正畸-正颌联合防治唇腭裂术后牙颌面畸形(1)
[摘要]目的：探索唇腭裂患术后牙颌面畸形正畸-正颌外科的防治方法。方法：56例唇腭裂伴牙颌面畸形患者，男性30例，女性26例，年龄8～38岁。其中25例患者为替牙列期或恒牙列初期，31例为恒牙列期。所有患者均进行正畸治疗，替牙列或恒牙列初期采用唇挡或颅颌面架干预性诱导上颌骨前后位的发育，上牙弓扩弓器扩大上颌骨左右位的发育并行牙槽裂植骨术；恒牙列期患者在完成排挤牙列、矫正错位牙、去代偿、关闭间隙等正畸治疗，手术方法如下：①伴牙槽裂的患者前期行髂骨取骨植骨术；②上颌Le Fort Ⅰ型截骨前徙术；③上颌多片段Le Fort Ⅰ型截骨术；④上颌Le Fort Ⅰ型截骨术+双侧下颌升支矢状劈开术(BSSRO)；⑤BSSRO+颏成形术。所有病例骨间均用钛板钛钉坚强内固定，并辅以2～3周颌间牵引固定。术后应配合正畸治疗并定期随访12～49月。结果：青少年患者经唇挡、腭弓扩大矫正器和上颌前牵引面架干预性诱导上颌骨发育，伴牙槽裂患者行牙槽裂植骨术，其颜面形态及牙牙合关系明显改善；成人患者经正畸-正颌-正畸治疗模式后，面部比例协调，咬合关系及面型均较满意。结论：正畸-正颌外科联合防治唇腭裂术后牙颌面畸形的疗效确切；应以患者牙牙合关系的具体情况、要求等因素，采用个体化的综合治疗方案宜于推崇。
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[关键词]正畸治疗；正颌外科；唇腭裂术后；牙颌面畸形；
[中图分类号]R782.2.3 [文献编码]A [文章编号]1008-6455(2009)03-0307-04
The prevention and treatment of secondary dento-maxillofacial deformities with orthodontics and orthognathic surgery following the repair of cleft lip and palate
LI Jin-feng1, ZHOU Hong2, REN Zhan-ping1，ZOU Min2, WANG Xiao-rong2, SI Xin-qin2, ZHANG Zhi-yong2，BAO Qing-hong2，WEN Yi-xi1，LIU Jian-hua1
, http://www.100md.com
(1.Department of Oral & Maxillofacial Surgery,2.Department of Orthodontics，Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China)
Abstract: Objective To prevent and treat secondary dento-maxillofacial deformities via the joint orthodontics and orthognathic surgery following the repair cleft lip and palate and to evaluate their outcomes.Methods 56 cases with secondary dento-maxillofacial deformities following the repair cleft lip and palate were prevented and corrected by the joint orthodontics and orthognathic surgery in our hospital. There were 30 males and 26 females, ranging from 8 to 38 years in age. 25 teenage cases were performed maxillofacial growth by orthodontics and alveolar bone graft. 31 adult cases were undergone preoperative orthodontics, their surgical procedures included：①alveolar bone graft before orthoganathic procedure; ② Le Fort Ⅰ osteotomy; ③ multisegment Le Fort Ⅰ osteotomy;④Le Fort Ⅰ osteotomy and bilateral sagittal split ramus osteotomy (BSSRO); ⑤BSSRO and genioplasty. Rigid internal fixation with Titanium palates and screws was applied and elastic traction of 2～3 weeks intermaxillary was essential in each case. All patients were undergone postoperative orthodontics and followed-up and ranged from 12 to 49 months. Results The teenage patients had a much-improved facial profile and occlusion. The adult cases had a satisfactory facial proportion with a good occlusion relationship and facial figure. Conclusion The joint orthodontics and orthognathic surgery could be performed satisfactorily to prevent and correct secondary dento-maxillofacial deformities following the repair cleft lip and palate. The authors recommend the joint orthodontics and orthognathic surgery should have individuation basing on patients' occlusion relationship and their requirements.
