Accuracy of virtual surgical planning-assisted management for maxillary hypoplasia in adult patients with cleft lip and palate.
- 作者列表："Wang Y","Li J","Xu Y","Huang N","Shi B","Li J
PURPOSE:Management of maxillary hypoplasia in patients with cleft lip and palate (CLP) remains a significant clinical challenge. The objective of this retrospective study is to evaluate the accuracy of virtual surgical planning (VSP) with different maxillary advancement techniques. METHODS:Ninety adult patients with cleft-related maxillary hypoplasia between April 2010 and April 2016 were enrolled in our study. Various surgical techniques including conventional orthognathic surgery, total maxillary distraction osteogenesis, and anterior maxillary segmental distraction were used according to the characteristics of patients. All the cases were aided with VSP and three-dimensional (3D)-printed surgical splints. The virtual surgical plan was compared with the postoperative surgical results by analyzing the positions of several landmarks and planes relative to reference planes. RESULTS:Both the profile and occlusion were improved significantly in all the cases. VSP was successfully transferred to actual surgery with the help of 3D-printed surgical splints in different surgical techniques. CONCLUSION:Management of cleft-related maxillary hypoplasia requires both comprehensive surgical planning and accurate execution. VSP serves as a viable alternative to conventional model surgery with high accuracy in patients with adult CLP.
目的: 唇腭裂 (CLP) 患者上颌骨发育不全的治疗仍然是一个重大的临床挑战。本回顾性研究的目的是评估不同上颌推进技术的虚拟手术计划 (VSP) 的准确性。 方法: 2010 年 4 月至 2016 年 4 月间，90 例成人上颌骨裂相关发育不全患者入选本研究。根据患者特点采用各种手术技术，包括常规正颌手术、全上颌牵张成骨、上颌前段牵张成骨。所有病例均采用VSP和 3D打印手术夹板辅助治疗。通过分析几个地标和平面相对于参考平面的位置，将虚拟手术计划与术后手术结果进行比较。 结果: 所有病例的侧貌和咬合均有明显改善。在不同手术技术的 3d打印手术夹板的帮助下，VSP成功转移到实际手术中。 结论: 唇裂相关的上颌骨发育不全的治疗既需要全面的手术计划，也需要准确的执行。VSP是成人CLP患者高准确性常规模型手术的可行替代方案。
METHODS:BACKGROUND:The anterior oronasal fistulae neighboring the alveolar cleft could persist or reappear after the alveolar reconstruction with cancellous bone grafting. The persistent symptomatic anterior oronasal fistulae need to be repaired, but surgery remains a challenge in cleft care. Surprisingly, this issue has rarely been reported in the literature. The purpose of this long-term study was to report a single surgeon experience with a therapeutic protocol for persistent symptomatic anterior oronasal fistula repair. METHODS:This is a retrospective study of consecutive patients with Veau type III and IV clefts and persistent symptomatic anterior oronasal fistulae managed according to a therapeutic protocol from 1997 to 2018. Depending on fistula size, patients were treated with local flaps associated with an interpositional graft or two-stage tongue flaps (small/medium or large fistulae, respectively). The surgical outcomes were classified as "good" (complete fistula closure with no symptoms), "fair" (asymptomatic narrow fistula remained), or "poor" (failure with persistent symptoms). RESULTS:Forty-four patients with persistent symptomatic anterior oronasal fistulae were reconstructed with local flaps associated with interpositional fascia or dermal fat grafting (52.3%) or two-stage tongue flaps (47.7%). Most of patients (93.2%) presented "good" outcomes, ranging from 87% to 100% (local and tongue flaps, respectively). Three (6.8%) patients presented symptomatic residual fistula ("poor" outcomes). CONCLUSIONS:For the repair of persistent symptomatic anterior oronasal fistulae, this therapeutic protocol provided satisfactory outcome with low fistula recurrence rate.
METHODS:OBJECTIVE:Methadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS. DESIGN/SETTING:This case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995-2011. PATIENTS:Cases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks' gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview. RESULTS:Among 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1-12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2). CONCLUSIONS:These findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk-benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
METHODS::Orthopedic treatment to improve deficient maxillary growth of cleft lip and palate patients is an important part of treatment. The success of this treatment is strongly dependent on the time of initiation of therapy. There has been a large controversy in the available literature regarding the skeletal age of these patients. The aim of the present study was to compare the skeletal age of cleft lip and palate patients with normal individuals.37 unilateral and 14 bilateral cleft lip and palate patients and 47 healthy individuals participated in this cross-sectional study. The patients were classified into 8 to 10 and 11 to 14-year-old individuals. Cervical vertebral maturational stage of participants was evaluated in the lateral cephalometry. The skeletal age of cleft lip and palate patients was compared with normal controls. Chi-square was used for statistical analysis. There was not a significant difference in the skeletal developmental stage of unilateral and bilateral cleft compared to their normal peers according to their age and sex. Also, significant difference in skeletal maturational stage of cleft lip and palate patients was not found between boys and girls (P = 0.8). Similarly, no significant difference was found in the skeletal age of the 3 studied groups without considering the age and sex of participants (P = 0.5). Regarding the similar skeletal maturational stage of cleft lip and palate patients with normal controls in our study, their maxillofacial orthopedic treatment can be initiated at similar time to normal peers.