Richardson Sunil, Krishna Shreya, Bansal Avi
Richardsons Dental and Craniofacial Hospital, Nagercoil, India.
J Korean Assoc Oral Maxillofac Surg. 2017 Dec;43(6):407-414. doi: 10.5125/jkaoms.2017.43.6.407. Epub 2017 Dec 26.
The study was designed to evaluate the efficacy of performing a second, repeat anterior maxillary distraction (AMD) to treat residual cleft maxillary hypoplasia.
Five patients between the ages of 12 to 15 years with a history of AMD and with residual cleft maxillary hypoplasia were included in the study. Inclusion was irrespective of gender, type of cleft lip and palate, and the amount of advancement needed. Repeat AMD was executed in these patients 4 to 5 years after the primary AMD procedure to correct the cleft maxillary hypoplasia that had developed since the initial procedure. Orthopantomogram (OPG) and lateral cephalograms were taken for evaluation preoperatively, immediately after distraction, after consolidation, and one year postoperatively. The data obtained was tabulated and a Mann Whitney U-test was used for statistical comparisons.
At the time of presentation, a residual maxillary hypoplasia was observed with a well maintained distraction gap on the OPG which ruled out the occurrence of a relapse. Favorable movement of the segments without any resistance was seen in all patients. Mean maxillary advancement of 10.56 mm was achieved at repeat AMD. Statistically significant increases in midfacial length, SNA angle, and nasion perpendicular to point A distance was achieved (=0.012, =0.011, and =0.012, respectively). Good profile was achieved for all patients. Minimal transient complications, for example anterior open bite and bleeding episodes, were managed.
Addressing the problem of cleft maxillary hypoplasia at an early age (12-15 years) is beneficial for the child. Residual hypoplasia may develop in some patients, which may require additional corrective procedures. The results of our study show that AMD can be repeated when residual deformity develops with the previous procedure having no negative impact on the results of the repeat procedure.
本研究旨在评估进行第二次上颌前部重复牵张成骨术（AMD）治疗残留腭裂上颌骨发育不全的疗效。
本研究纳入了5例年龄在12至15岁之间、有AMD病史且存在残留腭裂上颌骨发育不全的患者。纳入标准与性别、唇腭裂类型以及所需前移量无关。在初次AMD手术4至5年后，对这些患者进行重复AMD，以纠正初次手术后出现的腭裂上颌骨发育不全。术前、牵张后即刻、巩固期及术后1年拍摄曲面断层片（OPG）和头颅侧位片进行评估。将获得的数据制成表格，并采用曼-惠特尼U检验进行统计学比较。
就诊时，在OPG上观察到残留的上颌骨发育不全，牵张间隙保持良好，排除了复发的发生。所有患者均可见节段性的良好移动且无任何阻力。重复AMD时平均上颌前移10.56mm。面中部长度、SNA角和鼻根至A点垂直距离均有统计学意义的增加（分别为P = 0.012、P = 0.011和P = 0.012）。所有患者均获得了良好的面部轮廓。对轻微的短暂并发症，如前牙开颌和出血事件进行了处理。
在儿童早期（12 - 15岁）解决腭裂上颌骨发育不全问题对患儿有益。部分患者可能会出现残留发育不全，这可能需要额外的矫正手术。我们的研究结果表明，当残留畸形出现时，AMD可以重复进行，且先前的手术对重复手术的结果没有负面影响。
