Teblick Sofie, Van de Casteele Elke, Scheuermann Maria, Vanreusel Inne, Renier Lieven, Nadjmi Nasser
From the Faculty of Medicine & Health Sciences, University of Antwerp.
Department of Cranio-Maxillofacial Surgery, Antwerp University Hospital.
Plast Reconstr Surg. 2025 Aug 1;156(2):295-302. doi: 10.1097/PRS.0000000000011817. Epub 2024 Oct 18.
A palatal cleft can be reconstructed using various palatoplasty techniques. Many techniques use local mucoperiosteal flaps to close the hard palate cleft, without closing the underlying bone defect. The purpose of this study was to explore the possibility of spontaneous bone regeneration in the remaining bone defect following 2-stage palatoplasty. The effect of this bone regeneration on transverse maxillary growth also was studied.
A retrospective study of patients with unilateral cleft lip and palate was performed. Cleft size was measured at the hard-soft palate junction on plaster models obtained during palatoplasty. Residual bony cleft was evaluated at the time of alveolar process reconstruction using cone beam computed tomography images. The presence of crossbite was evaluated using clinical photographs to assess transverse maxillary growth.
Forty-six patients were included in this study. Thirteen patients (28%) presented with complete ossification of the hard palate at age 6 years. Six patients (13%) had no ossification, and 27 patients (59%) demonstrated partial closure, averaging 75% of the total hard palate length. All patients with complete closure and 89% of patients with partial closure presented without lateral crossbites. Statistical analysis revealed no significant correlation between lateral crossbites and the extent of hard palate ossification ( P = 0.4314).
A total of 87% of children presented with at least partial ossification of the hard palate after a 2-stage palatoplasty, indicating the potential for spontaneous bone regeneration. Lateral crossbites demonstrated no correlation with palatal ossification ( P = 0.1819), suggesting no detrimental impact of regenerated bone on transverse maxillary growth.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
腭裂可采用多种腭裂修复技术进行重建。许多技术使用局部黏骨膜瓣来关闭硬腭裂，而不闭合下方的骨缺损。本研究的目的是探讨两期腭裂修复术后剩余骨缺损处自发骨再生的可能性。还研究了这种骨再生对上颌横向生长的影响。
对单侧唇腭裂患者进行回顾性研究。在腭裂修复术中获取的石膏模型上，测量软硬腭交界处的裂隙大小。在牙槽突重建时，使用锥形束计算机断层扫描图像评估残余骨裂。使用临床照片评估反牙合的存在情况，以评估上颌横向生长。
本研究纳入了46例患者。13例患者（28%）在6岁时硬腭完全骨化。6例患者（13%）没有骨化，27例患者（59%）表现为部分闭合，平均占硬腭总长度的75%。所有完全闭合的患者和89%部分闭合的患者均无侧方反牙合。统计分析显示，侧方反牙合与硬腭骨化程度之间无显著相关性（P = 0.4314）。
两期腭裂修复术后，共有87%的儿童硬腭至少有部分骨化，表明存在自发骨再生的潜力。侧方反牙合与腭骨化无相关性（P = 0.1819），提示再生骨对上颌横向生长无不利影响。
临床问题/证据水平：风险，III级。
