Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA.
J Craniofac Surg. 2022 May 1;33(3):774-778. doi: 10.1097/SCS.0000000000008296. Epub 2021 Oct 21.
Competing hypotheses for the development of midface hypoplasia in patients with cleft lip and palate include both theories of an intrinsic restricted growth potential of the midface and extrinsic surgical disruption of maxillary growth centers and scar growth restriction secondary to palatoplasty. The following meta-analysis aims to better understand the intrinsic growth potential of the midface in a patient with cleft lip and palate unaffected by surgical correction. A systematic review of studies reporting cephalometric measurements in patients with unoperated and operated unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP), and isolated cleft palate (iCP) abstracted SNA and ANB angles, age at cephalometric analysis, syndromic diagnosis, and patient demographics. Age and Region-matched controls without cleft palate were used for comparison. SNA angle for unoperated UCLP (84.5 ± 4.0°), BCLP (85.3 ± 2.8°), and ICP (79.2 ± 4.2°) were statistically different than controls (82.4 ± 3.5°), (all P ≤ 0.001). SNA angles for operated UCLP (76.2 ± 4.2°), BCLP (79.8 ± 3.6°), and ICP (79.0 ± 4.3°) groups were statistically smaller than controls (all P ≤ 0.001). SNA angle in unoperated ICP (n = 143) was equivalent to operated ICP patients (79.2 ± 4.2° versus 79.0 ± 4.3° P = 0.78). No unoperated group mean SNA met criteria for midface hypoplasia (SNA < 80). Unoperated UCLP/BLCP exhibit a more robust growth potential of the maxilla, whereas operated patients demonstrate stunted growth compared to normal phenotype. Unoperated ICP demonstrates restricted growth in both operated and unoperated patients. As such, patients with UCLP/BCLP differ from patients with ICP and the factors affecting midface growth may differ.Level of Evidence: IV.
在唇腭裂患者中，中面部发育不全的发生机制有两种假说，一种是中面部内在生长潜力受限，另一种是上颌生长中心的外部手术干扰以及腭裂修复术后的瘢痕生长受限。本研究旨在更好地了解未接受手术矫正的唇腭裂患者中面部的内在生长潜力。系统检索了报道未手术治疗的单侧唇裂腭裂（UCLP）、双侧唇裂腭裂（BCLP）和单纯腭裂（iCP）患者以及年龄和部位匹配的无腭裂对照组患者的头颅侧位片的研究，提取 SNA 和 ANB 角、头颅侧位片分析时的年龄、综合征诊断和患者人口统计学数据。结果显示，未手术治疗的 UCLP（84.5±4.0°）、BCLP（85.3±2.8°）和 iCP（79.2±4.2°）患者的 SNA 角与对照组（82.4±3.5°）相比有统计学差异（均 P≤0.001）。接受手术治疗的 UCLP（76.2±4.2°）、BCLP（79.8±3.6°）和 iCP（79.0±4.3°）患者的 SNA 角与对照组相比明显更小（均 P≤0.001）。未手术治疗的 iCP 患者（n=143）的 SNA 角与接受手术治疗的 iCP 患者（79.2±4.2°与 79.0±4.3°，P=0.78）相当。未手术治疗的患者中，没有一个组的 SNA 平均值符合中面部发育不全的标准（SNA＜80）。未手术治疗的 UCLP/BCLP 患者上颌骨生长潜力更强，而接受手术治疗的患者与正常表型相比生长受限。未手术治疗的 iCP 患者无论是否接受手术，其生长均受到限制。因此，UCLP/BCLP 患者与 iCP 患者不同，影响中面部生长的因素可能也不同。证据等级：IV。
