Joos U
Department of Oral and Maxillo-facial Surgery, University of Münster, Germany.
Br J Oral Maxillofac Surg. 1995 Jun;33(3):139-44. doi: 10.1016/0266-4356(95)90285-6.
To compare two treatments for unilateral cleft lip and palate.
Follow-up study.
University department, Germany.
110 children with unilateral cleft lip and palate, 50 of whom were treated between 1980 and 1988 (group 1) and 60 of whom were treated between 1970 and 1979 (group 2).
Group 1 had no dentofacial treatment before operation. At the age of 3 months they had musculoperiosteal reconstruction with no orthopaedic treatment postoperatively. At the age of 9-12 months they had the velar muscle reconstructed but no orthopaedic treatment to follow. Group 2 had dentofacial treatment before operation. At the age of 6 months they had their lips operated on by Millard's technique. Postoperatively they had dentofacial orthopaedic treatment followed, at the age of 2.5 years, by palatal surgery by the Campbell-Widmaier technique. This was followed by more dentofacial orthopaedic treatment. Main outcome measure--Growth of the midface skeleton.
The course of the anterior tooth segment was similar in the two groups, as was the transverse development of the maxilla. Analyses of both dental casts and lateral cephalometric radiographs showed that the skeletal development in group 1 (who had undergone reconstruction of the perioral and perinasal muscles) was better than in group 2 (who had not) despite the fact that group 1 had had no orthopaedic growth stimulation.
If the primary and secondary growth centres are not joined at the first operation and the midfacial muscles are not reconstructed, even orthopaedic growth stimulation will not compensate for the defect.
比较两种单侧唇腭裂治疗方法。
随访研究。
德国大学科室。
110名单侧唇腭裂患儿，其中50名在1980年至1988年接受治疗（第1组），60名在1970年至1979年接受治疗（第2组）。
第1组在手术前未进行牙颌面治疗。3个月大时进行肌骨膜重建，术后未进行正畸治疗。9至12个月大时进行腭肌重建，但后续未进行正畸治疗。第2组在手术前进行牙颌面治疗。6个月大时采用米勒德技术进行唇部手术。术后进行牙颌面正畸治疗，2.5岁时采用坎贝尔 - 维德迈尔技术进行腭裂手术。之后继续进行更多牙颌面正畸治疗。主要观察指标——面中部骨骼的生长。
两组前牙段的情况相似，上颌的横向发育情况也相似。对牙模和头颅侧位X线片的分析表明，尽管第1组未进行正畸生长刺激，但该组（接受了口周和鼻周肌肉重建）的骨骼发育优于第2组（未接受重建）。
如果在首次手术时一级和二级生长中心未连接且面中部肌肉未重建，即使进行正畸生长刺激也无法弥补缺陷。
