Owman-Moll P, Katsaros C, Friede H
Department of Orthodontics, Göteborg University, Sweden.
J Orofac Orthop. 1998;59(5):286-300. doi: 10.1007/BF01321795.
Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n = 7 or unilateral [UCLP]; n = 22) or isolated cleft palate (CP; n = 9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate. The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.
硬腭延迟关闭被认为可改善唇腭裂患者的上颌骨生长和面部外观。然而，腭帆关闭后硬腭的裂隙开口可能会损害语音发育。本研究的目的是研究双侧完全性唇腭裂（BCLP；n = 7）或单侧完全性唇腭裂（UCLP；n = 22）或孤立性腭裂（CP；n = 9）患儿在两期腭裂修复术（TSPR）后硬腭残余裂隙的发育情况。此外，我们旨在研究术前的任何形态学因素是否可预测残余裂隙的发育。使用反射显微镜分析在腭帆修复术前（平均年龄7个月）以及术后1.5、3、4、5和7年获得的牙模，以观察硬腭裂隙的宽度、长度和面积。在所有3种类型的腭裂患者中，腭部裂隙在术前和术后的大小均有所不同。UCLP亚组中，裂隙宽度在腭帆修复后立即显著减小，但随后平均保持稳定，直至硬腭最终手术关闭。在BCLP亚组中，裂隙最初较窄，术后保持不变。CP亚组中的裂隙，尤其是那些完全性腭裂患者，在腭成形术后仍较大。在4例UCLP患者和2例BCLP患者中，裂隙宽度逐渐增加。在UCLP和BCLP亚组的其他一些受试者中，残余裂隙随时间功能性关闭，但这种发展无法预见。
