上颌骨牵引成骨术对腭裂患者腭咽部结构的影响

目的:探讨内置式上颌骨牵引成骨术(distraction osteogenesis, DO)对腭裂患者腭咽部结构的影响.方法:唇腭裂术后继发重度上颌骨发育不足畸形患者10例,男7例,女3例,平均年龄20.1岁,所有患者施行上颌高位台阶状LeFort Ⅰ型截骨术后,均采用内置式牵引器前徙上颌骨,术前、牵引完成时、牵引完成后6个月拍摄静止位定位头颅侧位片,定点测量6个腭咽部结构指标,进行统计分析.结果:所有患者均成功完成上颌骨DO,平均前徙距离为11.3 mm.牵引完成时及完成后6个月鼻棘点至咽后壁的距离、软腭鼻腔面最突点至咽后壁的距离、软腭长度及软硬腭交角与牵引前相比均有显著增加,而软腭厚度则明显减小,牵引距离与腭咽部结构变化程度间无明显相关关系.结论:采用内置式DO技术前徙上颌骨治疗腭裂继发上颌骨发育不足畸形会造成患者腭咽腔深度显著增加,可能会使腭咽闭合功能受损,但腭咽部软组织的代偿性改变会在一定程度上减轻这种损害.

Effects of maxillary distraction osteogenesis on the velopharyngeal configuration of cleft palate patients

OBJECTIVE: To study the effects of internal maxillary distraction osteogenesis(DO) on the velopharyngeal configuration of cleft palate patients. METHODS: Ten patients with severe maxillary hypoplasia secondary to cleft lip and palate patients (7 males and 3 females, average age 20.1 years old) had undertaken high step LeFort I osteotomy, and internal maxillary distraction devices were applied to advance the maxilla. Before surgery, when DO was completed and 6 months after DO was completed, oriented lateral cephalograms at rest position of each patient were taken, and 6 measure indexes of velopharyngeal configuration were collected and analyzed. RESULTS: All patients had successfully accomplished maxillary DO and the maxilla had been averagely advanced 11.3 mm. PNS-PhW, C-PhW, UL and ANS-PNS-T had all significantly increased, and UD had significantly decreased when DO was completed and 6 months after DO was completed as compared with pre-surgery. No significant linear correlation was found between maxilla advancement distance and velopharyngeal configuration changes. CONCLUSION: Correction of maxillary hypoplasia secondary to cleft palate surgery by using internal maxillary DO can increase the velopharyngeal cavity depth, and may impair velopharyngeal competence, but the compensatory changes of velopharyngeal soft tissue can alleviate this impairment to certain extent.