Meazzini Maria Costanza, Cohen Noah, Battista Valeria Marinella Augusta, Incorvati Cristina, Biglioli Federico, Autelitano Luca
Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Milan, Italy.
Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Università degli Studi di Milano, Milan, Italy.
Cleft Palate Craniofac J. 2022 Mar;59(3):347-354. doi: 10.1177/10556656211007697. Epub 2021 Apr 13.
Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure.
This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery.
Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2).
Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2.
In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.
对于外科医生而言，关闭伴有大软组织间隙的宽牙槽裂并重建牙槽骨缺损具有挑战性。一些作者成功使用了牙间节段性牵张术，但这需要额外的外科手术。
本研究评估利用牙支持式装置进行正畸推进较小节段的有效性，使牙槽残端软组织完全贴合，从而能够进行传统的同期软组织关闭和骨移植，避免额外手术的需要。
前瞻性选择8例生长发育期患者，其中2例单侧完全性唇腭裂（UCLP），6例双侧完全性唇腭裂（BCLP），这些患者在骨移植前存在大的软组织和牙槽骨缺损。对BCLP患者应用带环快速腭扩展器（RPE），对UCLP患者应用改良RPE，对于较年轻患者联合使用前牵引面罩，对于12岁以上患者使用改良Alt-Ramec。在T0（开始前）、牵引结束时（T1）以及骨移植后至少1年（T2）进行影像学和摄影记录。
存在大间隙的患者在T1时骨裂区域显著减小，软组织贴合。所有患者在T2时均接受了骨移植，愈合和骨化良好。
对于生长发育期的UCLP和BCLP且存在大间隙的患者，术前正畸牵引似乎是一种有效的减少腭裂缺损的方法，可将植骨后瘘管形成的风险降至最低，减少额外手术的需求。
