Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate
Midfacial Changes Through Anterior Maxillary Distraction Osteogenesis in Patients With Cleft Lip and Palate
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DOI：
10.1097/scs.0000000000003506
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发表时间：
2017-06-01
影响因子：
0.9
通讯作者：
Igarashi, Kaoru
中科院分区：
文献类型：
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作者：
Kanzaki, Hiroyuki;Imai, Yoshimichi;Igarashi, Kaoru
上颌骨发育不全是唇腭裂患者的主要问题，需要可预测的手术上颌骨前移。在本研究中，通过与Le Fort I型截骨术（LFI）和上颌骨牵引成骨术（DO）结合刚性外牵引（RED）的比较，研究了单侧唇腭裂和孤立性腭裂患者应用口内扩张器进行上颌骨前牵引成骨术（AMDO）后上颌骨和软组织侧貌的变化和稳定性。10例患者接受了正颌治疗与AMDO检查（AMDO组）。根据牵引前、牵引结束时和术后1年拍摄的头颅侧位片计算软硬组织标志位置的变化。与7例LFI组（LFI组）和6例RED组（RED组）比较，AMDO组和RED组的A点变化相似。在DO期间，与RED组相比，AMDO组的下颌骨顺时针旋转较少。AMDO组上唇和鼻部的软组织前移与RED组相似，但明显大于LFI组，提示AMDO可以作为唇腭裂患者的手术选择，其创伤小，但面中部骨骼和软组织的改善与DO-RED相似。
Maxillary hypoplasia is a major issue in cleft lip and palate patients, and predictable surgical maxillary advancement is required. In the present study, the changes and stability of the maxilla and soft tissue profile achieved after the application of anterior maxillary distraction osteogenesis (AMDO) using intraoral expander in unilateral cleft lip and palate and isolated cleft palate patients were investigated by comparing to the Le Fort I osteotomy (LFI) and maxillary distraction osteogenesis (DO) with rigid external distraction (RED) system.Ten patients who underwent orthognathic treatment with AMDO were examined (AMDO group). Changes in the positions of soft and hard tissue landmarks were calculated from the lateral cephalograms taken before the distraction, at the end of the distraction, and 1 year after the surgery. They were compared with the changes in 7 other unilateral cleft lip and palate patients who underwent LFI (LFI group) and 6 others who underwent DO with RED (RED group).The mean maxillary advancement of the AMDO group was similar to that of the RED group, judged by the change of point A. During DO, the AMDO group showed less clockwise rotation of mandible compared to the RED group. The soft tissue advancement of the upper lip and nose in the AMDO group was similar to that in the RED group, which was significantly larger than that in the LFI group.Our results indicate that AMDO can be surgical option to cleft lip and palate patients with less invasive but excellent improvement in both midfacial skeletal and soft tissue similar to DO-RED.