Brudnicki Andrzej, Sawicka Ewa, Brudnicka Renata, Fudalej Piotr Stanisław
Maxillofacial Surgery Unit, Department of Pediatric Surgery, Institute of Mother and Child (IMC), Warsaw, Poland.
Department of Orthodontics, Central Military Medical Outpatient Clinic CePeLek, Warsaw, Poland.
Cleft Palate Craniofac J. 2020 Jan;57(1):105-113. doi: 10.1177/1055665619866363. Epub 2019 Aug 1.
To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP).
Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP.
One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group).
Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. tests and regression models were made to analyze data.
Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited-cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected-1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted of the model was 0.11.
Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.
评估二期牙槽骨植骨（SABG）时机对完全性单侧唇腭裂（UCLP）患者颅面形态的影响。
对连续接受治疗的非综合征性完全性UCLP患者进行单中心回顾性评估。
167例完全性UCLP患者（男108例，女59例），其唇腭裂在约8个月大时采用一期修复法进行修复。128例患者进行SABG时的年龄在1.4至11.5岁之间（SABG组），而39例患者在进行头影测量评估时仍在等待SABG（未进行SABG组）。
使用线性和角度测量方法，对10岁时（标准差=0.8；范围：7.5 - 12.3岁）拍摄的侧位头影测量片上的颅面形态进行评估。进行检验和回归模型分析数据。
回归模型表明，SABG对颅面形态的影响有限——在控制了（1）腭裂一期修复年龄、（2）头影测量评估年龄、（3）腭裂侧、（4）性别和（5）手术医生后，SABG组和未进行SABG组之间在统计学上有显著差异的头影测量变量与SABG时机无关。仅上颌长度（髁突 - A点）受到影响——SABG延迟1年对应Co - A点距离增加0.52 mm。然而，模型的调整R²为0.11。
我们的研究结果谨慎地表明，8岁前进行SABG对颅面形态的负面影响可能有限。尽管如此，我们的结果应由实施腭裂替代手术修复的腭裂中心予以证实。
