Swennen G, Dujardin T, Goris A, De Mey A, Malevez C
Department of Oral and Maxillofacial Surgery, University of Brussels, Children's Hospital, Brussels, Belgium.
J Craniofac Surg. 2000 Mar;11(2):120-7. doi: 10.1097/00001665-200011020-00009.
Maxillary distraction osteogenesis is a challenging technique to treat severe maxillary retrusion. Maxillary advancement by distraction has the advantage to provide new bone in combination with simultaneous expansion of the soft-tissue functional matrix. Cleft lip and palate patients can present with severe maxillary retrusion and Class III malocclusion. Two 13-year-old patients, born with non-syndromic cleft lip and palate, underwent maxillary distraction--one had a bilateral, the other a unilateral complete cleft lip and palate. Maxillary advancement was performed using an external distraction device in combination with titanium miniplates as a skeletal maxillary anchorage. After a complete Lefort I osteotomy with pterygomaxillary disjunction, a latency period of 3 days was respected. On the fourth postoperative day, distraction was initiated at the rate of 1 mm/d. Preoperative clinical photographs, dental casts, lateral cephalograms, and panoramic radiographs were taken. Further lateral cephalograms were obtained after the latency period, after completion of the active period of distraction, at the completion of the consolidation period, and at 6 and 12 months postoperatively. The aesthetic outcome was excellent and skeletal advancement of 8 and 7 mm was measured without dentoalveolar compensations.
上颌骨牵张成骨术是治疗严重上颌后缩的一项具有挑战性的技术。通过牵张进行上颌前徙具有在软组织功能基质同时扩张的情况下提供新骨的优势。唇腭裂患者可能会出现严重的上颌后缩和Ⅲ类错牙合畸形。两名13岁非综合征性唇腭裂患者接受了上颌骨牵张——其中一名是双侧唇腭裂，另一名是单侧完全性唇腭裂。使用外部牵张装置结合钛微型钢板作为上颌骨骨骼锚固进行上颌前徙。在进行完全的Le Fort I截骨术并分离翼上颌后，等待3天的延迟期。术后第4天，以1毫米/天的速度开始牵张。术前拍摄了临床照片、牙模、头颅侧位片和全景X线片。在延迟期后、牵张活跃期结束时、巩固期结束时以及术后6个月和12个月时获取了进一步的头颅侧位片。美学效果极佳，测量到骨骼前徙分别为8毫米和7毫米，且无牙槽骨代偿。
