改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort I型前徙术对唇腭裂患者腭咽部结构的影响

doi:10.19438/j.cjoms.2020.05.009

中国口腔颌面外科杂志 ›› 2020, Vol. 18 ›› Issue (5): 427-433.doi: 10.19438/j.cjoms.2020.05.009

改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort I型前徙术对唇腭裂患者腭咽部结构的影响

牟思璇, 朱妍菲, 杜常欣, 王雪纯, 吴艳棋, 梅鹏, 王旭东, 朱敏

上海交通大学医学院附属第九人民医院·口腔医学院口腔颅颌面科,国家口腔疾病临床医学研究中心, 上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011

收稿日期:2020-03-25 修回日期:2020-05-14 出版日期:2020-09-20 发布日期:2020-10-28
通讯作者: 朱敏,E-mail：zminnie@126.com
作者简介:牟思璇（1992）,女,硕士研究生,E-mail：sharon568@qq.com
基金资助:
上海市科学技术委员会研究项目（17411964100）

Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients

MOU Szu-hsuan, ZHU Yan-fei, DU Chang-xin, WANG Xue-chun, WU Yan-qi, MEI Peng, WANG Xu-dong, ZHU Min

Department of Oral and Craniofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2020-03-25 Revised:2020-05-14 Online:2020-09-20 Published:2020-10-28

摘要/Abstract

摘要： 目的：比较改良牙支持式上颌骨前部牵引成骨术（anterior maxillary segmental distraction osteogenesis,AMSDO）及上颌骨Le Fort I型截骨术对唇腭裂(cleft lip palate,CLP)患者腭咽部结构的影响。方法：选择32例唇腭裂继发上颌骨发育不足患者,分为AMSDO组（16例）和上颌骨Le Fort I型截骨术组（16例）。治疗前（T1）和治疗后6个月（T2）拍摄头颅定位侧位片,对腭咽部结构进行测量。采用SPSS 12.0软件包对数据进行统计学分析。结果：AMSDO组治疗前、后腭咽部结构测量参数变化无显著差异,Le Fort I型组咽腔深度平均增加3.13 mm、软硬腭交角增加4.3°,腭咽闭合需值（need ratio）平均值大于术前0.11,差异有统计学意义(P<0.05)。结论：AMSDO对腭咽部结构的影响微小,腭咽闭合基本无变化。Le Fort I组术后结果提示可能造成腭咽闭合功能恶化及腭咽部结构适应性代偿。

关键词: 唇腭裂, 腭咽部结构, 上颌骨发育不足, 牵引成骨, Le Fort I型截骨术

Abstract: PURPOSE: To compare the effect of anterior maxillary segmental distraction osteogenesis (AMSDO) and Le Fort I osteotomy on velopharyngeal structure in cleft lip palate(CLP) patients. METHODS: Thirty-two patients with CLP were divided into AMSDO group (n=16) and Le Fort I osteotomy group (n=16). Lateral cephalograms were taken before, and 6 months after treatment for analysis of velopharyngeal structure changes. SPSS 12.0 software package was used to compare the pre- and post-operative changes. RESULTS: No significant difference was found in AMSDO group; In Le Fort I osteotomy group, pharyngeal depth, velar angle and need ratio were found significantly different with an average increase of 3.13 mm, 4.3° and 0.11, respectively(P<0.05). CONCLUSIONS: AMSDO has minimal effect on velopharyngeal structure. Results in Le Fort I group suggest possible deterioration of velopharyngeal function and adaptive compensation of the velopharyngeal structure.

Key words: Cleft lip palate, Velopharyngeal structure, Maxillary hypoplasia, Distraction osteogenesis, Le Fort I osteotomy

中图分类号:

R782.2

牟思璇, 朱妍菲, 杜常欣, 王雪纯, 吴艳棋, 梅鹏, 王旭东, 朱敏. 改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort I型前徙术对唇腭裂患者腭咽部结构的影响[J]. 中国口腔颌面外科杂志, 2020, 18(5): 427-433.

MOU Szu-hsuan, ZHU Yan-fei, DU Chang-xin, WANG Xue-chun, WU Yan-qi, MEI Peng, WANG Xu-dong, ZHU Min. Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients[J]. China J Oral Maxillofac Surg, 2020, 18(5): 427-433.

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改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort I型前徙术对唇腭裂患者腭咽部结构的影响

Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients

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