On Sung Woon, Baek Seung-Hak, Choi Jin-Young
Division of Oral and Maxillofacial surgery, Department of Dentistry, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong.
Department of Orthodontics.
J Craniofac Surg. 2018 Mar;29(2):309-314. doi: 10.1097/SCS.0000000000004122.
The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement (ΔA-vertical reference plane, 4.8 mm, P < 0.001; ΔSNA, 1.9 degree, P < 0.001; ΔA-N perp, 1.9 mm, P < 0.05), although the mandible exhibited a forward growth (ΔSNB, 1.2 degree, P < 0.05). Despite downward movement of the posterior maxilla with counterclockwise rotation (Δpalatal plane angle, -1.5 degree, P < 0.05), the mandible did not exhibit clockwise rotation but counterclockwise rotation (ΔSN to mandibular plane angle, -1.4 degree, ΔBjork sum, -1.4 degree, Δocclusal plane to SN plane angle, -1.5 degree, ΔFMA, -1.0 degree, all P < 0.05) and showed decrease in Gonial angle (-1.2 degree, P < 0.01). Although there was labioversion of the maxillary incisor (ΔU1 to SN, 4.1 degree, P < 0.05), the mandibular incisor did not exhibit significant linguoversion (ΔIMPA, -1.3 degree, P > 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage.
这项回顾性研究的目的是调查长期使用带微型钢板的面罩（FM-MP）对唇腭裂（CLP）患者上颌前牵引的影响。研究对象为21例CLP患者（16例单侧CLP患者和5例双侧CLP患者），他们接受了相同的唇腭裂手术方法以及由同一位外科医生和同一位正畸医生进行的FM-MP治疗。在进行上颌前牵引前（T1；平均年龄11.1岁）和牵引后（T2；平均年龄16.9岁）拍摄了头颅侧位片。FM-MP的平均使用时间为68.0个月。在测量了17项头影测量变量后，进行了统计分析。在T1至T2期间，上颌骨显示出明显的向前移动（A点至垂直参考平面，4.8毫米，P<0.001；SNA角，1.9度，P<0.001；A-N垂线，1.9毫米，P<0.05），尽管下颌骨有向前生长（SNB角，1.2度，P<0.05）。尽管上颌骨后部向下移动并逆时针旋转（腭平面角，-1.5度，P<0.05），但下颌骨并未顺时针旋转而是逆时针旋转（SN至下颌平面角，-1.4度，Bjork总和，-1.4度，咬合平面至SN平面角，-1.5度，FMA角，-1.0度，均P<0.05），且下颌角减小（-1.2度，P<0.01）。尽管上颌切牙出现唇倾（U1至SN，4.1度，P<0.05），但下颌切牙未出现明显舌倾（IMPA角，-1.3度，P>0.05）。长期使用FM-MP对青少年CLP患者的上颌前牵引有效，且不会导致下颌骨顺时针旋转，而这正是传统牙支抗面罩的主要缺点。
