。采用胫骨骨膜移植关闭硬腭时，瘘管发生率在统计学上较低，但该技术似乎会导致上颌后缩。马利克和塔尔芒两阶段腭成形术技术的戈斯隆评分为1或2。在语音方面，索默拉德腭帆内成形术效果更佳。
初步结果。需要扩展至其他中心。包括索默拉德腭帆内成形术的两阶段腭成形术似乎对上颌生长的负面影响最小，并能带来良好的语音效果。
治疗性研究。III级/回顾性多中心比较研究。
