Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities.
Profile Changes and Stability following Distraction Osteogenesis with Rigid External Distraction in Adult Cleft Lip and Palate Deformities.
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DOI：
10.4103/ccd.ccd_1164_16
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发表时间：
2017-04
影响因子：
1.2
通讯作者：
Kuriakose M
中科院分区：
文献类型：
--
作者：
Painatt JM;Veeraraghavan R;Puthalath U;Peter S;Rao LP;Kuriakose M
本研究的目的是分析成人唇腭裂（CLP）患者使用刚性外部牵张装置进行牵张成骨（DO）后硬组织和软组织轮廓的变化以及上气道的变化。该研究还评估了手术结果的稳定性。拍摄了三张侧位X线头影测量片：牵引前（T1）、牵引后（T2）和牵引器取出后1年（T3）。分析治疗变化（T1与T2）和稳定性（T2与T3）。还评价了1年后的总体治疗变化（T1 vs. T3）。利用海豚软件对头颅侧位片进行数字化分析。采用Wilcoxon Signed-Ranks检验，概率值（P值）为0.05为统计学显著水平。对11例成人CLP患者进行回顾性分析。牵引后，上颌骨平均前移14 mm（P < 0.01），从T1值73.54 ± 10.38增加到T2值88.2 ± 10.49。下面部高度和切牙暴露量显著增加。鼻唇角由T1值56.6 ± 21.03改善为T2值81.18 ± 14.4，改善24.5°（P <0.01）;上气道由T1值13.5 ± 3.8改善为T2值17.2 ± 3.66，改善3.7mm（P <0.01）。1年随访后，上颌骨复发3.20 mm（P < 0.05），从T2值8.29 ± 6.84到T3值5.09 ± 5.59。然而，软组织轮廓和上气道保持稳定。临床医生应该了解相关的硬组织和软组织以及气道变化，这可能有助于他为患有DO的CLP患者计划上颌骨前移。有显着改善后立即分心，但在1年的随访中，一些复发。这强调了成人CLP患者需要约35%-40%的过度矫正。
The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%–40% for adult CLP patients.