唇腭裂术后上颌骨发育不良骨牵引矫治的临床研究

目的:探讨口内入路牵引成骨技术在唇腭裂术后继发上颌骨发育不良患者成年之前矫治中的作用。方法:对12例9～12岁唇腭裂术后继发上颌骨明显发育不良者,采用高位LeFortI型截骨术,将上颌骨完全断离,安装口内牵引器,按一定的速度和频率牵引上颌骨向前,对术前、术后头颅定位X线侧位片进行颅颌面软硬组织的测量分析,数据以SPSS10.0统计软件包进行t检验。结果:本组病例上颌骨牵引前移明显,SNA角增加7°～11°,软组织鼻尖点、鼻底点及上唇最突点明显前移,面部外形得到明显改善,上下前牙获得正常覆牙合、覆盖关系。随访3～36个月,咬合关系保持稳定。结论:骨牵引成骨技术可以很好地用于矫治唇腭裂术后继发上颌骨发育不良,早期解除上颌骨畸形,使面部软组织得到适应性改变,面型更为协调,避免或减轻口颌系统继发畸形和功能障碍,不失为唇腭裂术后继发上颌骨发育不良的有效治疗方法。     

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目的    探讨口内入路牵引成骨术配合语音治疗对唇腭裂术后继发上颌骨发育不良患者的治疗效果。方法    对2007—2009年在南昌大学口腔医院接受治疗的9 ~ 12岁唇腭裂术后继发上颌骨发育不良畸形患者21例采用高位Le Fort I型截骨术,将上颌骨完全断离,安装口内牵引器,术后3个月开始语音训练,定期接受发音指导和语音测评,记录结果并进行统计分析。结果    21例患者手术效果满意,未见严重并发症,通过语音治疗,发音改善明显。结论    骨牵引成骨术用于矫治唇腭裂术后继发上颌骨发育不良,可早期解除上颌骨畸形,在一定程度上改善患者的腭咽闭合功能,再配合语音治疗可有效提高语音效果。     

Short-term changes in temporomandibular joint function in subjects with cleft lip and palate treated with maxillary distraction osteogenesis

OBJECTIVES: To investigate the short-term effects of maxillary distraction osteogenesis (DO) on temporomandibular joint (TMJ) function in 21 subjects with cleft lip and palate (CLP). Design - Morphological changes in the maxillofacial region were measured using lateral cephalometric radiographs taken immediately before (pre-DO) and after DO (post-DO) and 1 year after DO (1-year follow-up). A questionnaire was evaluated using a visual analog scale. A chi-square test was used to compare the prevalence of TMJ symptoms between pre-DO and 1-year follow-up. The Spearman correlation coefficient was used to determine the correlation between changes in cephalometric variables and TMJ symptoms in association with maxillary DO. Statistical significance was set at p < 0.05. Results - The ANB (anteroposterior relationship of the maxilla with the mandible) angle and the mandibular plane angle at pre-DO, post-DO, and 1-year follow-up were -4.3 degrees , +5.8 degrees , +4.3 degrees and 32.1 degrees , 33.5 degrees , 33.6 degrees , respectively. The average amounts of anterior and downward movement of the maxilla at post-DO and 1-year follow-up were 8.3, -1.3 and 0.9, 1.1 mm, respectively. The prevalence of TMJ symptoms showed no significant increase in association with maxillary DO. Moreover, there was no significant correlation between changes in cephalometric variables and TMJ symptoms. Conclusion - These results suggest that there was no short-term (i.e., up to 1 year after DO) effect of maxillary DO on TMJ function in subjects with CLP.     

牙附着式牵张成骨装置的研制及在牙槽突裂整复中的应用

目的:研制牙附着式口内牵张成骨装置整复牙槽突裂,探索牙槽突裂手术治疗的新途径。方法:自行研制牙附着式牵张装置,建立人工牙槽突裂的动物模型,8只成年杂种犬为实验组,对照组2只。以牙骨复合体作为转运盘,牵张器通过牙带环固定,并安装上颌牙弓弓丝。术后第7 d起,以每次0.4 mm的速度,每日2次沿弓丝方向行三维牵张成骨,直到关闭硬组织裂隙。0、14、28、63 d各处死动物2只,对照组动物在建立牙槽突裂模型12周后处死。进行X线摄片、大体标本和组织学观察。结果:利用牙附着式牵张装置,成功地进行牙槽突裂牵张成骨整复术,牙槽突硬组织裂隙关闭;骨牵张间隙完全为新生骨组织取代。结论:自行研制的牙附着式口内牵张装置设计合理,应用良好,牵张成骨提供了牙槽突裂治疗的新途径。     

