From the Department of Oral and Maxillofacial Plastic and Traumatic Surgery, Beijing Stomatological Hospital of Capital Medical University; and the Department of Cleft Lip and Palate Surgery, West China College of Stomatology, Sichuan University.
Plast Reconstr Surg. 2019 Jul;144(1):180-186. doi: 10.1097/PRS.0000000000005711.
The purpose of this study was to evaluate the effect of four different treatment protocols on maxillofacial growth in patients aged 7 to 8 years with unilateral complete cleft lip, palate, and alveolus.
Sixty-one patients with nonsyndromic unilateral complete cleft lip, palate, and alveolus were entered into this study and grouped as follows: group 1 patients had a repaired lip and an unrepaired palate; group 2 patients underwent one-stage palatoplasty; group 3 patients underwent two-stage palatoplasty; and group 4 patients underwent lip adhesion and two-stage palatoplasty. The control group was composed of 16 patients with unilateral incomplete cleft lip. The Kolmogorov-Smirnov test was used to test the nature of data distribution. The Bonferroni test and the Kruskal-Wallis H test were used for multiple comparisons.
Group 5 showed a more protruding maxilla (basion-nasion-A point, basion-nasion-anterior nasal spine, sella-nasion-anterior nasal spine; p < 0.05), longer maxillary sagittal length (anterior nasal spine-posterior maxillary point; p < 0.05) and maxillary basal sagittal length (A point-posterior maxillary point; p < 0.05), and a better jaw relationship (A point-nasion-B point angle; p < 0.05) than groups 2, 3, and 4. Group 2 had higher anterior facial height (anterior nasal spine-nasion, anterior nasal spine-menton, nasion-menton; p < 0.05) and posterior facial height (registration point-posterior maxillary point; p < 0.05) than groups 3 and 4. Groups 2 and 3 had better maxillary position (sella-pterygomaxillary fissure; p < 0.05) and deeper bony pharynx (basion-posterior maxillary point; p < 0.05) than group 4.
In patients aged 7 to 8 years with unilateral complete cleft lip, palate, and alveolus, both one- and two-stage palatoplasty inhibited maxillary sagittal growth. Vomer flap repair with denuded bone inhibited maxillary vertical growth. Lip adhesion did adversely affect maxilla position.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在评估四种不同治疗方案对 7-8 岁单侧完全唇裂、腭裂和牙槽突患者颌面生长的影响。
61 例非综合征性单侧完全唇裂、腭裂和牙槽突患者入组本研究，并分为以下几组：组 1 患者唇裂修复而腭裂未修复；组 2 患者行一期腭裂修复术；组 3 患者行二期腭裂修复术；组 4 患者行唇粘连术和二期腭裂修复术。对照组由 16 例单侧不完全唇裂患者组成。采用 Kolmogorov-Smirnov 检验检验数据分布性质。采用 Bonferroni 检验和 Kruskal-Wallis H 检验进行多重比较。
组 5 的上颌骨更突出（鼻底-前颅底点、鼻底-前鼻棘、蝶鞍-前鼻棘；p < 0.05），上颌矢状长度更长（前鼻棘-后上颌点；p < 0.05）和上颌基底部矢状长度（A 点-后上颌点；p < 0.05），以及更好的颌骨关系（A 点-前颅底点-B 点角；p < 0.05），优于组 2、3 和 4。组 2 的前面高（前鼻棘-前颅底点、前鼻棘-颏部、前颅底点-颏部；p < 0.05）和后面高（标志点-后上颌点；p < 0.05）高于组 3 和 4。组 2 和 3 的上颌位置更好（蝶鞍-翼突上颌缝；p < 0.05）和更深的骨性咽腔（鼻底-后上颌点；p < 0.05），优于组 4。
7-8 岁单侧完全唇裂、腭裂和牙槽突患者，一期和二期腭裂修复均抑制上颌矢状生长。裸骨 Vomer 瓣修复抑制上颌垂直生长。唇粘连术对上颌骨位置有不利影响。
临床问题/证据水平：治疗性，III 级。
