Dudak damak yarıklı bebeklerde nazoalveoler şekillendirme apareyinin burun, dudak ve alveoler bölge üzerindeki etkilerinin 3 boyutlu değerlendirilmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Amaç: Dudak damak yarıklı bebeklerde doğum sonrası erken ortopedik tedavi amacıyla kullanılan Nazoalveoler Şekillendirme Apareyinin burun, dudak ve alveoler bölge üzerindeki etkilerini 3 boyutlu olarak değerlendirmektir. Yöntem: Prospektif çalışmamız tek veya çift taraflı dudak damak yarığı olan 0-4 ay arasında toplam 41 bebek üzerinde yürütülmüştür. Çalışmaya alınan tek ve çift taraflı dudak damak yarıklı bebekler 4 gruba ayrılmıştır. Tek taraflı dudak damak yarığı olan bebeklerden 9 tanesine nazoalveoler şekillendirme tedavisi uygulanırken, 12 bebekte tedavi uygulanmamıştır. Benzer şekilde çift taraflı dudak damak yarığı olan olan bebeklerden 10 tanesine nazoalveoler şekillendirme tedavisi uygulanırken, 10 bebekte tedavi uygulanmamıştır. Tüm bebeklerden T0 (Nazoalveoler şekillendirme tedavisi öncesi), T1(Nazoalveoler şekillendirme tedavi sonrası-Primer cerrahi öncesi), ve T2 (Primer cerrahiden 1 ay sonra) 3 boyutlu olarak ağız dışı ve ağız içi kayıtlar Trios 3 (3Shape) tarama cihazı ile alınmıştır. Tek taraflı dudak damak yarığı olan bebeklerde 34 ağız dışı ve 14 ağız içi, çift taraflı dudak damak yarığı olan bebeklerde 34 ağız dışı ve 20 ağız içi ölçüm yapılmıştır. Elde edilen verilerin istatistiksel olarak değerlendirilmesinde, anlamlılık düzeyi p<0,05 seviyesinde, Lineer Karma Modeli (LMM) analizi ile değerlendirilmiştir. Bulgular: Tek taraflı dudak damak yarığı olan bebeklerde nazoalveoler şekillendirme tedavi sonrası nostril yükseklik oranında %25 iyileşme ( p<0,01), yarık taraftaki nostril yüksekliğinde (NtR-Subalar düzlemi) 2,75 mm artma ( p<0,01) ve ağız içi bölgesinde yarık uzunluğunda (ACG-ACL) 4,83 mm azalma bulunmuştur (p<0,05).Yarık uzunluğunda (ACG-ACL) (p<0,05), nostril yükseklik oranı (p<0,01) ve yarık taraftaki nostril yüksekliğinin (NtR-Subalar düzlemi) (p<0,001) zaman ile olan değişimi nazoalveoler şekillendirme tedavisinden anlamlı olarak etkilenmiştir. Ancak primer cerrahi sonrası iki grup arasında fark görülmemiştir. Nazal tip projeksiyonunun (PRN-Subalar düzlemi) zaman ile olan değişimi nazoalveoler şekillendirme tedavisinden anlamlı olarak etkilenmemiştir. Çift taraflı dudak damak yarığı olan bebeklerde nazoalveoler şekillendirme tedavi sonrası yarığın geniş olduğu bölgedeki nostril boyutunda (NmR-NlR) 2,62 mm azalma (p<0,01), premaksillanın sagittal düzleme olan uzaklığında (Inc-Sagittal) ise istatistiksel olarak anlamlı olmayan 5,5 mm azalma bulunmuştur. Ağız içi bölgesinde yarığın geniş olduğu taraftaki uzunluk (ACR-PxR) (p<0,05) ve aynı taraftaki nostril genişliğinin (NmR-NlR) (p<0,001) zaman ile olan değişimi tedaviden anlamlı olarak etkilenmiştir. Ancak ağız içi bölgesinde yarığın geniş olduğu taraftaki uzunlukta (ACR-PxR) primer cerrahi sonrası iki grup arasında fark görülmemiştir. Sağ ve sol nostril yükseklikleri (NtR-Subalar düzlemi), (NtL-Subalar düzlemi), anterior ark genişliği (BR-BL) ve premaksilla rotasyonunun (PxL-PxR*PL-PR) zaman ile olan değişimi tedaviden anlamlı olarak etkilenmemiştir. Sonuç: Nazoalveoler şekillendirme tedavisi uygulama kararı verilirken multidisipliner tedavi uygulayan ekibin tecrübesi başta olmak üzere; yarık deformitesinin şiddeti, ailenin işbirliği önemli olmaktadır. Özellikle 3.ay sonunda uygulanan primer cerrahiden elde edilen sonuç, dudak damak yarıklı bebeğin erişkin dönemde tamamlanan tedavi sonucunu etkilemekte olup, cerrahın bilgi, tecrübe ve deneyimi çok önemlidir.
