唇腭裂综合序列治疗中的牙颌畸形矫治

Orthodontic treatment in cleft lip and palate team approach

牙颌畸形的矫治贯穿唇腭裂综合序列治疗的始末。正畸医生是唇腭裂综合序列治疗获得理想治疗效果的必要保障。唇腭裂患者具有诸多异于普通患者的牙颌发育特征,其不同生长发育阶段的矫治目标及内容也不尽相同。新生儿期牙颌畸形矫治主要包括唇腭裂整复术前鼻牙槽矫形治疗;乳牙列期矫治重点在于牙颌畸形的防治及口腔不良习惯的破除;替牙列期矫治内容主要包括牙槽突植骨术前牙列预备、牙弓狭窄及上颌发育不足的治疗;恒牙列期矫治内容则包括正畸掩饰治疗、正畸正颌联合治疗以及牙槽节段牵张成骨的辅助正畸治疗。此外,针对唇腭裂患者特殊的心理特征,正畸医生还应特别重视对其依从性的管理。本文就唇腭裂综合序列治疗中患者不同生长发育阶段牙颌畸形的矫治进行述评,希望能使更多的正畸医生加入到以“生物⁃心理⁃社会”现代医学模式为基础的唇腭裂综合序列治疗团队中,帮助更多的患者获得理想的外形、良好的功能以及健康的心理。

Orthodontic treatment for dentofacial deformity is fundamental throughout the entire management process of cleft lip and palate.Orthodontist is one of those who are indispensable in the comprehensive multidisciplinary cleft team.Cleft lip and palate patients have unique dentofacial characteristics which makes the treatment goals and strate⁃gies different from those of other patients in different stages.For newborns with cleft lip and palate,the main treatment includes presurgical orthopedics.For patients in their primary dentition stage,the treatment mainly focuses on the pre⁃vention of bad oral habits and severe malocclusion.For those in their mixed dentition stage,the treatment mainly con⁃sists of dentition preparation for alveolar bone grafting and skeletal growth modification.For patients in their permanent dentition stage,treatment strategies include orthodontic camaflouge treatment,combined orthodontic⁃orthognathic ap⁃proach and segmental alveolar distraction osteogenesis.In addition to routine orthodontic treatment,orthodontists should pay special attention to managing the compliance of cleft lip and palate patients with unique psychological characteris⁃tics.By summarizing the state⁃of⁃art cleft lip and palate orthodontic care in the multidisciplinary team,this review aims to involve more orthodontic clinicians to join in the modern biopsychosocial medical practice of cleft lip and palate team approach and to improve the standard of care for cleft lip and palate patients.