Cohen S R, Kawamoto H K
Section of Plastic and Reconstructive Surgery, University of Michigan Medical Center, Ann Arbor.
Plast Reconstr Surg. 1992 Oct;90(4):574-84. doi: 10.1097/00006534-199210000-00005.
The clinical records of 125 patients undergoing treatment for posttraumatic facial deformities (PTFD) from 1979 to 1990 were retrospectively reviewed. Patients with complex fractures had a combination of at least three of the major fracture categories [Le Fort I, II, III; naso-orbital-ethmoid (NOE); zygomatic; frontobasilar; and mandibular]. Twenty-five patients (20 percent) were found to have severe posttraumatic facial deformities resulting from a complex facial fracture pattern. Sixteen were males and nine were females, and their ages at the time of our first reconstructive procedure ranged from 22 to 64 years (mean 33 years). All patients presented to our clinic with severe posttraumatic facial deformities from 1 month to 26 years (mean 5 years) after original injury. The number of prior reconstructive attempts averaged two (range 0 to 9). Arbitrary severity scores assigned by us were mild in 4, moderate in 12, and severe in 9 patients. Once treatment was initiated in our clinic, the average number of operations was 3.76 until completion (range 1 to 15). Surgical treatment was aimed first at reestablishing proper skeletal, vertical, transverse, and sagittal proportions. Once skeletal foundations were reset, the more delicate naso-orbital-ethmoid and lateral canthal relations were addressed. Of the 25 patients, 13 (52 percent) suffered a complication at some point during their surgical management. In these 13 patients, 20 complications occurred in a total of 94 operations for an overall complication rate of 21 percent. Fifteen of the 20 complications were related to infection. Skeletal abnormalities in patients with posttraumatic facial deformities can generally be corrected with current craniomaxillofacial techniques. Ultimately, an excellent result in terms of skeletal reconstruction is compromised by the status of the surrounding soft tissue. More in-depth knowledge of the nature and magnitude of the initial and subsequent soft-tissue injury will contribute to our ability to treat these disfiguring posttraumatic sequelae.
对1979年至1990年期间接受创伤后面部畸形（PTFD）治疗的125例患者的临床记录进行了回顾性研究。复杂骨折患者至少合并了三种主要骨折类型[勒福I型、II型、III型；鼻眶筛（NOE）；颧骨；额基底；下颌骨]。发现25例患者（20%）因复杂的面部骨折模式导致严重的创伤后面部畸形。其中男性16例，女性9例，首次重建手术时年龄在22至64岁之间（平均33岁）。所有患者在初次受伤后1个月至26年（平均5年）因严重的创伤后面部畸形前来我院就诊。既往重建尝试的次数平均为两次（范围0至9次）。我们自行设定的任意严重程度评分中，4例为轻度，12例为中度，9例为重度。在我院开始治疗后，直至完成治疗的平均手术次数为3.76次（范围1至15次）。手术治疗首先旨在重建合适的骨骼、垂直、横向和矢状比例。一旦骨骼基础复位，就会处理更精细的鼻眶筛和外眦关系。25例患者中，13例（52%）在手术治疗过程中的某个时间点出现了并发症。在这13例患者中，94次手术共发生20例并发症，总体并发症发生率为21%。20例并发症中有15例与感染有关。创伤后面部畸形患者的骨骼异常通常可以通过当前的颅颌面技术得到纠正。最终，骨骼重建方面的优异结果会受到周围软组织状况的影响。对初始及后续软组织损伤的性质和程度有更深入的了解，将有助于我们治疗这些毁容性的创伤后后遗症。
