Lonic Daniel, Yamaguchi Kazuaki, Chien-Jung Pai Betty, Lo Lun-Jou
Taoyuan, Taiwan; Munich, Germany; and Osaka and Tokyo, Japan.
From the Departments of Plastic and Reconstructive Surgery and Craniofacial Orthodontics and the Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University; MFACE KieferGesichtsZentrum München and HELIOS Hospital Munich West; Shonan Beauty Clinic; and Shonan Medical Memorial Hospital.
Plast Reconstr Surg. 2017 Oct;140(4):568e-578e. doi: 10.1097/PRS.0000000000003696.
Secondary alveolar bone grafting is the gold standard for the treatment of alveolar clefts in cleft lip and palate patients. The authors present a modified method using a Scarpa fascia graft that is placed deep into the mucoperiosteal pocket for watertight sealing of the bone graft chamber and limiting the graft position to the alveolar region for bony stability and tooth support. The outcome was assessed for clinical success in terms of bone graft stability and infection rate.
Seventy-four unilateral complete cleft lip and palate patients were enrolled in this retrospective study consisting of equal-size Scarpa fascia and control groups of consecutive unilateral complete cleft lip and palate patients undergoing secondary alveolar bone grafting. Occlusal radiographs of the alveolar cleft taken at least 1 year postoperatively were evaluated for Spearman correlated Bergland and Witherow scales. Statistical evaluation was conducted using t test, chi-square test, and odds ratio.
The clinical success rate (Bergland types I and II) of the Scarpa fascia procedure was significantly higher (67.6 versus 94.6 percent, respectively), with a significantly lower infection rate (16.2 versus 2.7 percent, respectively) and a high correlation of Bergland and Witherow scales (0.964; p < 0.001). There was no wound dehiscence, fistula, bone graft exposure, or additional donor-site morbidity in the Scarpa fascia group.
The authors' new method of alveolar bone grafting with the Scarpa fascia graft is safe and effective, and has one of the highest documented success rates.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
二期牙槽骨植骨术是治疗唇腭裂患者牙槽裂的金标准。作者提出一种改良方法，使用斯卡帕筋膜移植物，将其置于粘骨膜袋深部，以实现骨移植腔的水密密封，并将移植物位置限制在牙槽区域，以确保骨稳定性和牙齿支撑。根据骨移植稳定性和感染率评估临床疗效。
本回顾性研究纳入了74名单侧完全性唇腭裂患者，分为斯卡帕筋膜组和对照组，两组人数相等，均为连续接受二期牙槽骨植骨术的单侧完全性唇腭裂患者。术后至少1年拍摄的牙槽裂咬合片采用Spearman相关的伯格伦德和威瑟罗量表进行评估。采用t检验、卡方检验和比值比进行统计学评估。
斯卡帕筋膜手术的临床成功率（伯格伦德I型和II型）显著更高（分别为67.6%和94.6%），感染率显著更低（分别为16.2%和2.7%），伯格伦德和威瑟罗量表的相关性较高（0.964；p<0.001）。斯卡帕筋膜组未出现伤口裂开、瘘管、骨移植暴露或额外的供区并发症。
作者采用斯卡帕筋膜移植物进行牙槽骨植骨的新方法安全有效，是有记录的成功率最高的方法之一。
临床问题/证据级别：治疗性，III级
