Cleft‐Orthognathic Surgery: Complications and Long‐Term Results
Cleft‐Orthognathic Surgery: Complications and Long‐Term Results
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正颌手术：并发症和长期结果
DOI：
10.1097/00006534-199508000-00002
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发表时间：
1995
影响因子：
3.6
通讯作者：
B. Tompson
中科院分区：
文献类型：
--
作者：
J. Posnick;B. Tompson
我们回顾了一系列连续的青少年（67名男性，49名女性;年龄范围15至25岁;平均18岁）的并发症和长期结果，这些青少年在儿童时期接受了初次修复，后来发展为需要正颌手术的颌骨畸形和错牙合。1986年至1992年，116例单侧唇腭裂（n = 66），双侧唇腭裂（n = 33），或孤立性腭裂（n = 17）青少年进行了正颌手术，其中包括Le Fort I截骨术; 32例同时进行下颌骨矢状劈开截骨术; 87例进行了骨成形颏成形术。研究结束时的临床随访时间范围为1至7年（平均40个月）。术前临床检查因裂隙类型和个体差异而异，但所有患者均存在上颌骨发育不良。其他与唇腭裂相关的畸形包括残留的口鼻瘘和骨缺损、保留牙齿间隙的齿槽嵴裂开以及与侧段不愈合的移动的前上颌骨。总的来说，89%的残余瘘管作为正颌手术的一部分成功闭合。在92%的裂隙部位实现了手术裂隙闭合，并保持了计划的程度。所有其他患者（n = 9）均成功使用固定（修复）桥进行牙科修复，以闭合每个裂隙部位的差距。所有牙槽嵴裂患者（n = 99）保持角质化粘膜沿着唇面的裂相邻的牙齿（n = 264牙齿）。并发症很少，一般不严重。没有因无菌性坏死或感染而导致节段性骨质流失或牙齿缺失。由于上颌截骨术，只有5%的裂邻牙经历了一定程度的牙龈退缩和牙根暴露;所有牙齿都被长期保留。直接从术后晚期（>1年）的头颅侧位X线片测量的覆盖和覆牙合的长期维持表明，97%的患者保持正覆盖，89%的患者保持正覆牙合; 5%的患者转变为中性覆牙合。用于治疗先天性唇腭裂青少年的颌骨畸形、错牙合、残留口鼻瘘和骨缺损的方法安全可靠，可提高患者的生活质量。它们还提供了一个稳定的基础，在其中可以进行最终的软组织唇和鼻修正。
We reviewed the complications and long-term results of a consecutive series of adolescents (67 males, 49 females; age range 15 to 25 years; mean 18 years) born with a cleft who underwent primary repair in childhood and later developed a jaw deformity and malocclusion that required orthognathic surgery. Between 1986 and 1992, 116 adolescents with either unilateral cleft lip and palate (n = 66), bilateral cleft lip and palate (n = 33), or isolated cleft palate (n = 17) underwent an orthognathic procedure that included a Le Fort I osteotomy; 32 also underwent simultaneous sagittal split osteotomies of the mandible; and 87 underwent osteoplastic genioplasty. Clinical follow-up ranged from 1 to 7 years (mean 40 months) at the close of the study. The preoperative clinical examination varied according to cleft type and individual variation, but all patients had maxillary hypoplasia. Additional cleft-related deformities included residual oronasal fistula and bony defects, clefted alveolar ridges that retained dental gaps, and mobile premaxilla that lacked union to the lateral segments. Overall, 89 percent of residual fistulas underwent successful closure as part of the orthognathic procedure. Surgical cleft dental gap closure was achieved and maintained to the extent planned at 92 percent of the cleft sites. A fixed (prosthetic) bridge was used successfully for dental rehabilitation to close the gap in all other patients at each cleft site (n = 9). All patients with alveolar clefts (n = 99) maintained keratinized mucosa along the labial surface of the cleft-adjacent teeth (n = 264 teeth). Complications were few and generally not serious. There was no segmental bone loss or loss of teeth because of aseptic necrosis or infection. Only 5 percent of cleft adjacent teeth underwent a degree of gingival recession and root exposure as a result of the maxillary osteotomy procedure; all were retained long term. The long-term maintenance of overjet and overbite measured directly from the late (>1 year) postoperative lateral cephalometric radiograph indicated that 97 percent of patients maintained a positive overjet and 89 percent maintained a positive overbite; 5 percent shifted to a neutral overbite. The methods used to manage jaw deformity, malocclusion, residual oronasal fistula, and bony defects in adolescents born with a cleft are safe and reliable and offer the patient an enhanced quality of life. They also provide a stable foundation in which final soft-tissue lip and nose revisions may be carried out.