일측성 완전일·이차성구개열 환아에서 술전정악장치와 구순접합술 동시시행이 상악치조궁에 미치는 효과

Abstract

The ultimate goal of the treatment of cleft lip and palate is the obliteration of the entire cleft early without disturbing facial bone growth. Presurgical orthopedics attempts to correct the characteristic skeletal deformities that occur in cleft lip and palate, and lip adhesion reduces the tension of the definite lip repair and allows gentle molding until the solidification of the arch occurs. Additionally lip adhesion gives a psychologic benefit to the patient's parents because of the improvement in appearance. The authors performed presurgical orthopedics and lip adhesion for 26 cases of complete unilateral cleft of primary and secondary palate between 1997 and 2001. Postoperatively, the patients are evaluated by the analysis using preoperative and postoperative dental casts. Dental cast analyses evaluate width, length, height of maxillary alveolar cleft, alveolar gap, palatal gap, and angle of arch. Results include improvement of alignment of maxillary alveolar arch and reducement of cleft gap. Also, this study of serial dental cast is the objective method to explain the corrective effect on maxillary alveolar arch in cleft lip and palate. In conclusion, presurgical orthodontics and lip adhesion achieve the main goal of moving the palate into a normal position and stabilizing the arch with a bony bridge that attracts teeth. It avoids the difficult anterior fistulae and presents a more symmetrical platform upon which the lip can be united and the nose can be corrected early. Additionally, there is a psychologic benefit to the patient's parents because of the improvement in appearance.

술전정악장치와 구순접합술을 동시에 시행한 경우 변위된 경구개를 정상적인 해부학적 위치로 이동시킬 수 있으며, 대칭적인 상악치조골을 형성하여 구순성형술과 구순비변형에 대한 교정을 용이하게 할 수 있을 뿐만 아니라 외형적인 개선으로 말미암아 환자 부모의 심적인 부담을 완화시키는 역할을 하였다. 또한 치조골 석고모형을 이용한 연구는 이러한 상악복합체의 교정효과를 객관적으로 설명하는데 있어 훌륭한 연구방법으로 생각되며, 앞으로 점진적인 석고모형의 연구는 구순구개열 수술후 안면부 성장과 발달을 설명함에 있어 중요한 지표가 될 것으로 여겨진다.