Mandibular effects of maxillary distraction osteogenesis in cleft lip and palate

Maxillary distraction osteogenesis (DO) is a reliable treatment for severe maxillary deficiency in cleft lip and palate (CLP). The objective was to analyze its long-term effects on the mandible. A retrospective study of 24 CLP treated with maxillary DO using the Polley and Figueroa technique was done; patients were followed for more than 4 years. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess treatment stability, and a Procrustes superimposition method was used to assess local changes in the shape of the mandible. The mean age of patients at T0 was 15.4 ± 4.1 years. SNA increased at T1 and T2 (P < 0.001), with no significant relapse between T1 and T2, indicating stability at 1 year after treatment (T0 = 72.4 ± 5.3°; T1 = 81.3 ± 6.2°; T2 = 79.9 ± 6.1°). SNB, facial angle, gonial angle, and symphyseal angle remained stable. Long-term analysis of the mandible demonstrated a minimal counter-clockwise rotation of the body (mandibular plane = −0.2 ± 3.2°) and ramus (−0.6 ± 4.3°). Maxillary DO in CLP had no significant effect on the shape or rotation of the mandible. The maxillary advancement remained stable after 1 year.     

Effects of maxillary distraction osteogenesis on the upper-airway size and nasal resistance in subjects with cleft lip and palate

OBJECTIVES: To investigate the short- and long-term effects of maxillary distraction osteogenesis (DOG) on the upper-airway size and nasal resistance in nine patients with cleft lip and palate (CLP). STUDY DESIGN: Changes in the upper-airway size were measured by using lateral cephalometric radiographs taken immediately before and after DOG, and 1 year later. Nasal resistance was measured with a rhinomanometer. An analysis of variance was used to establish statistical significance. Spearman correlation coefficient was used to evaluate the relationship between changes in the cross-sectional area of the upper airway and nasal resistance in association with DOG. RESULTS: Immediately after DOG, the anteroposterior dimension of the superior part of the upper airway was significantly increased (p < 0.01) and nasal resistance was significantly decreased (p < 0.05). Moreover, the cross-sectional area of the total upper airway was significantly increased (p < 0.01). There was a significant correlation between the increase in the upper-airway cross-sectional area and the reduction in nasal resistance (p < 0.05). The upper-airway size was significantly augmented (p < 0.05) and nasal resistance was significantly reduced (p < 0.05) at 1 year after DOG compared with immediately before DOG. CONCLUSION: An increase in the upper-airway size and a reduction in nasal resistance occurred after maxillary DOG in patients with CLP, and these changes were stable after 1 year.     

Adult patient with bilateral cleft lip and palate treated using bone graft followed by lateral distraction: A case report

This is a case report of comprehensive treatment describing the management of an adult patient with bilateral cleft lip and palate who showed severe maxillary transverse deficiency caused by bilateral alveolar clefts. Since the residual alveolar clefts were extremely wide, we performed bone graft into the alveolar clefts first and then expanded the asymmetrically narrowed maxilla by asymmetric transverse distraction osteogenesis, in which an incision for osteotomy was made at the repaired bone bridge. The treatment accomplished successful reconstruction of the dental arches and occlusion. Aesthetic improvement was noted, with no discernible post-treatment relapse of occlusion after two years’ retention.     

截骨牵张联合骨缝牵张对腭裂修复后咬合关系影响的实验研究

目的:观察截骨牵张联合骨缝牵张对腭裂修复近期咬合关系的影响。方法:健康杂种幼犬6只,建立Ⅱ°腭裂模型,3~4周后沿腭外侧缝内侧1 mm纵行切开腭骨水平板,腭横缝区不截骨,立即以250~280 g力持续向内侧和后方牵张至硬腭裂隙关闭,裂隙关闭1周后进入保持期。分别于牵张结束即刻、1、2、4、8、12周处死动物,对牵张过程中咬合关系的变化进行观察,对牵张前后上颌牙列模型进行测量分析。结果:所有实验犬牵张5~7 d后人工裂隙逐渐关闭,牵张过程中上、下颌咬合关系稳定,上颌牙弓左、右对称,上颌牙弓长度、宽度较术前增加,有显著性差异(P<0.05)。结论:截骨牵张联合缝牵张不会导致咬合关系的改变,但对颌骨形态存在影响。     

Periodontal changes following distraction osteogenesis in patients with cleft lip and palate: a clinical trial

