Wen-Ching Ko E, Figueroa A A, Polley J W
Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Oral Maxillofac Surg. 2000 Sep;58(9):959-69; discussion 969-70. doi: 10.1053/joms.2000.8735.
This study was conducted to evaluate the soft tissue profile changes after maxillary advancement with distraction osteogenesis (DO).
Sixteen subjects underwent maxillary advancement with rigid external distraction after a high Le Fort I osteotomy. There were 11 male and 5 female patients, ages 5.2 to 25.7 years. The subjects included 9 with unilateral cleft lip and palate (UCLP), 4 with bilateral CLP, 2 with facial clefts and bilateral CLP, and 1 with cleft palate. Pretreatment and posttreatment lateral cephalograms were compared to evaluate the changes in soft tissue profile. A line 7 degrees below the SN plane was used as the horizontal coordinate, and a perpendicular line through Sella was used as the vertical coordinate in an XY coordinate system.
The preoperative facial concavity (N'SnPg') was reduced by 15.59 degrees, and the nasal tip moved 3.75 mm forward and 2.05 mm upward. These changes were positively correlated with the change of ANS position. The soft-tissue-to-hard-tissue ratio was 0.53:1 for nasal tip and ANS. The ratio was negatively correlated with the age of the patient. The ratio of soft tissue A point to skeletal A point was 0.96:1 and for the incisal edge to vermilion border of the upper lip it was 0.8:1. The soft tissue B point and Pg did not change significantly with maxillary distraction. However, the nasolabial angle increased by 4.96 degrees, the upper lip curvature flattened by 0.65 mm, and the lower lip curvature was accentuated by 0.89 mm after distraction. The amount of upper incisal exposure increased from 1.1 to 5.01 mm in the rest position.
Maxillary DO improved the soft tissue profile by increasing nasal projection, normalizing the nasolabial angle, and making the upper lip more prominent. More upper anterior tooth show in the rest position was obtained, but the upper lip length did not change. The concave facial profile became convex, with improved facial balance and aesthetics.
本研究旨在评估采用牵张成骨术（DO）进行上颌骨前移后软组织侧貌的变化。
16例患者在高位Le Fort I截骨术后采用坚固外牵张器进行上颌骨前移。其中男性11例，女性5例，年龄5.2至25.7岁。受试者包括9例单侧唇腭裂（UCLP）、4例双侧唇腭裂、2例面部裂隙合并双侧唇腭裂以及1例腭裂患者。比较术前和术后的头颅侧位片，以评估软组织侧貌的变化。在XY坐标系中，以SN平面下方7度的线作为横坐标，通过蝶鞍的垂线作为纵坐标。
术前面部凹陷（N'SnPg'）减少了15.59度，鼻尖向前移动3.75 mm，向上移动2.05 mm。这些变化与前鼻棘位置的改变呈正相关。鼻尖与前鼻棘的软组织与硬组织比例为0.53:1。该比例与患者年龄呈负相关。软组织A点与骨骼A点的比例为0.96:1，上唇切缘与唇红缘的比例为0.8:1。上颌骨牵张后，软组织B点和颏前点无明显变化。然而，牵张后鼻唇角增加了4.96度，上唇曲率变平0.65 mm，下唇曲率增加0.89 mm。静止位时上前牙暴露量从1.1增加到5.01 mm。
上颌骨DO通过增加鼻突度、使鼻唇角正常化以及使上唇更突出，改善了软组织侧貌。静止位时更多上前牙得以暴露，但上唇长度未改变。面部凹陷轮廓变为凸形，面部平衡和美观得到改善。
