唇腭裂继发上颌骨发育不足患者牵引成骨后软组织侧貌变化

SOFT TISSUE PROFILE CHANGES IN CLEFT LIP AND PALATE PATIENTS AFTER MAXILLARY DISTRACTION OSTEOGENESIS

目的 比较唇腭裂术后继发上颌骨发育不足患者颅外支架式牵引成骨术 (RigidExternalDistraction ,RED)前后软组织面型及鼻唇部变化 ,评价RED治疗上颌发育不足效果。方法 唇腭裂术后继发上颌骨发育不足患者 2 2名 ,其中男性 14名 ,女性 8名 ,平均年龄为 15 3岁。所有患者在改良高位LeFortⅠ型截骨术基础上行颅外支架式上颌骨牵引成骨术。测量RED前后头颅定位侧位片软组织面型、鼻唇部结构各项指标 ,用配对t检验比较RED术前术后变化。结果 RED前后面凸角、软组织鼻根点至零子午线距离、软组织颏前点至零子午线距离、上唇长度、唇间隙、唇颏比和颏唇沟深度变化具高度显著性差异。鼻唇角RED后增加了 7°。上中切牙露出程度无变化。结论 RED治疗唇腭裂术后继发上颌骨发育不足患者 ,在有效地延长前移上颌骨同时 ,面中下部软组织得到适应性改变 ,使面型更为协调 ,上唇长度得到延长 ,鼻唇角趋向增大。

Objective This study was conducted to evaluate the soft tissue profile changes after maxillary distraction osteogenesis by using a Rigid External Distraction Device (RED) in cleft lip and palate patients with maxillary dysplasia. Methods Twenty-two cleft lip and palate patients with maxillary dysplasia were included in this study. There were 14 male and 8 female patients, with average age 15 3 years. All the patients underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. Pretreatment and posttreatment lateral cephalograms were compared, and paired t test was used to evaluate the changes in soft tissue profile. Results After RED, facial convexity, O-meridian to Sn, O-meridian to Pog', upper lip length, interlabial gap, proportion of upper lip and chin and labiomental fold changed significantly. The naso-labial angle increased by 7°. And the exposure of upper median incisor showed no changes. Conclusion After maxillary distraction osteogenesis by using RED improved the soft tissue profile effectively by increasing nasal projection, making the upper lip more prominent, normalizing the naso-labial angle, and lengthening the upper lip. The facial profile became convex, with improved facial balance and aesthetics.