| Preoperative orthodontic treatment is the first step of the whole series treatment ofcleft lip and palate. The principle of it is when infants were undergoing the period of bodytissues rapidly development after their born, orthodontic force were loaded onmaxillofacial soft/hard tissue and human intervention were applied on their growth status,so that deformity of dental arch was reduced as much as possible. Which even more createan advantage for the cheiloplasty and palatoplasty. Preoperative nasal-alveolar molding(PNAM), which first submitted by Grayson was considered the most effective means ofpreoperative treatment. But, the oral appliance designing and therapeutic regimen makingare all completed by experience of the dentists in clinical treatment. As it lacks of basiccognition about law of cleft palata growth, PNAM didn’t formed an unified standards forclinical operation and therapeutic evaluation. So, how to make PNAM scientifically was still a difficult problem for international research filed of cleft lip and palate.In allusion to the problems mentioned above, in this article, visualized operationsdatabase of cleft lip and palate was established,64infants were completely collected bythe database,22UCP cases in which were treaded by PNAM and as subjects formorphological data collecting. Data analyzed every week a time from their birth to100days old. Finally work out the growth law of palate with PNAM treatment.Objective:1) Establish visualization database software for cleft lip and palate toprovide software platform and sample source for the study.2) To built up a high resolution3-D model of neonatus with unilateral complete cleft palate by Micro CT, and investigatethe validity and reliability of Micro CT on liner measurements of the models.3）To observeand study the growth law of cleft palate tissue of neonates with UCP under preoperativenasal-alveolar molding treatment.Method:1)Establish database software for cleft lip and palate:①The databaseprogramming was worked out by the powerful function of Microsoft Visual C++6.0(VC++).②Using its developed visual operating interface of software，constructedframework windows of the data and got integral frame structure of the whole database;Storing management of the data was done by Microsoft Office Access (Access). Physicslayer can be managed by operating of data saving and searching.③Editing function ofthe sample data in the database was realized by Open Graphics Library (OpenGL), whichcan implement the visualization for3-D models, construct preview windows for the dataand do some easy editions such as rotation, movement and transforming size of the models.2) Built up3-D model of neonatus with unilateral complete cleft palate:①Ten plastermodels of the neonate with unilateral complete cleft palate were made.②Mark points onthe models.③Experimenter a, b and c were trained to measure the models.④Theexperimenter a measures plaster models using calipers two times (interval a week).⑤scanned plaster models by Micro CT, and the3-D digital models were reconstructed bythe reversed engineering software.⑥The linear measurements were taken on the modelsby experimenter b and c, two times a week measured interval.⑦Intraclass correlationcoefficient (ICC) was used to analyze the intra-observe reliability of measurement obtained by experimenter a, b and c, respectively. Validity and reliability were assessed byaverage of the deviation, paired Student t tests and relative error.3) To observe and studythe growth law of cleft palate tissue of neonates with UCP under PNAM treatment.①Picking models: The subjects of this study are searched from the database mentionedabove, which should simultaneously meet the following status: the infants with UCP whohad been treated with the PNAM appliances were less than1month old when the firstvisit and without other craniofacial deformity. Take the whole models of every picked case.②Then the models were fixed point and measured by Geromagic (a reverse engineeringsoftware). Data were recorded according to requirement③Statistical analysis was donewith repeated measurement data Two-level of growth mode.Result:1) An visualization database software for cleft lip and palate has beenestablis hed in this study. It can accomplish general information and clinical informationdata saving, researching and browsing for the cleft palate patients.2)3-D model ofneonatus with unilateral complete cleft palate has been built up. Built up a digitalmodel of infant with UCP by Micro CT, distinct shape and complete interface. The ICCswith in the same observer were beyond0.99suggested that the intra-observer reliabilitywas good. The3-D digital models by Micro CT were intact and clearly. Of Micro CTmodels, between intraexaminers and interexaminers，the highest average of the deviationwas0.052mm., between digital models and the plaster models the maximum average ofthe deviation was-0.3611, the maximum of the Relative Error was only1.97%. For eachpair of compared data, there was no statistic difference (P>0.05).3) Got growth curves ofcleft palate tissue of neonates with UCP under PNAM treatment. From the curveswe can see under PNAM treatment the cleft displayed a narrowing trend with the timeincrease, and the trend is clear at the first two months. Seen from the curve of maxillarisgrowth, through PNAM treatment palate displayed a growth trend with the time increase,and the trend is clear at the first two months. The two group curves showed a discretetendency. The trend increased with time.Conclusion: In this study we1) established visualization3-D database software forcleft lip and palate, and collected64cases in it.2) First built up a3-D model of neonatus with unilateral complete cleft palate by Micro CT, and verifie d it is of high validity andreliability for the liner measurements.3) And first got the growth curves of cleft palatetissue of neonates with UCP under PNAM treatment which can provide experimental basefor PNAM treatment. |
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