Lilja J, Friede H, Lohmander-Agerskov A
Plastikkirurgiska kliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
Lakartidningen. 1998 Mar 18;95(12):1250-2, 1255-6.
When cleft lip and palate treatment was introduced at Gothenburg in 1957, the procedure used was early bone grafting (EBG). By 1965, EBG had been omitted from the regimen, bone grafting being postponed until the appearance of mixed dentition. Analysis of the results of both techniques showed maxillary retrusion of different degrees. Accordingly, this routine was abandoned in 1975, being replaced by a procedure which is characterised by delayed closure of the hard palate (DCHP). Thus, the surgical procedure comprised the following steps: 1, lip closure at 1-2 months of age; 2, soft palate repair at 6-8 months; 3, final lip-nose surgery at 12 months; and 4, closure of the left in the hard palate, and bone grafting to the alveolar process during mixed dentition at about 8-10 years of age. Follow-up has shown the majority of patients to manifest acceptable speech development during childhood, though problems may occur in some cases. Maxillary growth has been found to be improved after DCHP, and at present the need of maxillary advancement surgery has been reduced to approximately 5% of cases, as compared with the former rates of 50% of cases among those treated with EBG, and of 25% among those treated with the vomer flap procedure.
1957年哥德堡引入唇腭裂治疗时，采用的方法是早期植骨术（EBG）。到1965年，该方案中已不再使用EBG，植骨术被推迟到混合牙列期进行。对这两种技术的结果分析显示存在不同程度的上颌后缩。因此，1975年放弃了这种常规方法，取而代之的是一种以硬腭延迟闭合（DCHP）为特征的手术方法。该手术步骤如下：1. 1 - 2个月大时进行唇裂修复；2. 6 - 8个月大时进行软腭裂修复；3. 12个月大时进行最终的唇鼻手术；4. 大约8 - 10岁混合牙列期时进行硬腭闭合及牙槽突植骨。随访显示，大多数患者在儿童期言语发育可接受，不过某些情况下可能会出现问题。已发现DCHP术后上颌生长得到改善，目前上颌前徙手术的需求已降至约5%的病例，而采用EBG治疗的病例此前这一比例为50%，采用犁骨瓣手术治疗的病例为25%。