Aim: The aim is to evaluate, in 3D, the effects on the nose, lip, and alveolar region of the Nasoalveolar Molding Device, which is used for early orthopedic treatment in babies with cleft lip and palate after birth. Materials and Methods: Our prospective study was conducted on a total of 41 babies aged 0-4 months with unilateral or bilateral cleft lip and palate. The babies were divided into four groups. While 9 babies with unilateral cleft lip and palate received nasoalveolar molding treatment, 12 did not. Similarly, among babies with bilateral cleft lip and palate, 10 received the treatment, and 10 did not. Three-dimensional extraoral and intraoral records were taken from all babies at T0 (before nasoalveolar molding treatment), T1 (after nasoalveolar molding treatment - before primary surgery), and T2 (one month after primary surgery) using the Trios 3 (3Shape) scanning device. For babies with unilateral cleft lip and palate, 34 external and 14 internal measurements were performed, and for those with bilateral cleft lip and palate, 34 external and 20 internal measurements were performed. The data obtained were statistically evaluated using the Linear Mixed Model (LMM) analysis, with a significance level of p<0.05. Results: In babies with unilateral cleft lip and palate, after nasoalveolar molding treatment, there was a 25% improvement in nostril height ratio (p<0.01), a 2.75 mm increase in nostril height on the cleft side (NtR-Subalar plane) (p<0.01), and a 4.83 mm decrease in cleft length (ACG-ACL) (p<0.05). The changes over time in cleft length (ACG-ACL) (p<0.05), nostril height ratio (p<0.01), and nostril height on the cleft side (NtR-Subalar plane) (p<0.001) were significantly affected by nasoalveolar molding treatment. However, no difference was observed between the two groups after primary surgery. The change over time in nasal tip projection (PRN-Subalar plane) was not significantly affected by the treatment. In babies with bilateral cleft lip and palate, after nasoalveolar molding treatment, there was a 2.62 mm decrease in nostril size in the wider cleft area (NmR-NlR) (p<0.01), and a non-significant 5.5 mm decrease in the distance of the premaxilla to the sagittal plane (Inc-Sagittal). The changes over time in the length on the wider cleft side (ACR-PxR) (p<0.05) and nostril width on the same side (NmR-NlR) (p<0.001) were significantly affected by the treatment. However, no difference between groups was observed in the length on the wider cleft side (ACR-PxR) after primary surgery. The changes over time in right and left nostril heights (NtR-Subalar plane), (NtL-Subalar plane), anterior arch width (BR-BL), and premaxilla rotation (PxL-PxR*PL-PR) were not significantly affected by the treatment. Conclusion: The decision to apply NAM treatment varies for each baby, and factors such as the severity of the deformity, the cooperation of the family, and the skill of the multidisciplinary treatment team can influence the treatment decision. Particularly, the primary surgery performed at the end of the third month shapes the treatment outcome for the baby with cleft lip and palate. The surgeon's knowledge and expertise play a crucial role in this process.
Aim: The aim is to evaluate, in 3D, the effects on the nose, lip, and alveolar region of the Nasoalveolar Molding Device, which is used for early orthopedic treatment in babies with cleft lip and palate after birth. Materials and Methods: Our prospective study was conducted on a total of 41 babies aged 0-4 months with unilateral or bilateral cleft lip and palate. The babies were divided into four groups. While 9 babies with unilateral cleft lip and palate received nasoalveolar molding treatment, 12 did not. Similarly, among babies with bilateral cleft lip and palate, 10 received the treatment, and 10 did not. Three-dimensional extraoral and intraoral records were taken from all babies at T0 (before nasoalveolar molding treatment), T1 (after nasoalveolar molding treatment - before primary surgery), and T2 (one month after primary surgery) using the Trios 3 (3Shape) scanning device. For babies with unilateral cleft lip and palate, 34 external and 14 internal measurements were performed, and for those with bilateral cleft lip and palate, 34 external and 20 internal measurements were performed. The data obtained were statistically evaluated using the Linear Mixed Model (LMM) analysis, with a significance level of p<0.05. Results: In babies with unilateral cleft lip and palate, after nasoalveolar molding treatment, there was a 25% improvement in nostril height ratio (p<0.01), a 2.75 mm increase in nostril height on the cleft side (NtR-Subalar plane) (p<0.01), and a 4.83 mm decrease in cleft length (ACG-ACL) (p<0.05). The changes over time in cleft length (ACG-ACL) (p<0.05), nostril height ratio (p<0.01), and nostril height on the cleft side (NtR-Subalar plane) (p<0.001) were significantly affected by nasoalveolar molding treatment. However, no difference was observed between the two groups after primary surgery. The change over time in nasal tip projection (PRN-Subalar plane) was not significantly affected by the treatment. In babies with bilateral cleft lip and palate, after nasoalveolar molding treatment, there was a 2.62 mm decrease in nostril size in the wider cleft area (NmR-NlR) (p<0.01), and a non-significant 5.5 mm decrease in the distance of the premaxilla to the sagittal plane (Inc-Sagittal). The changes over time in the length on the wider cleft side (ACR-PxR) (p<0.05) and nostril width on the same side (NmR-NlR) (p<0.001) were significantly affected by the treatment. However, no difference between groups was observed in the length on the wider cleft side (ACR-PxR) after primary surgery. The changes over time in right and left nostril heights (NtR-Subalar plane), (NtL-Subalar plane), anterior arch width (BR-BL), and premaxilla rotation (PxL-PxR*PL-PR) were not significantly affected by the treatment. Conclusion: The decision to apply NAM treatment varies for each baby, and factors such as the severity of the deformity, the cooperation of the family, and the skill of the multidisciplinary treatment team can influence the treatment decision. Particularly, the primary surgery performed at the end of the third month shapes the treatment outcome for the baby with cleft lip and palate. The surgeon's knowledge and expertise play a crucial role in this process.
Açıklama
25.01.2025 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır.
Anahtar Kelimeler
Diş Hekimliği, Dentistry