ObjectivesTo evaluate inflammatory mediator levels and periodontal changes following distraction osteogenesis (DO) in patients with cleft lip and palate (CLP) using mid-maxillary distraction (MMD).Materials and MethodsA total of 20 healthy patients with CLP with Class III malocclusion were included. Segmental forward advancement of the anterior maxilla from the second premolars on both sides using DO was performed. A custom-made, tooth-borne distractor connecting buccal molar segments to the anterior maxilla was used for 7 days with 0.5-mm distraction for the first 2 days and then increased to 1 mm daily until overcorrection. Crevicular interleukin IL-1β and tumor necrosis factor TNF-α levels were measured during distraction. Periodontal clinical parameters and indices were recorded at baseline and 3 and 6 months postoperatively. Soft tissue healing was evaluated histologically at 2 and 4 weeks after distraction.ResultsThe periodontal parameters remained stable during the follow-up periods. Insignificant increases in the level of inflammatory cytokines compared with the control were observed. Histological findings revealed mild inflammatory and structural changes in the gingiva immediately after distraction, whereas regeneration was noticed after 4 weeks.ConclusionsMMD was an effective technique in treating patients with CLP, leading to new bone and soft tissue formation without significant detrimental effect on the periodontium of the adjacent teeth.     

牵张成骨在腭裂畸形矫治中应用的研究进展

腭裂是颌面部较常见的先天性发育畸形,其原发或继发畸形均会影响患者的口颌系统功能和身心健康。牵张成骨（DO）是矫治颌面部骨骼畸形和组织缺损的新型外科技术之一,利用其矫治先天性腭裂的原发或继发畸形的研究已取得一定的效果。本文对动物实验和临床应用中的术期选择、手术方式、牵张装置的设计、牵张时机、可能的并发症及其预后等方面进行综述,以诠释DO技术在关闭原发性腭裂裂隙、延长硬腭长度、矫治牙槽突裂、矫治继发性上颌骨发育不全中的研究和应用。     

Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates: Distraction osteogenesis performed separately for each bone segment

IntroductionPatients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results.Material and methodsThe subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia.ResultsAll patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory.ConclusionsThis method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments.     

应用牙间牵引成骨辅助唇腭裂牙槽植骨术前治疗1例报告

对于牙槽裂隙过宽（大于1个尖牙宽度）、裂隙两侧骨端错位、重叠或存在垂直落差的情况,直接植骨难度大、成功率低。牙间牵引成骨技术能有效减小牙槽裂隙宽度,获得新生软硬组织,为牙槽裂辅助治疗提供了一种新途径。牙间牵引成骨器的设计多样化,应结合病例难易程度选择不同固位方式,在保证牵引方向的同时,力求加力简便有效,牵引器稳固舒适。     

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双侧唇裂或(和)唇腭裂一期整复后,尽管修复了唇裂或唇腭裂,但仍有诸多畸形存在,如鼻尖低平、鼻小柱短小、双侧鼻孔不等大对称、鼻翼塌陷、鼻堤缺失;上唇过紧、人中     

唇腭裂患者不同截骨方式下上颌骨外置式牵引成骨的比较

目的：利用颅外支架外固定式牵引器治疗唇腭裂继发上颌骨重度发育不足患者,分别采用上颌骨前段截骨和整块截骨方式,探讨不同截骨方式的牵引成骨效果。方法：唇腭裂术后继发上颌骨重度发育不足患者10例,反覆盖均超过10mm。采用传统整块截骨5例,前段分块截骨5例,均利用颅外支架固定式牵引器行术后牵引。通过头影测量分析,比较其矫治效果。利用SPSS13.0软件包对数据进行独立样本t检验。结果：所有患者均成骨良好,无明显并发症,面形及咬合显著改善。牵引成骨后,SNA角、NA与FH夹角、前牙覆盖、零子午线与Sn距离等显著增加。前段截骨组硬腭长度增加7.50mm,2组间有显著差异（P〈0.05）。而软腭长度、静止位腭咽腔深度无显著差异。结论：上颌骨前段截骨牵引在增加硬腭和牙弓长度、避免腭咽腔深度增加及腭咽闭合功能恶化方面具有更大优势,是一种较为理想的矫治唇腭裂术后继发上颌骨发育不足的方法。     

牵引成骨术治疗唇腭裂继发颌骨畸形稳定性的研究进展

牵引成骨术（distraction osteogenesis,DO）在口腔颌面外科的应用越来越广,为唇腭裂继发颌骨畸形治疗提供了新的手段。DO按牵引类型主要分为内置式牵引（intraoral distraction osteogenesis, IDO）和外置式牵引（extraoral distraction osteogenesis, EDO）2种,在大距离前徙上颌骨时,唇腭裂牵引成骨术后的长期稳定性和复发的报道还很少。本文就牵引成骨治疗唇腭裂继发颌骨畸形术后的长期稳定性的临床研究进展作一综述。     

Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用与评价

目的:观察分析Le Fort Ⅰ型截骨术在唇腭裂正颌外科中的应用效果.方法:回顾2004年3月至2006年12月武汉大学口腔医学院口腔颌面外科收治的唇腭裂患者的临床资料,并进行总结与分析,所有患者均进行了以Le Fort Ⅰ型截骨术为主的正颌外科治疗.结果:共收集相关病例16例,其中男9例,女7例,平均年龄22.4岁.术前∠SNA平均73.2°,术后LSNA平均79.5°;上颌前移距离平均8.13mm.平均随访时间7.3个月.所有患者术后面容改善明显,经正畸治疗后咬合关系满意.结论:以Le Fort Ⅰ型截骨术为主的正颌外科治疗,可以显著改善唇腭裂患者的颌骨与面容畸形.     

唇腭裂患者上颌骨牵引成骨术后口鼻腔共鸣的变化

目的:通过研究行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)的唇腭裂患者前后过度鼻音、过低鼻音的变化,并结合腭咽部结构功能变化、上颌骨前移幅度等因素,综合分析上颌骨RED对口鼻腔共鸣的影响。方法:1999年至2001年行RED治疗的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED手术前后语音测听、拍摄静止位及[i]位头颅定位片测量腭咽闭合功能,对检测结果行非参数检验。结果:RED术后患者过度鼻音程度显著加重。RED前61.9%患者存在过度鼻音,RED术后增至90.5%,所有患者均未出现过低鼻音。上颌骨前移幅度对患者术后过度鼻音加重程度有显著影响。患者腭咽闭合冠状收缩不全率(RVCR)和RED前的过度鼻音程度也直接影响术后的过度鼻音程度。结论:唇腭裂患者经RED前移上颌骨后,鼻腔共鸣增加,过度鼻音加重。     

Tooth agenesis patterns in bilateral cleft lip and palate

Bartzela TN, Carels CEL, Bronkhorst EM, Rønning E, Rizell S, Kuijpers-Jagtman AM. Tooth agenesis patterns in bilateral cleft lip and palate. Eur J Oral Sci 2010; 118: 47–52. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci
Individuals with cleft lip and palate present significantly more dental anomalies, even outside the cleft area, than do individuals without clefts. Our aim was to evaluate the prevalence of tooth agenesis and patterns of hypodontia in a large sample of patients with complete bilateral cleft lip and palate (BCLP). Serial panoramic radiographs (the first radiograph was taken at 10.5–13.5 yr of age) of 240 patients with BCLP (172 male patients, 68 female patients) were examined. Third molars were not included in the evaluation. Agenesis of at least one tooth was present in 59.8% of patients. Upper laterals and upper and lower second premolars were missing most frequently. Using the tooth agenesis code (TAC), 52 different agenesis patterns were identified, of which simultaneous agenesis of 12, 22, 15, 25, 35, and 45 was the most frequent pattern. Nine of the 240 patients showed combined BCLP and oligodontia.     

Asymmetric lip-closing forces in children with repaired unilateral cleft lip and/or palate

The objectives of this study were to estimate the effects of cleft lip and/or palate (CLP) repair on the multidirectional lip-closing forces (LCF) produced during maximum voluntary pursing-like lip-closing movement in children. Thirty Japanese children were divided into the control group and repaired unilateral CLP (RUCL) group, which was subdivided into the unilateral cleft lip and/or alveolus (UCLA) and the unilateral cleft lip and cleft palate (UCLP) groups. The maximum voluntary LCF were recorded in eight directions. No significant differences in any of the directional LCF (DLCF) or total LCF were observed between RUCL and control groups. Symmetrical DLCF were seen in the oblique directions on both sides of the upper lip in the control group, while the oblique DLCF on the non-cleft side was significantly greater than that on the cleft side in RUCL group. Furthermore, symmetrical vertical DLCF were observed in the upper and lower directions in control and UCLA groups, while the vertical DLCF obtained from the lower direction was significantly greater than that obtained from the upper direction in UCLP group. These results indicate that children with repaired CLP display impaired directional specificity, which may cause secondary deformities. These findings aid our understanding of the pathology of secondary deformities in CLP patients after primary surgery for cleft lip or palate. We propose that quantitative assessments of lip-closing function based on the directional specificity of the multidirectional LCF produced during maximum voluntary pursing-like lip-closing movement are useful for assessing the nature of lip-closing dysfunctions.