Evaluation of Clinical Outcomes of Primary Gingivoperiosteoplasty in Patients with Unilateral Clefts

單側唇顎裂病患接受一期牙齦骨膜修復術之臨床結果評估

周邦昀(Pang-Yun Chou) ； 陳國鼎(Kuo-Ting Chen) ； 陳昱瑞(Yu-Ray Chen) ； 羅慧夫(M. Samuel Noordhoff)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 85-89

https://doi.org/10.7096/TJTSPS.201206.0085

摘要

背景：重建單側唇顎裂牙床缺損於文獻上可歸納出兩種方法，一為牙床植骨術，另一為牙齦骨膜修復術。目的及目標：評估十年前於長庚顱顏中心，單側唇顎裂之病患接受一期牙齦骨膜修復術之臨床結果比較。材料及方法：蒐集長庚醫院四十四位單側唇顎裂接受一期牙齦骨膜修復術的病患，於術後十年的定期追蹤回診，藉柏格蘭的評比標準，來檢視牙床X光上骨頭製造的量，以定義其是否需要再接受牙床植骨手術。結果：在柏格蘭的評比標準下，成功的一期牙齦骨膜修復術的病患有三十名，須再接受牙床植骨術者為十四名，一期牙齦骨膜修復術的成功率為百分之六十八。結論：二期牙床植骨術現今仍為我們顱顏中心，單側唇顎裂病患修復牙床的主要術式。唯中心之一期牙齦骨膜修復術亦能得到良善之結果，如可減少需二期牙床植骨術的病患、避免供骨區造成的骨皮缺損、及減少所需手術次數。

並列摘要

Background:There are two standard methods to reconstruct the alveolar cleft in unilateral cleft patients. The first method is bone grafting and the second is primary gingivoperiosteoplasty (GPP). Even today, the debate over which method is superior continues. Aim and Objectives:This study was designed to retrospectively evaluate the clinical outcomes of primary gingivoperiosteoplasty in patients with unilateral clefts. Materials and Methods:Retrospectively, 44 unilateral complete cleft lip/palate patients were collected from Dec. 1999 to Dec. 2001 at Chang Gung memorial Hospital. All patients underwent naso-alveolar molding prior to lip repair in order to align and approximate the maxillary segments. They all underwent primary gingivoperiosteoplasty at the time of primary lip repair around the age of 3 months. A minimum of 10 year follow-up, including X-ray images with periapical and occlusal views, is available for all patients. The Bergland Scale was used to measure the quantity of bone formation at the site of the alveolar cleft. Results:As per the Bergland Scale, 3 patients were classified as type I, 27 patients were classified as type II, 10 patients were classified as type III, and 4 patients were classified as type IV. Bergland type I (3) and Bergland type II (27) signify adequate bone formation with no need for additional alveolar bone grafting. The successful bone formation rate was 30/44 (68.2%), and the inadequate bone production rate was 14/44 (31.8%). Conclusion:Primary GPP can decrease the proportion of patients requiring secondary bone grafting, prevent donor site morbidity, and decrease overall operative time.

並列關鍵字

gingivoperiosteoplasty ； bone grafting ； unilateral cleft ； bergland scales