唇顎裂症例に対する早期顎裂部骨移植の臨床的評価

Abstract

AIM: The purpose of this study was to evaluate the effectiveness of early alveolar bone grafting in patients younger than 8 years.MATERIALS AND METHODS: The treated group comprised 15 patients (mean age, 13.2 years; range, 11.4-16.3 years) with cleft lip and alveolus (13 unilateral and 2 bilateral clefts) who underwent alveolar bone grafting at Kitasato University Hospital between July 1999 and January 2004. The mean age at the time of surgery was 6.8 years (range, 5.3 to 7.11) and the mean follow-up period after grafting was 6.6 years (range, 4.8 to 9.1) . We evaluated maxillary growth, bone bridge formation, alveolar bone height and overjet in the cleft area, molar overjet on the cleft side, dental arch width, and basal arch width. The control group comprised 13 patients (mean age, 13.4 years; range, 12.4-14.2) with unilateral cleft lip and alveolus who underwent alveolar bone grafting. The mean age at the time of surgery was 9.2 years (range, 8.0 to 11.4). The Mann-Whitney U-test was used to examine the statistical significance of differences between the two groups in upper jaw growth, dental arch width, and basal arch width.RESULTS: Maxillary growth was not significantly restricted in any of the patients in the treated group, with a mean SNA angle of 82.4° and 81.6° and a mean ANB angle of 7.3° and 6.1° before and after grafting, respectively. After surgery, the mean dental arch width was 44.8 mm, and the mean basal arch width was 48.8 mm. Bone bridge formation in the cleft area was observed in all patients in the treated group, and the alveolar bone height was similar to that on the non-cleft side. A proper overjet was achieved in 14 of the 15 patients by orthodentic treatment after grafting. In the control group, the mean SNA angle was 80.8°, the mean dental arch width was 44.0 mm, and the mean basal arch width was 48.8 mm after bone grafting. There was no significant difference in SNA angle, dental arch width, and basal arch width between the treated and control groups.CONCLUSION: The results suggest that early alveolar bone grafting followed by orthodontic treatment at least does not affect the maxillary growth of patients with cleft lip and alveolus who are younger than 8 years.