顎, 口蓋裂患者における骨裂隙補填の効果に関する研究

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Since Schmid made the first report on the bone grafting in the young patients with cleft palate in 1954, many workers were engaged in the study of the technique, and divergent opinions still exist as to the validity of the bone grafting for maintaining the normal relation between progressive growth of jaw and the dental arch. One of the problems in the treatment of bilateral cleft with excessive protruding premaxilla is the relative merit of whether one should take non-surgical methods or surgical methods. The present author reports the 32 cases of unilateral cleft of lip, alveolus and palate which were treated with the autogenous rib graft and comparison was made with 34 cases which were treated without grafting. Also reported were the 9 cases of the autogenous rib graft for the unilateral cleft of lip and alveolus. Of the 12 cases of the bilateral cleft of lip, alveolus and palate, 5 cases were treated with fresh autogenous rib graft and 7 cases were treated with the surgical resection of premaxilla combined with various bone graftings. The resuls obtained were summarized as follows. Of unilateral cleft of lip, alveolus and palate of the bone grafted cases, 33% maintained the normal overjet relation and only 19% of cases not treated with bone graft maintained the normal overjet relation. A total of 15 cases accounting for 54% of the bone grafted group were found to maintain the normal relationship of maxillo-mandibular basal arch and only 12 cases (35%) of the non-grafted group showed normal relationship. There were observed a few cases of bone graft in which the tooth germ migrated into the grafted bone. There was no instance where the grafted bone was resected as sequester after it was packed into the alveolar defect. The lateral X-Ray cephalogram obtained from 5 patients of unilateral cleft of lip, alveolus and palate who were treated with the bone grafting, showed a good growth of mandible comparable to that of normal subjects of the same age stage as reported by Iizuka. Antero-posterior relation of the upper and lower jaws of these patients was also normal. It was observed in a few cases of bone graft that the periphery of the grafted bone chips tended to grow concomitantly with the growth of recipient bone. In the cases of unilateral cleft lip and alveolus, treatment with bone graftitg resulted in the recovery of bony depression of nasal floor. Treatment with the bone graft also brought about, a good result in lifting up the base of ala nasi. In the cases of bilateral cleft of lip, alveolus and palate, the treatment with bone grafting did not interfere with normal growth of the prepalate. In a few particular cases of bilateral cleft of lip, alveolus and palate where excessively protruding premaxilla was resected, grafting with the vomer bone either just resected or kept frozen or with autogenous rib bone brought about a favorable result in stabilizing the otherwise floating premaxilla and the operation proved successful. In summary, the present method of bone grafting as applied to 32 cases of unilateral cleft of lip, alveolus and palate, 9 cases of unilateral cleft of lip and alveolus and particularly 7 cases of bilateral cleft of lip, alveolus and palate, did not bring any appreciable interference with normal growth of prepalate and basal arch, and many advantages were rather noticed with this treatment. Best result of this method may be the successful attainment of stabilizing the floating premaxilla in the treatment of bilateral cleft of lip, alveolus and palate.
九州歯科学会の論文
1973-01-31

顎, 口蓋裂患者における骨裂隙補填の効果に関する研究

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