Satoh Kaneshige, Suzuki Hiroyuki, Uemura Tetsushi, Hosaka Yoshiaki
Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
Ann Plast Surg. 2002 Dec;49(6):572-8; discussion 578-9. doi: 10.1097/00000637-200212000-00003.
To obviate or lessen the long period of use of orthodontic appliances after distraction for hemifacial microsomia in the mixed dentition patients, simultaneous maxillo-mandibular distraction osteogenesis has been performed in 10 patients aged 7 to 12 years with hemifacial microsomia. In these patients, there were two cases of type I, five cases of type IIa, and three cases of type IIb. A uniplanar internal distraction device was used in all cases. After maxillary Le Fort I osteotomy and mandibular ramus osteotomy, a uniplanar internal distraction device was attached to the mandible. On days 5 to 6 after surgery, distraction of 1 mm per day was started. Rigid intermaxillary fixation (IMF) using soft wires was performed at the distraction and was retained for 1 hour. Except for this period, rigid IMF was released. Distraction length ranged from 10 to 21 mm. After the distraction, a slight lateral crossbite in one case and a slight occlusal change in two cases, which did not necessitate the particular orthodontic treatment, were noted. Postoperative follow-up ranged from 16 to 40 months. The postoperative clinical course was uneventful thereafter. Maxillary growth impairment after the osteotomy has been obscure because of the short postoperative period. This procedure is effective for obviating or lessening the long duration of use of orthodontic appliances in the mixed dentition period of 7 to 14 years of hemifacial microsomia.
为避免或缩短乳牙恒牙混合期半侧颜面短小患者牵张成骨后正畸矫治器的长期使用时间,我们对10例7至12岁的半侧颜面短小患者进行了同期上颌-下颌牵张成骨术。这些患者中,I型2例,IIa型5例,IIb型3例。所有病例均使用单平面内牵张装置。在进行上颌Le Fort I截骨术和下颌升支截骨术后,将单平面内牵张装置固定于下颌骨。术后第5至6天开始每天牵张1mm。牵张时使用软丝进行坚固内固定(IMF),并保持1小时。除此之外,坚固内固定松开。牵张长度为10至21mm。牵张后,1例出现轻度侧方反合,2例出现轻度咬合改变,但均无需特殊正畸治疗。术后随访16至40个月。此后术后临床过程平稳。由于术后时间短,截骨术后上颌生长受限情况不明显。该方法对于避免或缩短7至14岁半侧颜面短小患者乳牙恒牙混合期正畸矫治器的使用时间有效。