唇裂患童乳牙齒列生長完成前之手術修補及治療照護回溯性分析

Retrospective Analysis of Treatment and Management for Cleft Lip and Palate Patients before the Completion 208 of Primary Dentition

目的：唇裂患童在本院會安排接受唇裂修補手術；這群患童在手術前依需求進行牙床鼻形塑形治療。本實驗目的即針對這群患童乳牙齒列生長完成前所進行之照護治療的回顧探討。對象與方法：選取 2000 年 1 月到 2014 年 12 月出生至高雄長庚就診的唇裂患童。以患童病歷回溯紀錄關於其出生日期，性別，唇裂診斷，以及所接受的唇裂修補的手術術式和時間。結果：總計在這期間共有 991 位唇裂患童接受治療。其中男孩有 534 位（54%），女孩有 457 位（46%），男女比為 1.19:1。「初生裂」及「初生合併次生裂」患童中，男性多於女性；而「單純次生裂」則以女性略多。「初生裂」患童的裂隙位置是左側比右側多。唇裂患童所進行的修補手術，主要分為唇修補（cheiloplasty）以及修補（palatoplasty）。唇修補手術共計 660 例，在這治療階段的平均患童手術年齡為 4.3 個月；而修補手術共計 612 例，其平均手術年齡為 13.6 個月。991 位唇裂患童進行的修補手術次數為 1272，而延遲手術的次數則為 160，其比例僅佔 12.6 %。結論：藉由回顧性分析，上述調查期間的唇裂患童在乳牙齒列生長完成前所應接受的治療照護大致符合本院唇裂患童的治療準則。

Objective: This study involved a retrospective review of treatment and management for cleft lip and palate patients before the completion of their primary dentition. These newborn cleft babies were assessed immediately in the craniofacial center, and referral for presurgical nasoalveolar molding was arranged if it was indicated. The aims of this study were to retrospectively investigate (1) the distributions of varied types of cleft among our patients, and (2) the repair treatment and relevant management for cleft patients before the completion of their primary dentition. Methods: Hospital records of newborn cleft lip and palate patients enrolled in Kaohsiung Chang Gung Memorial Hospital between 2000 and 2014 were collected. The following data were inspected: (1) the date of birth, (2) gender, (3) diagnosis, (4) the record of surgical repair, and (5) the date of surgical treatment. Results: A total of 991 children with cleft lip and palate were treated in Kaohsiung Chang Gung Memorial Hospital. There were 534 boys and 457 girls. The overall male to female ratio was 1.91:1. Male patients were dominant in the group of “cleft of primary palate with or without secondary palate”; while female patients were dominant in the group of “cleft of secondary palate”. The unilateral cleft occurred more frequently on the left side than on the right side in the group of “cleft of primary palate”. The major repair surgeries were cheiloplasty and palatoplasty. There were 660 cheiloplasty surgeries and 612 palatoplasty surgeries carried out in these cleft patients. The mean age for cleft patients to have cheiloplasty was 4.3 months old, and the mean age for cleft patients to have palatoplasty was 13.6 months old.The total amount of repair surgeries was 1272, and the delayed surgical treatment was only 160 (12.6%). Conclusion: The aim of this study was to investigate the management for children with cleft lip and palate in our hospital. The condition of management was tested by the treatment protocol for cleft lip and palate patients set up. And the result indicated that the condition of management for the majority of cleft patientsenrolled between 2000 and 2014 fulfilled the criteria of treatment protocol for those patients aged less younger than 3.5 years old.