两种术式矫治唇腭裂患者上颌发育不足的比较研究

doi:10.13591/j.cnki.kqyx.2024.12.003

Abstract

Abstract:

Objective To evaluate the clinical efficacy of anterior maxillary segmental distraction osteogenesis and Le Fort Ⅰ Osteotomy 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 Nanjing Medical University were selected. Ten cases were treated using tooth-borne distractors for anterior maxillary distraction osteogenesis, and fifteen cases underwent Le Fort Ⅰ Osteotomy. Cone-beam CT, positive and lateral features, speech recording and nasopharyngeal 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.

Key words: distraction osteogenesis, orthognathic surgery, cleft lip, cleft palate, speech evaluation

CLC Number:

R782.22

GUO Songsong, ZHANG Zhenxing, ZHANG Ping, JIANG Chenghui, CHENG Jie, JIANG Hongbing, LI Sheng. Evaluation of two surgical methods for maxillary hypoplasia in patients with cleft lip and palate[J]. Stomatology, 2024, 44(12): 892-898.

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References 25

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类型	测量项目	含义
上颌骨改变	Ax/mm	A点在X轴上的坐标
	SNA/(°)	S-N-A形成的角度
	ANS-Ptm/mm	ANS与Ptm点在X轴上投影点间的距离
	SNPP/(°)	ANS-PNS平面与SN平面的交角
	UI-SN/(°)	上切牙长轴与SN平面的交角
硬组织侧貌	SNB/(°)	S-N-B形成的角度
	ANB/(°)	SNA与SNB角的差值
	NA-PA/(°)	NA连线与PA连线的交角
	覆盖/mm	UI点与LI点在X轴上的投影点间的差值
软组织侧貌	Ns-Prn-Pgs/(°)	Ns-Prn-Pgs形成的角度
	As-Ns-Bs/(°)	As-Ns-Bs形成的角度
	Ns-Sn-Pgs/(°)	Ns-Sn-Pgs形成的角度,反映面型的凸度
腭咽部结构	软腭长度/mm	PNS与U的距离
	软腭厚度/mm	PNS-U的垂线与软腭最宽处两点相交形成的距离
	软硬腭交角/(°)	ANS-PNS平面与PNS-U平面的交角
	咽腔深度/mm	PNS与PPW的距离
	腭咽间隙/mm	Ve与Pe的距离
	骨性腭咽间隙/mm	Ve与Te的距离

测量项目	AMSDO(T2-T1)	Le FortⅠ型截骨术(T2-T1)	P
Ax/mm	6.91±1.73	2.82±0.69	0.00^a
SNA/(°)	7.74±1.65	5.01±0.98	0.00^a
ANS-Ptm/mm)	10.68±2.13	3.02±0.69	0.00^a
SNPP/(°)	-(3.11±1.64)	3.23±2.82	0.00^a
UI-SN/(°)	3.62±3.23	0.82±0.91	0.00^a

测量项目	AMSDO(T2-T1)	Le FortⅠ型截骨术(T2-T1)	P
覆盖/mm	11.02±1.82	8.21±1.39	0.00^a
SNB/(°)	-(0.41±0.65)	-(4.82±1.75)	0.00^a
ANB/(°)	7.32±1.86	9.61±2.02	0.00^a
NA-PA/(°)	13.82±1.94	14.81±3.66	0.22
Ns-Prn-Pgs/(°)	10.35±4.85	7.15±2.82	0.02^b
As-Ns-Bs/(°)	6.21±2.28	8.89±2.06	0.00^a
Ns-Sn-Pgs/(°)	2.25±1.60	6.65±2.08	0.00^a

测量项目	AMSDO组	Le FortⅠ组	P
软腭长度/mm	0.65±0.69	2.01±1.71	0.01^b
咽腔深度/mm	0.89±0.92	3.06±1.35	0.00^a
软硬腭交角/(°)	5.62±2.23	10.23±3.11	0.00^a
软腭厚度/mm	-(0.15±0.14)	-(0.98±0.50)	0.03^b
腭咽间隙/mm	0.06±0.10	0.39±0.33	0.00^a
骨性腭咽间隙/mm	0.12±0.16	0.58±0.62	0.02^b

测量项目	AMSDO组			Le FortⅠ组
测量项目	术前1周	术后1个月	P	术前1周	术后1个月	P
鼻音	1.60±0.22	1.70±0.21	0.75	2.07±0.18	2.00±0.20	0.80
语音可理解性	1.80±0.25	1.70±0.26	0.78	2.47±0.19	2.40±0.19	0.80
腭咽闭合功能	1.90±0.18	1.90±0.18	1.00	1.87±0.13	1.80±0.14	0.73
呼吸习惯	1.80±0.13	1.80±0.13	1.00	1.87±0.09	1.87±0.09	1.00

Evaluation of two surgical methods for maxillary hypoplasia in patients with cleft lip and palate

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