Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Viničná 7, 128 43, Prague 2, Czech Republic.
Department of Otorhinolaryngology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 00, Prague 5, Czech Republic.
J Craniomaxillofac Surg. 2020 Apr;48(4):383-390. doi: 10.1016/j.jcms.2020.02.019. Epub 2020 Mar 3.
The aim of this study was to assess palatal growth in newborns with complete bilateral cleft lip and palate (cBCLP) and bilateral cleft lip and palate with tissue bridges (BCLP + B) 1 year after early neonatal cheiloplasty (ENC).
The methodology was based on classic and morphometric analysis of dental models of newborns with cBCLP or BCLP + B. These analyses included metric analysis, coherent point drift-dense correspondence analysis, superprojection methods, and multivariate statistics. Dental casts were observed in two age categories, which were compared with each other. The first cast was obtained from each patient before ENC (T0, 5 ± 5 days) and the second one prior to palatoplasty (T1, 12 ± 6 months).
Fifty-two dental models obtained from 26 newborns with cBCLP and BCLP + B were evaluated. The results showed that over the 12-month period, alveolar clefts were narrowed in both cleft types due to anterior growth combined with the formative effect of suturing. This was confirmed by decreases in the dimensions of the right (T0 9.93 ± 2.80 mm, T1 6.64 ± 2.43 mm; p ≤ 0.003) and left (T0 10.71 ± 4.13 mm, T1 6.69 ± 4.29 mm; p ≤ 0.003) alveolar clefts in cBCLP patients. Similar reductions in alveolar cleft widths occurred on the left side (T0 11.69 ± 4.75 mm, T1 4.34 ± 2.97 mm; p ≤ 0.001) of BCLP + B patients, while on the right side, which was connected by a combined tissue bridge, there was non-significant narrowing of the alveolar cleft (T0 1.61 ± 1.34 mm, T1 1.04 ± 0.70 mm; p = 0.120). The ENC did not restrict posterior palatal growth, meaning that intertuberosity width was extended in cBCLP (T0 32.80 ± 3.15 mm, T1 35.86 ± 2.80 mm; p ≤ 0.001) and in BCLP + B neonates (T0 34.01 ± 2.15 mm, T1 36.21 ± 2.14 mm; p ≤ 0.004). Width and length measurements in the observed groups showed growth tendencies equivalent to those in noncleft or LOP patients. Palatal variability was greater in neonatal cBCLP, but was reduced during the monitored period, approximating that for BCLP + B. Regions with the most notable palatal growth were located primarily at the premaxilla and at the anterior and partially posterior ends of the maxillary segments.
Early neonatal cheiloplasty had no negative effect on palatal growth in any direction. There was no reduction in the length or width of the palate during the first year of life, nor was there narrowing of the dentoalveolar arch. The formative effect of the operated lip on the anterior part of the palate was confirmed. This, in combination with the favorable growth, lead to closure of the alveolar cleft.
本研究旨在评估新生儿完全双侧唇裂腭裂（cBCLP）和双侧唇裂腭裂伴组织桥（BCLP+B）在接受早期新生儿唇裂整复术（ENC）后 1 年的腭部生长情况。
本研究采用经典和计量分析方法对 cBCLP 或 BCLP+B 新生儿的牙模进行分析。这些分析包括计量分析、相干点漂移密集对应分析、超投影方法和多变量统计分析。牙模观察分为两个年龄组，然后进行相互比较。第一个牙模是每个患者在接受 ENC 前（T0，5±5 天）获得的，第二个是在腭裂修复术前（T1，12±6 个月）获得的。
对 26 例 cBCLP 和 BCLP+B 新生儿的 52 个牙模进行了评估。结果表明，在 12 个月的时间里，由于前牙生长和缝合的成形作用，两种类型的裂隙牙槽都变窄了。这一结果得到了证实，即 cBCLP 患者右侧（T0 9.93±2.80mm，T1 6.64±2.43mm；p≤0.003）和左侧（T0 10.71±4.13mm，T1 6.69±4.29mm；p≤0.003）牙槽的尺寸减小。在 BCLP+B 患者中，左侧牙槽裂宽度也出现了类似的减小（T0 11.69±4.75mm，T1 4.34±2.97mm；p≤0.001），而在右侧牙槽裂，由于有联合组织桥连接，牙槽裂没有明显变窄（T0 1.61±1.34mm，T1 1.04±0.70mm；p=0.120）。ENC 并未限制腭后生长，这意味着 cBCLP 患者的蝶骨间宽度增加（T0 32.80±3.15mm，T1 35.86±2.80mm；p≤0.001）和 BCLP+B 新生儿的蝶骨间宽度增加（T0 34.01±2.15mm，T1 36.21±2.14mm；p≤0.004）。观察到的两组中，宽度和长度的测量都显示出与非裂隙或 LOP 患者相似的生长趋势。新生儿 cBCLP 的腭部变异较大，但在监测期间有所减少，接近 BCLP+B。腭部生长最明显的区域主要在前颌骨和上颌骨的前、后部分。
早期新生儿唇裂整复术对任何方向的腭部生长都没有负面影响。在生命的第一年，腭部的长度或宽度都没有减小，也没有牙牙槽弓变窄。证实了手术唇对腭前部分的成形作用。这与有利的生长一起导致了牙槽裂的闭合。
