Hierl T, Klisch N, Klöppel R, Hemprich A
Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Leipzig.
Mund Kiefer Gesichtschir. 2003 Jan;7(1):7-13. doi: 10.1007/s10006-002-0440-1. Epub 2002 Nov 13.
Between May 1998 and May 2002, 38 patients suffering from severe midfacial retrusion and atrophy were treated by way of midfacial distraction osteogenesis. Diagnoses included cleft lip and palate (32 patients) and one case of Crouzon's disease. Ages ranged from 6-65 years. A total of 28 patients presented a velopharyngeal flap and nine patients were almost or fully edentulous. Using an extraoral halo device, distraction was performed after a subtotal Le Fort-I/II/III or modified quadrangular osteotomy.
Distraction ranged from 9 to 31 mm (17 mm average). Following the primary operation, seven patients underwent a second intervention due to problems with the procedure or the device. Two patients needed a secondary Le Fort-I-osteotomy. With respect to velopharyngeal insufficiency, 21% showed a deterioration and 8% an improvement. Postoperatively, a decrease of 15-20% in the attained sagittal advancement was seen during the first 6 months. This was attributed to relapses and postoperative orthodontics. Thereafter skeletal stability was maintained.
Distraction osteogenesis of the midface can be the method of choice in severe midfacial retrusion. Due to the difficult patient situation and the technical intricacies a higher complication rate has to be accepted than for conventional dysgnathia operations.
1998年5月至2002年5月期间，38例严重面中部后缩和萎缩患者接受了面中部牵张成骨治疗。诊断包括唇腭裂（32例）和1例克鲁宗病。年龄范围为6至65岁。共有28例患者存在腭咽瓣，9例患者几乎或完全无牙。采用口外 Halo 装置，在进行次全 Le Fort - I/II/III 或改良四边形截骨术后进行牵张。
牵张范围为9至31毫米（平均17毫米）。初次手术后，7例患者因手术或装置问题接受了二次干预。2例患者需要进行二次 Le Fort - I 截骨术。关于腭咽功能不全，21%的患者病情恶化，8%的患者病情改善。术后，在最初6个月内，已获得的矢状位前移量减少了15%至20%。这归因于复发和术后正畸治疗。此后骨骼稳定性得以维持。
面中部牵张成骨可作为严重面中部后缩的首选治疗方法。由于患者情况复杂且技术难度大，与传统牙颌面畸形手术相比，必须接受更高的并发症发生率。
