The Influence Of Two-stage Cleft Palate Repair Model On Maxillary Development And Dental Arch Relationship In 6-7 Years Old Patients

ObjectiveAfter patients with unilateral complete cleft lip and palate(UCLP)underwent two-stage cleft palate surgery repair mode.Study of the effect of this cleft palate repair model on the patient’s maxillary bone development and dental arch relationship at the age of 6-7 years.MethodsA retrospective study was used to collect patients with UCLP who attended the Department of Plastic and Maxillofacial Surgery at the Affiliated People’s Hospital of Nanchang University from 1 January 2013 to 31 December 2014 and were treated with a two-stage cleft palate surgical repair model(repairing the hard palate first and then the soft palate)and a one-stage cleft palate surgical repair model.According to the treatment mode of the patients,20 cases were divided into Two-stage group(3-6months old cleft lip repair(Millard II type)with vomer bone flap to repair the hard palate at the same time,16-18 months old with soft palate(modified von Langenbeck method)repair.)and One-stage Group 21 patients(3 to 6 months old underwent cleft lip repair(Millard II),16 to 18 months old after cleft lip repair,soft and hard palate repair(modified von Langenbeck method)).Follow-up to 6 to 7 years old,collect the patient’s gender,age,time of cleft lip surgery,time of cleft palate surgery,cleft lip and palate,and whether there are complications and other general information;take facial photos,intraoral photos,and lateral head X Line film,take the tooth occlusion model and other materials.(1)Use the Uceph software to measure the lateral X-rays of the heads of the two groups of patients,and analyze whether there are differences in the upper jaw measurement indicators between the two groups.(2)Orthodontists use the Goslon(great ormond street,London and Oslo)-Yardstick evaluation system to grade the dental arch of the patients,and statistically analyze whether there is any difference in the relationship between the dental arches of the two groups.Results1.General information: There was no statistically significant difference between the two groups in data comparison of male and female composition,age,UCLP(left/right),cleft lip surgery time,and cleft palate surgery time(P>0.05).There was a statistically significant difference in the use of relaxed incisions between the two groups(P=0.011<0.05).2.Cephalometric measurement indicators: Results When the Two-stage group and the One-stage group were 6 to 7 years old,the upper and lower jaw relative to the skull(SNA),the lower jaw relative to the skull(SNB),the upper and lower jaw pairs The relationship between the cranial positions(ANB),the height of the maxilla(N-ANS),the length of maxilla(A-Ptm),the anteroposterior position of the maxilla(S-Ptm)and the p-values were all greater than 0.05,and the difference was not statistically significant.3.Goslon-Yardstick score: In the Two-stage group,the number of people with Goslon-Yardstick level 2 is 8(40%),followed by the number of people with Goslon-Yardstick level 3 is 7(35%),and the Two-stage group is Goslon-Yardstick score;The mean is 2.55 and the standard deviation is 0.887;In the One-stage group,the highest number of people with Goslon-Yardstick level 3 was 11(52.4%),followed by the number of people with Goslon-Yardstick level 4 was 6(28.6%);The mean Goslon-Yardstick score of the One-stage group was 3.24,and the standard deviation was 0.768.P=0.015(P<0.05),the difference between the two groups was statistically significant.Conclusions1.Patients with UCLP in the two-stage cleft palate surgical repair modality had varying degrees of inhibition of maxillary growth and development in both the sagittal and vertical positions as assessed by cephalometric measurements at 6-7 years of age.Comparing patients with UCLP in the one-stage cleft palate surgical repair modality,there was no significant difference in the effect of the two cleft palate repair modalities on the sagittal and vertical growth and development of the maxillae of patients at 6-7 years of age.2.Patients with a two-stage surgical repair model for cleft palate(hard palate first,soft palate second)have a better occlusal relationship between the upper and lower dental arches.3.The two-stage cleft palate surgical repair model(hard palate first,soft palate second)can reduce the use of relaxation incisions.4.This study is pending long-term follow-up due to the small sample size and the fact that the patients are still growing and developing.