Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry - University of São Paulo, Bauru, São Paulo, Brazil.
Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Faculty of Medicine and Surgery, Universita' Degli Studi Di Milano, Milan, Italy.
Clin Oral Investig. 2022 Feb;26(2):1975-1983. doi: 10.1007/s00784-021-04177-z. Epub 2021 Oct 19.
This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries.
The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1 year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05).
At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017).
This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches.
Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.
本研究旨在比较单侧完全唇腭裂患儿在不同一期唇裂整复术和腭裂整复术式前后牙弓的三维变化。
将样本分为两组：组 1-采用 Millard 法行唇裂整复术和 von Langenbeck 法行腭裂整复术；组 2-采用 Millard 法行唇裂整复术和 Hans Pichler 法行前腭裂整复术及 Sommerlad 法行后腭裂整复术。在一期手术前（T1）、一期手术后（T2）和二期手术后 1 年（T3）分别对牙弓进行测量。测量项目包括线距和牙弓面积。为了分析方法的误差，应用了组内相关系数。采用方差分析（Tukey 检验）、独立 t 检验和配对 t 检验（p<0.05）。
在 T1 时，G2 组的眶耳距明显大于 G1 组（p=0.004）。在 T2 时，G2 组的前牙弓长度明显大于 G1 组（p=0.025），而较小腭段面积（p=0.001）、裂隙面积（p=0.014）和总牙弓面积（p=0.002）则明显小于 G1 组。在 T3 时，眶耳距在 G2 组明显大于 G1 组（p=0.017）。
本研究表明，与唇裂整复术和腭裂两期整复术相比，唇裂整复术和腭裂一期整复术导致上颌骨线性测量（T-T' 和 I-CC'）和总牙弓面积的生长较小。
需要对手术方案进行评估，以验证其效果，从而改善跨学科团队的临床实践，为唇腭裂患者的康复确定新的参数。
