双侧唇裂腭裂修复术联合鼻牙槽塑形术和牙龈骨膜成形术对面部成熟度的临床效果。
Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding and Gingivoperiosteoplasty to Facial Maturity.
机构信息
From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine.
出版信息
Plast Reconstr Surg. 2023 Dec 1;152(6):1088e-1097e. doi: 10.1097/PRS.0000000000010450. Epub 2023 Mar 22.
BACKGROUND
The long-term effects of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. The authors report clinical outcomes of facially mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP).
METHODS
A single-institution retrospective study of nonsyndromic patients with complete BCLP who underwent NAM between 1991 and 2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained. The total number of cleft operations and cephalometric measures was compared with a previously published external cohort of patients with complete and incomplete BCLP in which a minority (16.7%) underwent presurgical orthopedics before cleft lip repair without GPP.
RESULTS
Twenty-four patients with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent alveolar bone graft, and nine (37.5%) required speech surgery. The median number of operations per patient was five (interquartile range, two), compared with eight (interquartile range, three) in the external cohort ( P < 0.001). Average age at the time of lateral cephalogram was 18.64 years (1.92). There was no significant difference between our cohort and the external cohort with respect to sella-nasion-point A angle (SNA) [73 degrees (6 degrees) versus 75 degrees (11 degrees); P = 0.186] or sella-nasion-point B angle (SNA) [78 degrees (6 degrees) versus 74 degrees (9 degrees); P = 0.574]. Median ANB (SNA - SNB) was -3 degrees (5 degrees) compared with -1 degree (7 degrees; P = 0.024). Twenty patients (83.3%) underwent orthognathic surgery.
CONCLUSION
Patients with BCLP who underwent NAM and GPP had significantly fewer total cleft operations and mixed midface growth outcomes at facial maturity compared with patients who did not undergo this treatment protocol.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
鼻牙槽塑形（NAM）对双侧唇腭裂（BCLP）患者的长期影响尚不清楚。作者报告了接受 NAM 和牙龈骨膜成形术（GPP）的完全性 BCLP 面型成熟患者的临床结果。
方法
对 1991 年至 2000 年间接受 NAM 的非综合征性完全性 BCLP 患者进行了单中心回顾性研究。所有研究患者均随访至骨骼成熟，此时获得侧位头颅侧位片。比较了总腭裂手术次数和头影测量值，与之前发表的一组完全性和不完全性 BCLP 患者的外部队列进行比较，其中少数（16.7%）患者在唇裂修复前接受了术前正畸，而没有进行 GPP。
结果
24 例 BCLP 患者组成了研究队列。所有患者均接受了 GPP，13 例（54.2%）接受了牙槽骨移植，9 例（37.5%）需要接受语音手术。每位患者的平均手术次数为 5 次（四分位距，2 次），而外部队列为 8 次（四分位距，3 次）（P < 0.001）。侧位头颅侧位片拍摄时的平均年龄为 18.64 岁（1.92）。我们的队列与外部队列在蝶鞍-前鼻棘点 A 角（SNA）[73 度（6 度）与 75 度（11 度）；P = 0.186]或蝶鞍-前鼻棘点 B 角（SNA）[78 度（6 度）与 74 度（9 度）；P = 0.574]方面无显著差异。中位数 ANB（SNA-SNB）为-3 度（5 度），而外部队列为-1 度（7 度）（P = 0.024）。20 例（83.3%）患者接受了正颌手术。
结论
与未接受该治疗方案的患者相比，接受 NAM 和 GPP 治疗的完全性 BCLP 患者在面部成熟时的总腭裂手术次数更少，混合中面部生长结果也更好。
临床问题/证据水平：治疗，III 级。
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