目的 比较上颌前段牵张成骨术及Le Fort Ⅰ型截骨术矫治唇腭裂继发上颌发育不足的临床疗效.方法 选取南京医科大学附属口腔医院颌面外科唇腭裂上颌发育不足患者 25 例,其中利用牙支持式牵张器的上颌前段牵张成骨术 10 例,Le FortⅠ型截骨术15 例.术前1 周及术后1 个月拍摄锥形束CT、正侧貌相,语音评估及鼻咽纤维镜检查,分析两种术式的临床疗效.结果 两种术式均有效前徙上颌骨并明显改善患者侧貌,上颌前段牵张成骨术微创、经济,更有利于前移上颌骨;而Le Fort Ⅰ型截骨术后患者的侧貌更佳,差异有统计学意义(P＜0.05).两种术式对发音无显著影响,Le Fort Ⅰ型截骨术对腭咽部解剖影响更大,表现为软腭长度增加(2.01±1.71)mm、厚度减小(0.98±0.50)mm,咽腔深度增加(3.06±1.35)mm,差异有统计学意义(P＜0.05).结论 上颌前段牵张成骨从经济效益以及对软腭结构的影响上较Le Fort Ⅰ型截骨有优势.
Evaluation of two surgical methods for maxillary hypoplasia in patients with cleft lip and palate
Objective To evaluate the clinical efficacy of anterior maxillary segmental distraction osteogenesis and Le Fort Ⅰ Osteot-omy on secondary maxillary hypoplasia in patients with cleft lip and palate.Methods Twenty-five patients with maxillary hypoplasia secondary to cleft lip and palate underwent surgery in maxillofacial surgical department of the Affiliated Stomatological Hospital of Nan-jing Medical University were selected.Ten cases were treated using tooth-borne distractors for anterior maxillary distraction osteogene-sis,and fifteen cases underwent Le Fort Ⅰ Osteotomy.Cone-beam CT,positive and lateral features,speech recording and nasopharyn-geal fibroscope were taken one week before operation and one month after surgery.The clinical outcomes of the two methods and their influence on patients'speech function were measured and compared using t-test.Results Both techniques effectively advanced the maxilla and significantly improved the patients'profiles.Anterior maxillary segmental distraction osteogenesis,which was economical and minimally invasive,greater advanced the maxilla.However,the postoperative profile was better in patients undergoing Le Fort Ⅰ osteotomy,with statistically significant differences(P<0.05).Neither technique significantly affected speech,but Le Fort Ⅰ osteotomy had a greater impact on palatopharyngeal anatomy,indicated by increased soft palate length(2.01±1.71)mm,reduced thickness(0.98±0.50)mm,and increased pharyngeal depth(3.06±1.35)mm,with statistically significant differences(P<0.05).Conclusion Anterior maxillary segmental distraction osteogenesis and orthognathic surgery are both effective methods for the treatment of secondary maxillary hypoplasia in cleft lip and palate patients.Anterior maxillary distraction osteogenesis has advantages over Le Fort I osteotomy in terms of economic benefits and its impact on the soft palate structure.
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