Can Occlusal Evaluation Determinate Future Maxillofacial Morphology of Children with Unilateral Cleft Lip and Palate?

对85例5岁、10岁和15岁以上的单侧唇腭裂患者进行了两项研究：(A)对单侧唇腭裂(CLA)、单侧唇腭裂(CLP)和单侧腭裂(CP)三种类型的单侧唇腭裂(CLA)、单侧唇腭裂(CLP)和单侧腭裂(CP)进行了颌面部生长发育的相关分析；(B)对38名男性和46名女性CLP患者从3个月到15岁或15岁以上的颌面部纵向生长模式进行了比较。从这两项研究中得出以下结论：(1)用5岁的指数或Goslon标准来评价咬合关系是一种简单的衡量上颌-下颌关系的方法，但这些指标直到那时才能评价颌面生长的结果。(2)在…，用Goslon标准在10岁时进行的咬合评价与用5岁的指数评价的结果相似在单侧唇腭裂患者中，正畸治疗5年以上有改善咬合关系的趋势。(3)唇裂和/或腭裂患者的咬合关系评估结果与唇裂和/或腭裂患者下颌骨生长的大小和方向有关，而与上颌骨生长无关。(4)在10岁时用Goslon标准评估的咬合状况与成年后的颌面生长无显著关系。这提示青春期颌面部的生长发育可能较好，并决定了成人面部的成熟轮廓。在这项研究中，有一些CLP受试者根据五岁指数和Goslon标准被归类为良好组，但在成年后接受了正颌手术。(5)从研究B比较受试者与CLA、CLP和CP受试者的颌面纵向生长，唇腭部整形手术都影响颌面生长，但不影响下颌生长。由于我们的腭裂修复手术是相同的，也就是改良的V-Y向后推进法，手术对颌面部生长的影响将在未来的中心间研究中进行评估和比较。(6)本研究表明，成年后的颌面部最终形态将取决于发育中的CLP儿童，尤其是青春期儿童的遗传生长潜力。我们需要评估更多因素的影响；其中包括整形手术、遗传背景，以预测唇腭裂患者的成熟颌面发育。较少

Two studies were carried out ;(Study A) Correlation analyses between the occlusal relationship evaluated by the Goslon Yardstick and the maxillofacial growth measured from longitudinal cephalographs taken on 85 subjects with unilateral cleft lip and palate at the ages of five, ten, and over fifteen.(Study B) Comparison of maxillofacial growth patterns from 3-4 months old to fifteen years or older taken on longitudinal cephalographs of 38 male and 46 female CLP subjects among three cleft types ; unilateral cleft lip and alveolus(CLA), unilateral cleft lip and palate(CLP), and isolated cleft palate(CP). The followings were concluded from these two studies(1) Occlusal evaluation by the Five-year-old index or the Goslon Yardstick is a simple measure to represent maxilla-mandibular relationship, but those measures evaluate the outcome of maxillofacial growth until the time.(2) The occlusal evaluation by the Goslon Yardstick at ten years was similar with the one by the Five-year-old index at … More five years, furthermore orthodontic treatment has a tendency to make the outcome of occlusal evaluation better.(3) The outcome of occlusal evaluation has a significant relation with the amount and direction of mandibular growth rather than maxillary growth affected by labioplasty and/or palatoplasty in the subjects with unilateral cleft lip and palate.(4) Occlusal outcome evaluated by the Goslon Yardstick at the age of ten had no significant relation with future maxillofacial growth after then until adulthood. This suggests the maxillofacial growth in puberty may be great and determined the matured facial profile in adult. In this study, there were some CLP subjects who had been classified in good groups by the five-year-old index and the Goslon Yardstick, but underwent Orthognathic surgery in adulthood.(5) From the Study B comparing the longitudinal maxillofacial growth among the subjects with CLA, CLP, and CP, both labial and palatal plastic surgeries affected maxillofacial growth, but not mandibular growth. As our surgical procedure for palatal repair was the same one, the modified V-Y push back method, the effects of surgical procedures on maxillofacial growth will be evaluated and compared by the inter-centers study in future.(6) This study suggests that final maxillofacial morphology in adulthood will be determined by the genetic growth potential of the growing CLP children, especially in puberty. We need to evaluate the effects of more factors ; ones by plastic surgeries, genetic background, in order to predict the matured maxillofacial growth of the subjects with cleft lip and/or palate. Less