Costa Ana Isabel, Morgado Hélder, Mariz Carlos, Estevão-Costa José Manuel
Faculdade de Medicina. Universidade do Porto. Porto.
Serviço de Cirurgia Pediátrica. Centro Hospitalar São João. Porto.
Acta Med Port. 2016 Mar;29(3):210-6. doi: 10.20344/amp.6418. Epub 2016 Mar 31.
Orofacial clefts are the most frequent craniofacial birth defects. In the presence of bone defect, the secondary alveolar bone grafting is the correction method most commonly accepted by clinicians. This study evaluates the result of this technique in a tertiary hospital.
Analysis of the secondary alveolar bone grafting performed between 2007 and 2014, with inclusion of cases in which the iliac crest was the donor site for the graft and the clinical and imaging information was complete. The success of the intervention was assessed radiographically using the Bergland scale (type I-IV) and correlated to variables associated with pathology and/or surgical correction.
Of the 32 secondary alveolar bone grafting performed, 29 met the inclusion criteria: 13 cases (44.8%) corresponded to complete unilateral pre-foramen clefts; four (13.8%) to complete bilateral pre-foramen clefts; eight (27.6%) to transforamen unilateral clefts and four (13.8%) to bilateral transforamen clefts. According to the scale of Bergland (applied with a mean follow-up of 8 ± 5 months) six were classified as type I, 15 as type II, five as type III and three as type IV. No association was found between the effectiveness of the surgery and the type of orofacial clefts, the presence of the incisor and the canine eruption phase. Five patients were re-operated (three of type II and two of type III at baseline).
In this series, the secondary alveolar bone grafting was effective in most patients (72% type I and II) regardless of the type of orofacial clefts. The relatively high proportion of failures (10.3%) and subsequent need for re-intervention (17%) justify long-term follow up and the continuation of this study.
It is important to highlight the multidisciplinary involvement in order to identify previously the ideal timing for each intervention and to optimize results.
口面部裂隙是最常见的颅面先天性缺陷。在存在骨缺损的情况下，二期牙槽骨植骨是临床医生最常接受的矫正方法。本研究评估了该技术在一家三级医院的治疗效果。
分析2007年至2014年间进行的二期牙槽骨植骨情况，纳入以髂嵴为植骨供区且临床和影像资料完整的病例。采用Bergland量表（I-IV型）通过影像学评估干预的成功率，并与病理和/或手术矫正相关变量进行关联分析。
在进行的32例二期牙槽骨植骨中，29例符合纳入标准：13例（44.8%）为完全性单侧孔前腭裂；4例（13.8%）为完全性双侧孔前腭裂；8例（27.6%）为单侧经孔腭裂；4例（13.8%）为双侧经孔腭裂。根据Bergland量表（平均随访8±5个月），6例为I型，15例为II型，5例为III型，3例为IV型。未发现手术效果与口面部裂隙类型、切牙存在情况及尖牙萌出阶段之间存在关联。5例患者接受了再次手术（基线时3例II型和2例III型）。
在本系列研究中，无论口面部裂隙类型如何，二期牙槽骨植骨对大多数患者（72%为I型和II型）有效。相对较高的失败比例（10.3%）以及随后再次干预的需求（17%）证明了长期随访和本研究继续进行的必要性。
强调多学科参与很重要，以便预先确定每次干预的理想时机并优化治疗效果。
