Painatt Jaeson M, Veeraraghavan Ravi, Puthalath Ushass, Peter Sherry, Rao Latha P, Kuriakose Maria
Department of Oral & Maxillofacial Surgery, Amrita School of Dentistry, Amrita University, Kochi, Kerala, India.
Department of Craniofacial Surgery, Aster Medcity, Kochi, Kerala, India.
Contemp Clin Dent. 2017 Apr-Jun;8(2):236-243. doi: 10.4103/ccd.ccd_1164_16.
The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result.
Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin.
Wilcoxon Signed-Ranks test was used, and the probability value ( value) of 0.05 was considered as statistically significant level.
Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm ( < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° ( < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm ( < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm ( < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable.
The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%-40% for adult CLP patients.
本研究的目的是分析成年唇腭裂（CLP）患者使用坚固外固定牵张成骨装置进行牵张成骨（DO）后软硬组织轮廓变化以及上气道变化。本研究还评估手术结果的稳定性。
拍摄三张头颅侧位片：牵张前（T1）、牵张后（T2）以及去除牵张器1年后（T3）。分析治疗变化（T1与T2）和稳定性（T2与T3）。还评估1年后的总体治疗变化（T1与T3）。借助名为Dolphin的软件对头颅侧位片进行数字化分析。
采用Wilcoxon符号秩检验，概率值（P值）0.05被视为具有统计学意义。
对11例成年CLP患者进行回顾性分析。牵张后，平均上颌显著前移14mm（P<0.01），从T1值73.54±10.38变为T2值88.2±10.49。面下高度和切牙暴露显著增加。鼻唇角从T1值56.6±21.03显著改善24.5°（P<0.01）至T2值81.18±14.4。上气道显著改善3.7mm（P<0.01），从T1值13.5±3.8变为T2值17.2±3.66。1年随访后，上颌显著复发3.20mm（P<0.05），从T2值8.29±6.84变为T3值5.09±5.59。然而，软组织轮廓和上气道保持稳定。
临床医生应了解相关软硬组织以及气道变化，这在为成年唇腭裂患者计划上颌前移的DO手术时可能会对其有所帮助。牵张后立即有显著改善，但在1年随访期间出现了一些复发。这强调了成年唇腭裂患者需要约35%-40%的过度矫正。
