Seoul, Republic of Korea.
From the Department of Plastic and Reconstructive Surgery, Ulsan University College of Medicine, Seoul Asan Medical Center; and the Eastman Orthodontic Center.
Plast Reconstr Surg. 2018 Mar;141(3):736-746. doi: 10.1097/PRS.0000000000004172.
The conventional approach during orthognathic surgery for cleft-related deformities has focused largely on restoration of maxilla retrusion, using the maxillary advancement as a standard treatment objective. However, the authors thought that maxillary vertical shortening and deficient incisor show could be additional key elements of cleft-related deformities. Although slight vertical lengthening can be obtained with only maxillary advancement, it would not be enough to obtain satisfactory aesthetic results in terms of the anterior facial height. The authors hypothesized that vertical deficiency and anteroposterior maxillary retrusion exists in cleft-related deformities. Therefore, orthognathic surgery including intentional vertical lengthening and advancement would be better than the conventional simple advancement.
A new approach was used to treat consecutive patients with dentofacial deformities between December of 2007 and December of 2016. Patients with cleft-related dentofacial deformities were included in the study.
Forty-one patients with cleft-related dentofacial deformities were included. The distance from the nasion to the incisor tip was 76.70 mm; the angle of the lines connecting the sella, nasion, and point A was 74.03 degrees; and the incisor show was 1.02 mm. Corresponding measurements in 40 patients without clefts were 81.57 mm, 80.08 degrees, and 3.38 mm, respectively. Postoperatively, the average vertical lengthening achieved was 0.88 mm in the simple maxillary advancement group and 7.65 mm in the intentional vertical lengthening accompanied by maxillary advancement group.
The authors' results suggest that simultaneous maxillary vertical lengthening with horizontal advancement is a viable approach to orthognathic surgery for cleft-related deformities, given the long-term stability of outcomes demonstrated in this study.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在针对唇腭裂相关畸形的正颌手术中，传统方法主要集中在恢复上颌后缩，将上颌前徙作为标准治疗目标。然而，作者认为上颌垂直缩短和切牙缺失也是唇腭裂相关畸形的重要因素。虽然仅通过上颌前徙就可以获得轻微的垂直延长，但这对于前面部高度的美学效果来说是不够的。作者假设唇腭裂相关畸形存在垂直不足和上颌前后向后缩。因此，包括有意垂直延长和前徙的正颌手术将优于传统的单纯前徙。
作者采用一种新方法治疗 2007 年 12 月至 2016 年 12 月期间连续就诊的牙颌面畸形患者。本研究纳入了唇腭裂相关牙颌面畸形患者。
共纳入 41 例唇腭裂相关牙颌面畸形患者。从鼻根到切牙尖端的距离为 76.70mm；连接鞍结节、鼻根和 A 点的线的角度为 74.03 度；切牙显露为 1.02mm。40 例无腭裂患者的相应测量值分别为 81.57mm、80.08 度和 3.38mm。术后，单纯上颌前徙组平均垂直延长 0.88mm，有意垂直延长伴上颌前徙组平均延长 7.65mm。
作者的研究结果表明，上颌垂直延长伴水平前徙是唇腭裂相关畸形正颌手术的一种可行方法，本研究结果表明其长期效果稳定。
临床问题/证据水平：治疗性，III 级。
