Wiltfang Joerg, Kessler Peter
Received from the Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
J Oral Maxillofac Surg. 2002 Oct;60(10):1142-5; discussion 1146. doi: 10.1053/joms.2002.34987.
The purpose of this report was to show the feasibility of the combination of a minimally invasive endoscopic approach to the maxilla with transverse and sagittal distraction procedures.
Four human cadavers were used for training of a minimally invasive access to the maxilla to perform a endoscopically assisted Le Fort I osteotomy, before this technique was applied in 3 patients with transverse and sagittal growth deficits of the maxilla. Access to the maxilla was gained through a small mucosa incision in the vestibule to create a visualization port to the maxillary sinus through a bur hole. Landmarks were identified through the endoscope before a Le Fort I osteotomy was performed using chisels of different shapes and angulations. In 2 patients the maxilla was split sagittally to perform a transverse maxillary expansion; in 1 patient, a buried distractor was applied close to the piriform aperture to correct a sagittal growth deficit in a hypoplastic maxilla.
Endoscopic exposure of the maxillary sinus walls from within the sinus, the accurate identification of landmarks, and the creation of a Le Fort I osteotomy were achieved in all cases. Distractor application close to the piriform aperture rendered good stability.
The results of these cases indicate that the endoscopic approach to the maxillary sinus allows excellent exposure of the sinus walls to perform a endscopically assisted Le Fort I osteotomy. The combination of endoscopy and osteodistraction processes supports the tendency to perform minimally invasive, less-traumatizing surgical procedures, especially in individuals who are still growing.
本报告的目的是展示对上颌骨采用微创内镜入路结合横向和矢状向牵张手术的可行性。
在将该技术应用于3例上颌骨存在横向和矢状向生长不足的患者之前，使用4具人体尸体进行上颌骨微创入路训练，以实施内镜辅助的Le Fort I型截骨术。通过前庭的一个小黏膜切口进入上颌骨，通过钻孔创建一个通向鼻窦的可视化通道。在使用不同形状和角度的凿子进行Le Fort I型截骨术前，通过内镜确定标志点。2例患者的上颌骨进行矢状劈开以实施横向上颌骨扩展；1例患者在梨状孔附近应用埋入式牵张器以纠正发育不全的上颌骨的矢状生长不足。
所有病例均实现了从鼻窦内对上颌窦壁进行内镜暴露、准确识别标志点以及创建Le Fort I型截骨术。在梨状孔附近应用牵张器具有良好的稳定性。
这些病例的结果表明，上颌窦的内镜入路能够很好地暴露窦壁，以实施内镜辅助的Le Fort I型截骨术。内镜检查与骨牵张过程相结合，支持了实施微创、创伤较小的外科手术的趋势，尤其是在仍处于生长阶段的个体中。
