Wood R J, Grayson B H, Cutting C B
Center for Cleft and Craniofacial Anomalies, Emory University School of Medicine, Atlanta, GA 30322, USA.
Cleft Palate Craniofac J. 1997 Jan;34(1):17-20. doi: 10.1597/1545-1569_1997_034_0017_gamg_2.3.co_2.
The objective of this study was to report the effect of gingivoperiosteoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and palate who underwent primary cleft lip and nose repair with and without gingivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years. All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgical orthopedics was performed by the same surgeon and the same orthodontist. Twenty-five consecutively treated patients who presented with complete unilateral clefts of the primary and secondary palate were included in the study. Of these, 20 patients were available for 6-year follow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement technique. The difference between the two groups was whether or not gingivoperiosteoplasty was performed. The reason for not performing gingivoperiosteoplasty was incomplete approximation of the alveolar segments usually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial base (S-N), maxilla (ANS-PNS), and mandible (Go-Pg) were digitized for shape coordinate analysis. No significant difference in the mean position of ANS-PNS was found between groups (with or without gingivoperiosteoplasty). There was, however, a significant difference in the variance of position for the points ANS-PNS between the groups (p < .002). We were unable to observe any difference (anteroposterior or supero-inferior) in the average position of the hard palate (ANS-PNS) between groups. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS-PNS) relative to patients that did not receive gingivoperiosteoplasty. We were unable to demonstrate any clear impairment of maxillary growth in the patients treated with gingivoperiosteoplasty when compared to patients treated without gingivoperiosteoplasty.
本研究的目的是报告牙龈骨膜成形术对一期手术修复后6年面中部骨骼生长的影响。通过头颅侧位片对接受或未接受牙龈骨膜成形术（GPP）的单侧完全性唇腭裂患者进行一期唇裂和鼻修复的情况进行回顾性比较。评估时的平均年龄为5.7岁。所有患者均在纽约大学医学中心重建整形外科研究所接受治疗。所有手术和术前正畸均由同一位外科医生和同一位正畸医生进行。本研究纳入了25例连续接受治疗的原发性和继发性腭裂单侧完全性腭裂患者。其中，20例患者可进行6年随访的头影测量记录和复查。所有患者均接受了使用被动塑形矫治器的术前正畸治疗，随后在3个月大时一期修复唇、牙槽突和鼻。修复采用旋转/推进技术。两组之间的差异在于是否进行牙龈骨膜成形术。未进行牙龈骨膜成形术的原因通常是牙槽突段对合不完全，这通常是由于治疗开始较晚。获取并描绘了头颅侧位片（一期手术后68.5个月）。对颅底（S-N）、上颌骨（ANS-PNS）和下颌骨（Go-Pg）进行数字化处理以进行形状坐标分析。两组之间（接受或未接受牙龈骨膜成形术）ANS-PNS的平均位置没有显著差异。然而，两组之间ANS-PNS点位置的方差存在显著差异（p < .002）。我们无法观察到两组之间硬腭（ANS-PNS）平均位置的任何差异（前后或上下）。我们得出结论，相对于未接受牙龈骨膜成形术的患者，牙龈骨膜成形术可使硬腭（ANS-PNS）的位置更加均匀。与未接受牙龈骨膜成形术治疗的患者相比，我们无法证明接受牙龈骨膜成形术治疗的患者上颌骨生长有任何明显受损。
