Kim Erinn N, Moss Whitney D, Kunkel Ryan P, Yamashiro Duane K, Gociman Barbu R
University of Utah Division of Plastic Surgery, University of Utah Hospital, Salt Lake City, Utah.
Plast Reconstr Surg Glob Open. 2022 Feb 9;10(2):e4099. doi: 10.1097/GOX.0000000000004099. eCollection 2022 Feb.
Cleft repair has been in constant evolution since its inception. Conventional repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. In many instances, this approach is adequate, but, particularly in complete clefts, the lack of bony support can lead to collapse of the maxillary arch, dental crowding, and posterior cross-bite. To address these shortcomings, our institution performs a two-staged palatoplasty with concomitant bone grafting of the alveolus and hard palate in the second stage. A retrospective review of children who underwent a two-staged palatoplasty at our institution was performed. These patients' records and images were reviewed for complications and changes in maxillary morphology. Fourteen patients with complete clefts had a two-staged palatoplasty with bone grafting in the second stage. The mean age at surgery was 37.5 months, and the mean follow-up was 16 months. One patient had resorption of the alveolar bone graft requiring additional bone grafting. The remaining patients were without complications and had good consolidation of the bone graft on follow-up imaging. Our early results support that there is a low complication rate (7% regrafting) in those patients who underwent bone grafting at the time of cleft palate repair with early evidence of bony consolidation on imaging and clinical examination. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair and may alleviate the shortcoming of soft-tissue closure only. Future study is necessary to determine long-term outcomes.
自唇腭裂修复术问世以来，其一直在不断发展。传统的腭裂修复术包括封闭鼻黏膜和口腔黏膜，而不进行骨重建。在许多情况下，这种方法是足够的，但特别是在完全性腭裂中，缺乏骨支撑可能导致上颌弓塌陷、牙齿拥挤和后牙反合。为了解决这些缺点，我们机构采用两阶段腭裂修复术，第二阶段同时进行牙槽突和硬腭的植骨。对在我们机构接受两阶段腭裂修复术的儿童进行了回顾性研究。对这些患者的记录和影像进行了并发症及上颌形态变化方面的检查。14例完全性腭裂患者接受了两阶段腭裂修复术，第二阶段进行了植骨。手术时的平均年龄为37.5个月，平均随访时间为16个月。1例患者牙槽突植骨吸收，需要再次植骨。其余患者无并发症，随访影像显示植骨愈合良好。我们的早期结果表明，在腭裂修复时进行植骨的患者中，并发症发生率较低（再次植骨率为7%），影像和临床检查早期有骨愈合的证据。修复过程中的广泛暴露使得上颌骨缺损能够完全植骨，这是传统牙槽裂修复无法做到的，并且可能缓解仅进行软组织封闭的缺点。有必要进行进一步研究以确定长期疗效。
