Fan Haidong, Wang Xing, Lin Ye, Zhou Yanheng, Yi Biao, Li Zili
Center of Stomatology, Shenzhen people's Hospital, Shenzhen 518020, China.
Zhonghua Yi Xue Za Zhi. 2002 May 25;82(10):699-702.
To evaluate the effect of distraction osteogenesis in correction of severe undeveloped maxilla secondary to cleft palate and to evaluate the selection of distraction modality.
Distraction osteogenesis was performed upon 8 patients, 6 males and 2 females, aged 11 to 25 years, one with incomplete cleft palate, 4 with unilateral complete left palate, and 3 with bilateral complete cleft palate, all accompanied with severe maxillary hypoplasia. The 7 adult patients were treated by modified high-stepped Le Fort I osteotomy, the other patient, a child, was treated by Le Fort I osteotomy followed by rigid external distraction. X-ray films of skull in lateral, frontal, or panoramic positions, and X-ray film of temporomandibular joint in Schiller's position were taken pre- and postoperatively. In model surgery the accurate distraction distance was measured and the direction of distraction designed. Orthodontic therapy was started immediately after the distraction was completed and the distractor was removed after a period of 4 months' consolidation.
The designed distraction was achieved in a11 8 patients. Except in one case with a bone defect 1 cm x 0.5 cm at the osteotomy line in the lateral wall of the right maxillary sinus, dense new bone was formed in the area of distraction in the other cases. The postoperative occlusal relationship was good and stable. No infection and other complication was found. During an average of 20 months' follow-up, the maxilla and occlusion were stable, and no relapse was found. The distance of forward distraction of the maxilla reached an average of l2 mm (5 approximately 15 mm). The SNA angle increased from 71 degree on average preoperatively to an average of 79 degree postoperatively. Both the facial appearance and occlusal relationship returned to normal in a11 the patients.
Without need of bone grafting and with a stable effect and little influence on platatopharyngeal competence, distraction osteogenesis is an effective method of correcting maxillary hypoplasia secondary to cleft palate and is worthy of spreading.
评估牵张成骨术矫治腭裂继发严重上颌骨发育不全的效果，并评估牵张方式的选择。
对8例患者实施牵张成骨术，其中男性6例，女性2例，年龄11至25岁，1例为不完全性腭裂，4例为左侧单侧完全性腭裂，3例为双侧完全性腭裂，均伴有严重上颌骨发育不全。7例成年患者采用改良高阶梯Le Fort I截骨术治疗，另1例儿童患者采用Le Fort I截骨术加坚固外牵张治疗。术前、术后拍摄头颅侧位、正位或全景X线片以及颞下颌关节许勒位X线片。在模型外科中测量准确的牵张距离并设计牵张方向。牵张完成后立即开始正畸治疗，4个月巩固期后拆除牵张器。
8例患者均达到设计的牵张效果。除1例右侧上颌窦外侧壁截骨线处有1 cm×0.5 cm骨缺损外，其余病例牵张区均形成致密新骨。术后咬合关系良好且稳定。未发现感染及其他并发症。平均随访20个月，上颌骨及咬合关系稳定，未见复发。上颌骨向前牵张距离平均达12 mm（5至15 mm）。SNA角术前平均为71°，术后平均增至79°。所有患者面部外观及咬合关系均恢复正常。
牵张成骨术无需植骨，效果稳定，对腭咽功能影响小，是矫治腭裂继发上颌骨发育不全的有效方法，值得推广。
