Brusati Roberto, Meazzini Maria Costanza, Rezzonico Angela, Biglioli Federico, Garattini Giovanna, Battista Valeria Marinella Augusta, Autelitano Luca
Regional Center for Cleft Lip and Palate, Smile House-CLP Center, San Paolo University Hospital, Università degli Studi di Milano.
Regional Center for Cleft Lip and Palate, Smile House-CLP Center, Department of Maxillo-Facial Surgery.
J Craniofac Surg. 2018 Nov;29(8):2058-2064. doi: 10.1097/SCS.0000000000004789.
The aim of this paper was to assess growth, speech, and aesthetic results at the completion of growth in patients with unilateral cleft lip and palate treated with the 2 stages Milan surgical protocol.Craniofacial growth was evaluated with cephalometric analysis and a theoretical need for orthognathic surgery.Nasolabial appearance was qualitatively assessed using the Asher McDade Aesthetic Index.Speech was assessed using the Gos.Sp.Ass '98 modified for Italian language scoring system.Burden of care was recorded in terms of number of secondary surgical procedures. All of the patients were treated and evaluated at San Paolo Hospital, Smile House, Milan.Fifty-two consecutive patients treated by the same surgeon were recalled, 12 patients did not come for assessment.The first surgical step (average age of 6 months) was cheilorhinoplasty (Millard modified Delaire technique) and soft palate rapair (Pigott). The second step (average age of 35 months) was hard palate and alveolar repair performed simultaneously with an early secondary gengivo alveolo plasty. Fifty-six percent of the patients did not need further surgery after the 2-stage surgery protocol.The 2-stage surgical protocol of Milano, Smile House, seems to be effective for treatment of unilateral cleft lip and palate, with good results in terms of speech, labial appearance, and alveolar cleft management. Nevertheless, maxillary growth was moderately impaired by the protocol.
本文旨在评估采用两阶段米兰手术方案治疗的单侧唇腭裂患者生长发育完成时的生长、语音及美学效果。通过头影测量分析和正颌手术的理论需求评估颅面生长情况。使用阿舍·麦克达德美学指数对鼻唇外观进行定性评估。采用针对意大利语评分系统修改后的Gos.Sp.Ass '98评估语音。根据二次手术的数量记录护理负担。所有患者均在米兰圣保罗医院微笑之家接受治疗和评估。召回了由同一位外科医生治疗的52例连续患者，12例患者未前来进行评估。第一步手术（平均年龄6个月）为唇鼻整形术（改良米勒德-德莱尔技术）和软腭修复术（皮戈特法）。第二步手术（平均年龄35个月）为硬腭和牙槽突修复术，同时进行早期二次牙龈牙槽成形术。56%的患者在两阶段手术方案后无需进一步手术。米兰微笑之家的两阶段手术方案似乎对单侧唇腭裂的治疗有效，在语音、唇部外观和牙槽裂处理方面取得了良好效果。然而，该方案对上颌生长有中度影响。
