Lingeshbabu Pawar Adarsh, Basavapattana Shivasubramanya Jayanth, Kolothu Parambil Shanavas, Shivamoga Raju Anand, Debata Abhitosh
Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, 573201 India.
ABMSS/DCKH Cleft Centre, Indi, India.
J Maxillofac Oral Surg. 2021 Dec;20(4):680-688. doi: 10.1007/s12663-020-01404-0. Epub 2020 Sep 1.
Nonsyndromic unilateral CLAP patients despite the best surgical efforts present with variable degree of maxillary hypoplasia after cleft palate repair. AMOD is an extension of anterior maxillary osteotomy where the resulting segment anterior to the chosen site of vertical corticotomy cut is distracted with the help of hyrax screw through a tooth-borne appliance.
To analyze the hard and soft tissue profile changes following AMOD. To determine the ratio of soft tissue changes to the given extent of hard tissue movements.
Study group consisted of 25 patients with cleft maxillary hypoplasia reporting to the Department of OMFS, Coorg Institute of Dental Science. The preoperative and postoperative radiographs were taken followed by prediction tracing. In comparison of pre-op and post-op ceph mean improvement in hard tissue profile was seen at N-A by 2.84 mm, N-A-Pg by 2.52, ANS-Gn by 2.28 mm, N-ANS by 0.68 mm, 1-Nf by 0.32 and at PNS-ANS was 4.2 mm signifying improvement in middle third of face. Mean improvement in soft tissue profile at G-Sn-Pg angle by 1.2, G-Sn was 3.92 mm, nasolabial angle by 10.92, incisor exposure (Stm-1) by 0.24 mm and interlabial gap by 0.56 mm. On ratio and correlation of soft tissue changes to given extent of hard tissue change, with movement of point A and U1 resulted significant changes in Sn and Ls. Movement of ANS resulted in significant changes in pronasale and columella.
In our study significant improvement was seen in hard and soft tissue facial profile. In conclusion, AMOD is one of the emerging techniques to correct cleft maxillary hypoplasia which will have a defined definitive role to play in future.
非综合征性单侧腭裂患者尽管接受了最佳手术治疗，但腭裂修复后仍存在不同程度的上颌骨发育不全。前上颌骨骨切开术扩展术（AMOD）是前上颌骨截骨术的一种延伸，在选定的垂直骨切开部位前方形成的骨段，借助Hyrax螺钉通过牙支持式矫治器进行牵张。
分析AMOD术后硬组织和软组织侧貌的变化。确定软组织变化与给定硬组织移动程度的比例。
研究组由25例上颌骨发育不全的腭裂患者组成，他们前往库格牙科学院口腔颌面外科就诊。术前和术后拍摄X线片，随后进行预测描记。术前和术后头影测量比较显示，硬组织侧貌的平均改善情况为：鼻根点至鼻前点（N-A）增加2.84毫米，鼻根点至鼻前点至颏前点（N-A-Pg）增加2.52毫米，前鼻棘至颏下点（ANS-Gn）增加2.28毫米，鼻根点至前鼻棘（N-ANS）增加0.68毫米，上唇突点至鼻根点（1-Nf）增加0.32毫米，后鼻棘至前鼻棘（PNS-ANS）增加4.2毫米，表明面部中三分之一有所改善。软组织侧貌的平均改善情况为：颏点至鼻根点至颏前点角（G-Sn-Pg）增加1.2，颏点至鼻根点（G-Sn）增加3.92毫米，鼻唇角增加10.92，切牙外露（Stm-1）增加0.24毫米，唇间隙增加0.56毫米。在软组织变化与给定硬组织变化程度的比例及相关性方面，随着A点和上中切牙（U1）的移动，鼻根点（Sn）和上唇（Ls）有显著变化。前鼻棘（ANS）的移动导致鼻小柱和鼻尖有显著变化。
在我们的研究中，硬组织和软组织面部侧貌有显著改善。总之，AMOD是一种新兴的矫正上颌骨发育不全的技术，在未来将发挥明确的决定性作用。