, http://www.100md.com
Key words：orthodontics;orthognathic surgery;dento-maxillofacial deformity;cleft lip and palate
唇腭裂是口腔颌面部最常见的先天性发育畸形之一，严重影响患者口颌系统功能与心理健康。尽管对唇腭裂患儿的手术方法不断完善，但术后由于瘢痕挛缩、异常肌力及先天的颌面部发育缺陷等因素，常形成难以避免的较严重的牙颌面畸形等问题[1-3]。
唇腭裂术后继发颌骨发育畸形严重影响着患者的容貌美观及咬合功能，表现为上颌后缩，面中1/3的凹陷，形成特有的“碟形脸”面型 ，上颌牙弓狭窄，前牙或全牙列反牙合，腭高拱，下颌真性或假性前突，牙齿排列不齐，牙牙合关系紊乱等[4-6]。这些畸形的矫正仅凭单纯正畸或正颌外科是远不能达到满意的外形及功能[4-7]。正畸一正颌联合技术为在这类牙颌面畸形的预防与矫治开辟疗了思路和途径。本项研究目的是通过对56例唇腭裂术后牙颌面畸形患者进行正畸与正颌外科治疗，探讨唇腭裂术后牙颌面畸形的预防与矫治及其相关问题。, 百拇医药(李锦峰 周 洪 任战平 邹 敏 王晓荣 司新芹 张智勇 鲍庆)
, http://www.100md.com
[关键词]正畸治疗；正颌外科；唇腭裂术后；牙颌面畸形；
[中图分类号]R782.2.3 [文献编码]A [文章编号]1008-6455(2009)03-0307-04
The prevention and treatment of secondary dento-maxillofacial deformities with orthodontics and orthognathic surgery following the repair of cleft lip and palate
LI Jin-feng1, ZHOU Hong2, REN Zhan-ping1，ZOU Min2, WANG Xiao-rong2, SI Xin-qin2, ZHANG Zhi-yong2，BAO Qing-hong2，WEN Yi-xi1，LIU Jian-hua1
, http://www.100md.com
(1.Department of Oral & Maxillofacial Surgery,2.Department of Orthodontics，Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China)
Abstract: Objective To prevent and treat secondary dento-maxillofacial deformities via the joint orthodontics and orthognathic surgery following the repair cleft lip and palate and to evaluate their outcomes.Methods 56 cases with secondary dento-maxillofacial deformities following the repair cleft lip and palate were prevented and corrected by the joint orthodontics and orthognathic surgery in our hospital. There were 30 males and 26 females, ranging from 8 to 38 years in age. 25 teenage cases were performed maxillofacial growth by orthodontics and alveolar bone graft. 31 adult cases were undergone preoperative orthodontics, their surgical procedures included：①alveolar bone graft before orthoganathic procedure; ② Le Fort Ⅰ osteotomy; ③ multisegment Le Fort Ⅰ osteotomy;④Le Fort Ⅰ osteotomy and bilateral sagittal split ramus osteotomy (BSSRO); ⑤BSSRO and genioplasty. Rigid internal fixation with Titanium palates and screws was applied and elastic traction of 2～3 weeks intermaxillary was essential in each case. All patients were undergone postoperative orthodontics and followed-up and ranged from 12 to 49 months. Results The teenage patients had a much-improved facial profile and occlusion. The adult cases had a satisfactory facial proportion with a good occlusion relationship and facial figure. Conclusion The joint orthodontics and orthognathic surgery could be performed satisfactorily to prevent and correct secondary dento-maxillofacial deformities following the repair cleft lip and palate. The authors recommend the joint orthodontics and orthognathic surgery should have individuation basing on patients' occlusion relationship and their requirements.
, http://www.100md.com
Key words：orthodontics;orthognathic surgery;dento-maxillofacial deformity;cleft lip and palate
唇腭裂是口腔颌面部最常见的先天性发育畸形之一，严重影响患者口颌系统功能与心理健康。尽管对唇腭裂患儿的手术方法不断完善，但术后由于瘢痕挛缩、异常肌力及先天的颌面部发育缺陷等因素，常形成难以避免的较严重的牙颌面畸形等问题[1-3]。
唇腭裂术后继发颌骨发育畸形严重影响着患者的容貌美观及咬合功能，表现为上颌后缩，面中1/3的凹陷，形成特有的“碟形脸”面型 ，上颌牙弓狭窄，前牙或全牙列反牙合，腭高拱，下颌真性或假性前突，牙齿排列不齐，牙牙合关系紊乱等[4-6]。这些畸形的矫正仅凭单纯正畸或正颌外科是远不能达到满意的外形及功能[4-7]。正畸一正颌联合技术为在这类牙颌面畸形的预防与矫治开辟疗了思路和途径。本项研究目的是通过对56例唇腭裂术后牙颌面畸形患者进行正畸与正颌外科治疗，探讨唇腭裂术后牙颌面畸形的预防与矫治及其相关问题。, 百拇医药(李锦峰 周 洪 任战平 邹 敏 王晓荣 司新芹 张智勇 鲍庆)