- 期刊
單側唇顎裂孩童進行廣泛性骨膜修復術合併手術前後矯正治療－病例報告
Outcomes of Extensive Gingivoperiosteoplasty Combined with Perioperative Orthodontic Treatment Performed in Unilateral Cleft Lip and Palate - A Case Report
摘要
唇顎裂是顱顏部位最常見先天性異常，台灣發生率約為1/600-1/700。唇顎裂患者會有三次可能需要的重建手術：唇修復、顎修復及9至11歲間進行的齒槽修復。傳統的齒槽修復為齒槽植骨手術，在90年代中期前，改善過的齒槽植骨手術成功率已達到98%，但仍有一些問題，像是術後傷口感染（植骨感染）、術前裂隙太寬增加手術困難度、裂隙附近牙齒排列落差太大造成縫合困難。在90年代後期，研究發現只要施力適當，牙齒的移動可以刺激齒槽產生新的骨頭。本篇病例報告為一9歲男童，經整形外科醫師評估後開始術前矯正，並於2019年6月進行廣泛性骨膜修復術，術後持續進行上顎擴張及牙齒矯正，並定期拍攝電腦斷層，比較手術前、手術後半年、術後矯正前及術後矯正一年後裂隙中骨頭體積變化，發現有良好的骨頭生成量，經評估後不需再次植骨手術。本篇病例報告之目的為藉由此案例的手術及矯正過程，呈現唇顎裂孩童透過手術前後的矯正能輔助廣泛性骨膜修復術的成骨結果，讓患者免於傳統植骨手術，並探討其矯正介入之時機。
並列摘要
Cleft lip and palate are the most common congenital craniofacial anomalies, with an incidence of approximately 1 in 600-700 in Taiwan. Patients with cleft lip and palate may require three major surgeries: lip repair, palate repair, and alveolar repair performed between the ages of 9 and 11. The traditional approach for alveolar repair involves alveolar bone grafting surgery, which had a success rate of 98% by the mid-1990s. However, there were still some challenges associated with this procedure, such as postoperative wound infection and graft infection, difficulty in surgical manipulation due to wide cleft gaps, and difficulty in adequate closure of the wound. This case report presents the treatment of a 9-year-old male patient with cleft lip and palate. After evaluation by the plastic surgeon, the patient underwent preoperative orthodontic treatment. In June 2019, he underwent extensive gingivoperiosteoplasty surgery. Postoperatively, he received maxillary expansion and orthodontic treatment, with regular cone-beam computed tomography scans taken to compare the changes in bone volume within the cleft gap. Significant bone formation was observed, and it was determined that further bone grafting surgery was not required. The purpose of this case report is to demonstrate how orthodontic intervention before and after surgery can assist in bone formation in patients undergoing extensive gingivoperiosteoplasty, eliminating the need for traditional bone grafting surgery. It also discusses the timing of orthodontic intervention in these cases.