腭裂整复时间对单侧完全性唇腭裂患者颅颌面形态影响的差异性研究

Diversity research about facial morphology of unilateral complete cleft lip and palate affecting by different repair periods of palate repair

目的了解腭裂整复术的时问对单侧完全性唇腭裂患者面部形态的影响。方法选择46例13岁以上的非综合征性单侧完全性唇腭裂患者为试验组，根据腭裂整复术的时间将其分为4岁前行腭裂整复术、4～7岁行腭裂整复术、7岁后行腭裂整复术。另选择38例年龄和性别与试验组相当的无裂者为对照组。通过测量颅颌面三维方向的26个指标对4组的面部形态进行比较分析。结果4岁后行腭裂整复术者较4岁前行腭裂整复术者ANS点突度（Ba—N—ANS，Ba—ANS）大，Y轴角小，7岁后行腭裂整复术者较4岁前行腭裂整复术者上颌骨矢状向长度（A—PMP）及上颌基骨矢状向长度（ANS—PMP）大，7岁前修复腭裂者下面高（ANS—Me）较无裂者小，7岁后修复者与无裂者无明显差异。结论在上颌骨生长发育期间的腭裂整复手术都会对患者上颌骨生长发育造成影响，晚行腭裂整复术者较早行腭裂整复术者有较好的下面高、上颌突度、上颌矢状向长度和下颌骨生长方向，即较晚行腭裂整复术者有较好的颅面部矢状向形态。

Objective To evaluate facial morphology characteristics of patients with unilateral complete cleft lip and palate （UCCLP） after cleft palate repair in different periods. Methods 46 nonsyndromic UCCLP patients were chosen as test group and divided into three kinds （under 4-year-old, 4-7-year-old, over 7-year-old） according to periods of palate repair. 38 age and gender matched non-clefts children were involved as control group. 26 cephalometric measurements were measured to evaluate facial morphology of four groups. Results Compared with patients who received palate repair before 4-year-old, patients who received repair after 4-year-old had more protrusive ANS point （Ba-NANS, Ba-ANS） and less Y-axis angle. Patients who received palate repair after 7-yesr-old had greater A-PMP and ANS-PMP than patients who received palate repair before 4-year-old, patients who received palate repair before 7- year-old had smaller ANS-Me but after had no significant difference when compared with non-clefts. Conclusion Whenever palate repair is undertaken in the period of maxillary growth and development, patients＇ maxillary growth would be restrained, the delayed repair sample have better lower face height, maxillary protrusion, maxillary sagittal length and mandible growing direction when compared with the early repair sample, that is to say, the delayed repair sample have preferable head-face morphology.