Bueno Patricia Martins, Kiemle Trindade Paulo Alceu, Medeiros Laís Hollara, Fidélis da Silva Leide Vilma, Trindade-Suedam Ivy Kiemle
Postgraduate Program in Rehabilitation Sciences, Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.
Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.
J Oral Biol Craniofac Res. 2025 Jan-Feb;15(1):33-40. doi: 10.1016/j.jobcr.2024.11.002. Epub 2024 Dec 2.
To prospectively evaluate the long-term effects of orthognathic surgery on masticatory function in individuals with repaired complete cleft lip and palate and to compare the results with a control group.
A total of 40 individuals were prospectively analyzed before (PRE-ORTHOG) and approximately 12 months after orthognathic surgery (POST-ORTHOG). The participants were divided into two groups: 1) Cleft Lip and Palate Group (CLP): 20 adults with CLP undergoing orthognathic surgery (14 ♂, 6 ♀, age 24 ± 3 years), and 2) Control Group (CON): 20 paired adults with Angle Class I skeletal pattern who had never undergone orthognathic surgery (14 ♂, 6 ♀, age 25 ± 5 years). Three variables were evaluated: 1) Bite Force (BF) (measured in Newtons - N) presented as the average of the bite force from the right and left molars ( RM + LM), using a gnathodynamometer (IDDK Kratos), 2) Masticatory Efficiency (ME) (ranging from 0 to 1, with values closer to 1 indicating poorer efficiency), assessed through a dual-color masticatory gum test analyzed visually and optoelectronically (ViewGum©), and 3) Masticatory Capacity (MC): patient-reported ability to chew, rated on a two-point scale (P/R = poor to reasonable, G/O = good to optimal).
In the PRE-ORTHOG phase, the BF for the CLP group ( RM + LM = 285 ± 141) was significantly lower compared to the CON group ( RM + LM = 524 ± 202). In the POST-ORTHOG phase, the CLP group ( RM + LM = 373 ± 129) showed significant improvements in BF in relation to the PRE-ORTHOG phase, with values similar to those of the CON group. Masticatory efficiency improved significantly in the POST-ORTHOG phase (0.222 ± 0.071) compared to PRE-ORTHOG (0.470 ± 0.126) in the CLP group, while PRE-ORTHOG values were worse than those of the CON group (0.148 ± 0.050). Furthermore, 45 % of CLP participants reported P/R MC before surgery, while none reported this after surgery, a statistically significant improvement. The POST-ORTHOG MC results for CLP participants were comparable to the CON group, with 100 % reporting G/O MC after surgery.
Overall, the group with CLP demonstrated impaired masticatory function in the preoperative phase compared to the control group across all variables analyzed. Orthognathic surgery improves masticatory function in patients with CLP, with postoperative parameters comparable to those of the control group.
前瞻性评估正颌手术对唇腭裂修复患者咀嚼功能的长期影响，并与对照组进行结果比较。
前瞻性分析了40例患者术前（正颌手术前）和约正颌手术后12个月（正颌手术后）的情况。参与者分为两组：1）唇腭裂组（CLP）：20例接受正颌手术的成年唇腭裂患者（男14例，女6例，年龄24±3岁）；2）对照组（CON）：20例配对的从未接受过正颌手术的安氏I类骨型成年患者（男14例，女6例，年龄25±5岁）。评估了三个变量：1）咬合力（BF）（以牛顿 - N为单位测量），表示为右、左磨牙咬合力的平均值（RM + LM），使用咬力计（IDDK Kratos）测量；2）咀嚼效率（ME）（范围为0至1，值越接近1表示效率越低），通过双色咀嚼口香糖试验进行评估，该试验通过视觉和光电方式（ViewGum©）进行分析；3）咀嚼能力（MC）：患者报告的咀嚼能力，采用两点量表进行评分（P/R = 差至一般，G/O = 好至最佳）。
在正颌手术前阶段，CLP组的BF（RM + LM = 285±141）显著低于CON组（RM + LM = 524±202）。在正颌手术后阶段，CLP组（RM + LM = 373±129）的BF相对于正颌手术前阶段有显著改善，其值与CON组相似。CLP组在正颌手术后阶段的咀嚼效率（0.222±0.071）相对于正颌手术前（0.470±0.126）有显著提高，而正颌手术前的值比CON组（0.148±0.050）更差。此外，45%的CLP参与者在手术前报告咀嚼能力为P/R，而手术后无人报告，这是一个具有统计学意义的改善。CLP参与者正颌手术后的MC结果与CON组相当，100%的参与者在手术后报告咀嚼能力为G/O。
总体而言，与对照组相比，CLP组在所有分析变量的术前阶段均表现出咀嚼功能受损。正颌手术可改善CLP患者的咀嚼功能，术后参数与对照组相当。
