Surgical and orthodontic approach for a patient with a severely constricted maxillary arch caused by bilateral cleft lip and palate
Surgical and orthodontic approach for a patient with a severely constricted maxillary arch caused by bilateral cleft lip and palate
复制标题
双侧唇腭裂导致上颌弓严重缩窄患者的手术和正畸治疗方法
DOI：
10.1080/13440241.2020.1751456
复制
发表时间：
2020
影响因子：
0.4
通讯作者：
Yamashiro Takashi
中科院分区：
文献类型：
--
作者：
Oka Ayaka;Kurosaka Hiroshi;Nakatsugawa Kohei;Yamashiro Takashi
目的唇腭裂(CLP)是头面部最常见的畸形之一，发生在活产儿的1/500~1/1000之间，不同的种族背景不同。在各种类型的面裂中，完全性双侧唇腭裂(BCLP)因其上颌牙弓畸形和严重的骨性错位而成为正畸和外科医生最具挑战性的病例之一。众所周知，在某些先天性疾病中，CLP也可以作为表型的一部分出现。然而，从其极其多样化的表型组合来看，我们遇到的一些病例仍然很难诊断。在本病例报告中，一位18岁的男性患者，双侧完全性唇腭裂，骨性III类，张开咬合伴上颌骨狭窄，除有尿道下裂、上颌骨膨出、反张和高张外，还接受了方丝弓矫治器治疗，结合正颌外科手术。治疗开始于手术辅助的快速腭部扩张术(SARPE)，在前后和横向尺寸上使用三向扩张器来增加上颌骨的前后长度和宽度。扩弓后，患者接受Le Fort I截骨术和双侧矢状劈开截骨术矫正骨性III类和开放咬合。结果与结论在手术和正畸治疗结束时，患者获得了功能性咬合，面部轮廓得到改善。我们还讨论了由于他的先天性疾病而导致的不同的一般表型。
PurposeCleft lip and/or palate (CLP) is one of the most frequent craniofacial defects that could happen in 1/500 to 1/1000 live birth depending on different racial background. Among different patterns of facial cleft, complete bilateral cleft lip and palate (BCLP) is one of the most challenging cases for orthodontic and surgeons because of their deformed maxillary dental arch and severe skeletal discrepancy. It is also well known that CLP could occur as part of the phenotype in certain congenital diseases. However, from its extremely diversified phenotypic combination, some of the cases that we encounter remains difficult to diagnose. From these reasons, it is important to continuously report the outcome of orthodontic treatment in such cases which exhibit syndromic phenotypes with CLP.Material and MethodsIn the present case report, an 18-year-old man with complete bilateral cleft lip and palate, skeletal Class III and open-bite with maxillary constriction, in addition to hypospadias, bubonocele, opisthotonus, and hypertonia was treated with edgewise appliance therapy combined with orthognathic surgery. The treatment began with surgically assisted rapid palatal expansion (SARPE) in anteroposterior and transverse dimensions with a three-way expander to increase the maxillary anteroposterior length and width. After the expansion, the patient underwent Le Fort I osteotomy and bilateral sagittal split osteotomy to correct skeletal Class III and open bite.Results and ConclusionAt the end of the surgical and orthodontic treatments, functional occlusion and an improved facial profile were achieved. We also discuss his diverse general phenotype due to his congenital disease.