口蓋裂患者の上顎劣成長に対する初回手術および二次手術における対応

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  • 吉増 秀實
    東京医科歯科大学歯学部口腔保健学科地域・福祉口腔保健衛生学講座地域・福祉口腔保健衛生学分野

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  • Primary and secondary surgeries for the management of cleft maxillary hypoplasia
  • コウガイレツ カンジャ ノ ジョウガク レツセイチョウ ニ タイスル ショカイ シュジュツ オヨビ 2ジ シュジュツ ニ オケル タイオウ

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Maxillary hypoplasia of patients with cleft lip and palate (CLP) is one of the most important problems in the management of CLP. In this article, the author presents primary and secondary procedures which were devised to treat cleft maxillary hypoplasia.<BR>The goal of a primary palatoplasty should be the closure of a palatal deft, acquisition of normal speech, and less maxillary hypoplasia. In order to achieve them, a primary palatoplasty with mucosal graft from buccal mucosa has been performed and the Furlow method has also been applied to patients with isolated cleft palate in our clinic since 1998. Twenty-two percent of CP and 75% of CLP showed anterior cross bite after our procedures occurring at the age of 5. This result was better than that by the conventional push-back method. From a short-term follow-up study, our recent methods seem to give better results for both speech and maxillary growth than the conventional push-back method.<BR>To a total of 9 cases of adolescent and adult patients with severe cleft maxillary hypoplasia, maxillary distraction using a rigid external distraction device or Zurich maxillary distraction device was applied. The cases showed 7.5 to 17mm maxillary advancement after the procedures. More maxillary advancement was achieved by the distraction we performed than by the conventional orthognathic surgery using Le Fort I osteotomy.<BR>Our primary and secondary methods of surgeries seemed very useful and effective in the management of cleft maxillary hypoplasia.

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