Gosain Arun K, Santoro Timothy D, Havlik Robert J, Cohen Steven R, Holmes Ralph E
Division of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
Plast Reconstr Surg. 2002 May;109(6):1797-808. doi: 10.1097/00006534-200205000-00004.
Distraction osteogenesis has been used increasingly for midfacial advancement in patients with syndromic craniosynostosis and in severe developmental hypoplasia of the midface. In these patients, the degree of advancement required is often so great that restriction of the adjacent soft tissues may preclude stable advancement in one stage. Whereas distraction is an ideal solution by which to gradually lengthen both the bones and the soft tissues, potential problems remain in translating the distraction forces to the midface. In these patients, severe developmental hypoplasia may be associated with weak union between the zygoma and the maxilla, increasing the chance of zygomaticomaxillary dysjunction when using internal devices that translate distraction force to the maxilla through the zygoma. Eight cases are reported in which either internal or external distraction systems were used for midface advancement following Le Fort III (n = 7) or monobloc (n = 1) osteotomies. Cases of patients in whom hypoplasia at the zygomaticomaxillary junction altered or impaired plans for midface distraction were reported from three host institutions. Seven patients had midface hypoplasia associated with syndromic craniosynostosis, and one patient had severe developmental midface hypoplasia. The distraction protocol was modified to successfully complete midface advancement in light of weakness at the zygomaticomaxillary junction in seven patients. Modifications included change from an internal to an external distraction system in two patients, rigid fixation and bone graft stabilization of the midface in one patient, and plate stabilization of a fractured or unstable zygomaticomaxillary junction followed by resumption of internal distraction in four patients. Previous infection and bone loss involving both malar complexes precluded one patient from being a candidate for an internal distraction system. Using a problem-based approach, successful advancement of the midface ranging from 9 to 26 mm at the occlusal level as measured by preoperative and postoperative cephalograms was undergone by all patients. Advantages and disadvantages of the respective distraction systems are reviewed to better understand unique patient characteristics leading to the successful use of these devices for correction of severe midface hypoplasia.
牵引成骨术已越来越多地用于综合征性颅缝早闭患者及严重的面中部发育不全患者的面中部前移。在这些患者中，所需的前移程度通常非常大，以至于相邻软组织的限制可能会妨碍一次性稳定前移。虽然牵引是逐渐延长骨骼和软组织的理想解决方案，但将牵引力传递至面中部仍存在潜在问题。在这些患者中，严重的发育不全可能与颧骨和上颌骨之间的愈合薄弱有关，当使用通过颧骨将牵引力传递至上颌骨的内部装置时，会增加颧上颌骨分离的几率。本文报告了8例患者，这些患者在Le Fort III型（n = 7）或整块骨（n = 1）截骨术后使用内部或外部牵引系统进行面中部前移。来自三个主办机构的病例报告了颧上颌交界处发育不全改变或影响面中部牵引计划的患者情况。7例患者存在与综合征性颅缝早闭相关的面中部发育不全，1例患者存在严重的发育性面中部发育不全。鉴于7例患者颧上颌交界处薄弱，对牵引方案进行了修改，以成功完成面中部前移。修改措施包括：2例患者从内部牵引系统改为外部牵引系统；1例患者对面中部进行坚固固定和植骨稳定；4例患者对骨折或不稳定的颧上颌交界处进行钢板固定，随后恢复内部牵引。既往感染和双侧颧骨复合体骨质流失使1例患者不适合使用内部牵引系统。通过基于问题的方法，所有患者均成功实现了面中部前移，术前和术后头颅侧位片测量显示咬合平面处前移范围为9至26毫米。本文回顾了各牵引系统的优缺点，以更好地了解导致这些装置成功用于矫正严重面中部发育不全的独特患者特征。
