目的

分析比较不同的正畸-正颌联合治疗方式对复杂唇腭裂患者的疗效，为该类型患者的治疗方式选择提供临床依据。

方法

收集15名复杂唇腭裂患者，根据上颌骨的手术方式分为三个实验组，每组5人。分组为：Le Fort I型截骨牵张术（TMD组）、上颌前部截骨牵张术（AMD组）和Le Fort I型截骨坚固内固定术（MA组）。搜集患者术前（T0）、术后3月(T1)两个时间段的影像资料。利用mimics对患者CBCT治疗前后颅颌面以及气道进行三维重建，测量指标包含颌骨的三维方向变化及上气道体积，比较治疗前后变化。

结果

经过正畸-正颌联合治疗，患者治疗前后ANB角、ANS-冠状面距离、牙槽嵴缺隙面积有增加趋势，增加幅度TMD组>MA组>AMD组；FMA角平均值AMD组治疗前后减小，其余两组增加,且TMD组>MA组；上气道体积平均值MA组减小其余两组增加，TMD组>AMD组。ANB角及AMD组上气道体积变化有统计学意义（P＜0.05），其余指标无统计学意义但可观察到平均值的增减。

结论

对上颌骨严重发育不足的病例，TMD能够纠正矢状向差异及增加上气道体积，但可能扩大缺隙面积及增加垂直高度；AMD主要用于上颌牙列中重度拥挤，矢状向差异较小的病例，该方式对缺隙面积影响最小同时伴有下颌骨的逆旋，但若双颌差异过大则需要二次手术；MA适用于上颌发育不足中度，上颌牙列拥挤轻度病例，有减小上气道体积可能。

Comparation of different orthodontic combined orthognathic treatments’ outcomes for complex cleft lip and palate patients.

Objectives: To compare the therapeutic outcomes of different kinds of orthodontic combined orthognathic treatments on patients with complex cleft lip and palate (CLP) and to provide more evidence to choose the appropriate technique clinically.

Methods: 15 subjects were included dividing into three group based on the different surgical treatments which were total maxillary distraction (TMD), anterior maxillary distraction (AMD) and maxillary advancement (MA), 5 in each group. Cone-beam computed tomography (CBCT) scans were obtained before the surgery (T0) and 3 months after the surgery (T1) and exported into Mimics. Skeletal three-dimensional analysis and reconstruction of upper airway were processed to evaluate pre-and postoperative changes of jaws and the upper airway volume.

Results: After surgical treatment, there was a tendency of increasing of three groups’ ANB angle, ANS-coronal plane, cleft alveolar space, for the magnitude of increase, TMD group>MA group>AMD group. The average value of FMA angle decreased in the AMD group while it increased in the other two groups and TMD group> AMD group. As for the upper airway volume, the mean decreased in MA group and increased in other groups, TMD group> AMD group. There was significant difference in ANB angle of three groups and upper airway volume of AMD group, others were not significant but obvious pre-and postoperative changes could be observed.

Conclusions: For the severe maxillary hypoplasia, TMD could correct the sagittal discrepancy and increase the upper airway volume effectively, but the largening of cleft alveolar space and increase of vertical height might company. AMD was mainly aimed for the cases which existed mid crowding in maxilla and moderate sagittal discrepancy of two jaws. AMD expressed the minimal influence of cleft alveolar space and anticlockwise rotation of mandible, however, the second surgery might follow if the sagittal discrepancy was too large. MA could be operated for mid maxillary hypoplasia with moderate crowding in maxilla, but it might decrease upper airway volume.

Key words: Complex cleft lip and palate, Orthodontic combined orthognathic treatments, Distraction osteogenesis, Three-dimensional reconstruction, Cone-beam computed tomography.