Posnick J C, Tompson B
Craniofacial Center, Georgetown University Medical Center, Washington, D.C., USA.
Plast Reconstr Surg. 1995 Aug;96(2):255-66.
We reviewed the complications and long-term results of a consecutive series of adolescents (67 males, 49 females; age range 15 to 25 years; mean 18 years) born with a cleft who underwent primary repair in childhood and later developed a jaw deformity and malocclusion that required orthognathic surgery. Between 1986 and 1992, 116 adolescents with either unilateral cleft lip and palate (n = 66), bilateral cleft lip and palate (n = 33), or isolated cleft palate (n = 17) underwent an orthognathic procedure that included a Le Fort I osteotomy; 32 also underwent simultaneous sagittal split osteotomies of the mandible; and 87 underwent osteoplastic genioplasty. Clinical follow-up ranged from 1 to 7 years (mean 40 months) at the close of the study. The preoperative clinical examination varied according to cleft type and individual variation, but all patients had maxillary hypoplasia. Additional cleft-related deformities included residual oronasal fistula and bony defects, clefted alveolar ridges that retained dental gaps, and mobile premaxilla that lacked union to the lateral segments. Overall, 89 percent of residual fistulas underwent successful closure as part of the orthognathic procedure. Surgical cleft dental gap closure was achieved and maintained to the extent planned at 92 percent of the cleft sites. A fixed (prosthetic) bridge was used successfully for dental rehabilitation to close the gap in all other patients at each cleft site (n = 9). All patients with alveolar clefts (n = 99) maintained keratinized mucosa along the labial surface of the cleft-adjacent teeth (n = 264 teeth). Complications were few and generally not serious. There was no segmental bone loss of teeth because of aseptic necrosis or infection. Only 5 percent of cleft adjacent teeth underwent a degree of gingival recession and root exposure as a result of the maxillary osteotomy procedure; all were retained long term. The long-term maintenance of overjet and overbite measured directly from the late (> 1 year) postoperative lateral cephalometric radiograph indicated that 97 percent of patients maintained a positive overjet and 89 percent maintained a positive overbite; 5 percent shifted to a neutral overbite. The methods used to manage jaw deformity, malocclusion, residual oronasal fistula, and bony defects in adolescents born with a cleft are safe and reliable and offer the patient an enhanced quality of life. They also provide a stable foundation in which final soft-tissue lip and nose revisions may be carried out.
我们回顾了一系列连续的青少年患者（67名男性，49名女性；年龄范围15至25岁；平均18岁）的并发症及长期结果，这些青少年出生时患有唇腭裂，童年期接受了一期修复，后来出现颌骨畸形和错牙合畸形，需要进行正颌手术。1986年至1992年间，116名患有单侧唇腭裂（n = 66）、双侧唇腭裂（n = 33）或孤立性腭裂（n = 17）的青少年接受了包括Le Fort I截骨术的正颌手术；32名患者同时接受了下颌骨矢状劈开截骨术；87名患者接受了骨成形颏成形术。在研究结束时，临床随访时间为1至7年（平均40个月）。术前临床检查因腭裂类型和个体差异而有所不同，但所有患者均有上颌骨发育不全。其他与腭裂相关的畸形包括残留口鼻瘘和骨缺损、保留牙间隙的腭裂牙槽嵴以及与外侧段未愈合的活动前颌骨。总体而言，89%的残留瘘管在正颌手术过程中成功闭合。92%的腭裂部位按计划实现并维持了手术性腭裂牙间隙闭合。在每个腭裂部位，均成功使用固定（修复）桥进行牙齿修复以关闭间隙（n = 9）。所有牙槽嵴裂患者（n = 99）在腭裂相邻牙齿（n = 264颗牙齿）的唇面均保留了角化黏膜。并发症较少且一般不严重。未因无菌性坏死或感染导致牙齿节段性骨丧失。由于上颌骨截骨术，仅5%的腭裂相邻牙齿出现一定程度牙龈退缩和牙根暴露；所有牙齿均长期保留。直接从术后晚期（>1年）头颅侧位X线片测量的覆盖和覆牙合的长期维持情况表明，97%的患者保持了正覆盖，89%的患者保持了正覆牙合；5%的患者转变为中性覆牙合。用于治疗患有唇腭裂青少年的颌骨畸形、错牙合畸形、残留口鼻瘘和骨缺损的方法安全可靠，可提高患者的生活质量。它们还为最终的唇部和鼻部软组织修复提供了稳定的基础。
