正畸-正颌联合防治唇腭裂术后牙颌面畸形

目的：探索唇腭裂患术后牙颌面畸形正畸-正颌外科的防治方法。方法：56例唇腭裂伴牙颌面畸形患者，男性30例，女性26例，年龄8～38岁。其中25例患者为替牙列期或恒牙列初期，31例为恒牙列期。所有患者均进行正畸治疗，替牙列或恒牙列初期采用唇挡或颅颌面架干预性诱导上颌骨前后位的发育，上牙弓扩弓器扩大上颌骨左右位的发育并行牙槽裂植骨术；恒牙列期患者在完成排挤牙列、矫正错位牙、去代偿、关闭间隙等正畸治疗，手术方法如下：①伴牙槽裂的患者前期行髂骨取骨植骨术；②上颌Le Fort I型截骨前徙术；③上颌多片段Le Fort I型截骨术；④上颌Le Fort I型截骨术＋双侧下颌升支矢状劈开术（BSSRO）；⑤BSSRO＋颏成形术。所有病例骨间均用钛板钛钉坚强内固定，并辅以2～3周颌间牵引固定。术后应配合正畸治疗并定期随访12～49月。结果：青少年患者经唇挡、腭弓扩大矫正器和上颌前牵引面架干预性诱导上颌骨发育，伴牙槽裂患者行牙槽裂植骨术，其颜面形态及牙牙A关系明显改善；成人患者经正畸-正颌-正畸治疗模式后，面部比例协调，咬合关系及面型均较满意。结论：正畸-正颌外科联合防治唇腭裂术后牙颌面畸形的疗效确切；应以患者牙袷关系的具体情况、要求等因素，采用个体化的综合治疗方案宜于推崇。

The prevention and treatment of secondary dento-maxillofacial deformities with orthodontics and orthognathic surgery following the repair of cleft lip and palate

Objective To prevent and treat secondary dento-maxillofacial deformities via the joint orthodontics and orthognathie surgery following the repair cleft lip and palate and to evaluate their outcomes. Methods 56 cases with secondary dento-maxitlofacial deformities following the repair cleft lip and palate were prevented and corrected by the joint orthodontics and orthognathic surgery in our hospital. There were 30 males and 26 females, ranging from 8 to 38 years in age. 25 teenage cases were performed maxillofacial growth by orthodontics and alveolar bone graft. 31 adult cases were undergone preoperative orthodontics, their surgical procedures included：①alveolar bone graft before orthoganathic procedure; ② Le Fort I osteotomy; ③multisegment Le Fort I osteotomy; ④Le Fort I osteotomy and bilateral sagittal split ramus osteotomy （BSSRO）;⑤BSSRO and genioplasty. Rigid internal fixation with Titanium palates and screws was applied and elastic traction of 2-3 weeks intermaxillary was essential in each case. All patients were undergone postoperative orthodontics and followed-up and ranged from 12 to 49 months. Results The teenage patients had a much-improved facial profile and occlusion. The adult cases had a satisfactory facial proportion with a good occlusion relationship and facial figure. Conclusion The joint orthodontics and orthognathic surgery could be performed satisfactorily to prevent and correct secondary dento-maxillofacial deformities following the repair cleft lip and palate. The authors recommend the joint orthodontics and orthognathic surgery should have individuation basing on patients＇ occlusion relationship and their requirements.