Smahel Z, Müllerová Z
Chair of Anthropology, Faculty of Natural Sciences, Charles University, Prague.
Acta Chir Plast. 1995;37(1):29-32.
The main problem of facial development in cleft palate consists of deficient anterior growth of the upper jaw. Roentgencephalometric data showed that the sagittal jaw relations deteriorated gradually from palate surgery up to adulthood. In spite of this adverse trend of growth, orthodontic therapy succeeded in improving the occlusion of incisors during prepubertal period. However during the pubertal growth spurt occurred an impairment of occlusion which was caused by the depletion of compensatory dentoalveolar mechanisms of the jaws due to the previous orthodontic treatment. An effective compensation of the gradual impairment of sagittal jaw relations can be attained with fixed appliances. These observations showed that the main problems of facial growth in clefts developed only after palate surgery and in particular during puberty. For favourable sagittal jaw relations and the configuration of the facial profile is of paramount importance the restoration of a positive overjet which exerts marked effects on the position of the mandible. On the other hand the configuration of the facial profile and the results of orthodontic therapy are affected by the rotation of the lower jaw and the amount of posterior displacement of the TM joint, which represent inborn growth patterns of the skull. The most favourable developmental situation represents the posterior displacement of the TM joint associated with neutral type of rotation. Therefore, it is of importance to predict the development of these characteristics.
腭裂患者面部发育的主要问题在于上颌前部生长不足。X线头影测量数据显示，从腭裂手术到成年期，矢状向颌骨关系逐渐恶化。尽管存在这种不利的生长趋势，但正畸治疗在青春期前成功改善了前牙咬合。然而，在青春期生长突增期间，由于先前正畸治疗导致颌骨代偿性牙牙槽机制耗竭，出现了咬合障碍。使用固定矫治器可以有效补偿矢状向颌骨关系的逐渐损害。这些观察结果表明，腭裂患者面部生长的主要问题仅在腭裂手术后出现，尤其是在青春期。对于有利的矢状向颌骨关系和面部轮廓形态而言，恢复正向覆盖至关重要，其对下颌位置有显著影响。另一方面，面部轮廓形态和正畸治疗结果受下颌旋转以及颞下颌关节后移位量的影响，这代表了颅骨的先天性生长模式。最有利的发育情况是颞下颌关节后移位并伴有中性旋转类型。因此，预测这些特征的发展很重要。
