Posnick J C, Tompson B
Division of Plastic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Oral Maxillofac Surg. 1992 Jul;50(7):666-75; discussion 675-6. doi: 10.1016/0278-2391(92)90092-e.
Modifications of the Le Fort I osteotomy are described that allow for the simultaneous routine and safe management of maxillary hypoplasia, residual oronasal fistula, bony defects, soft-tissue scarring, and cleft-dental gap in adolescents with unilateral cleft lip and palate (UCLP). The results of this operation with 40 consecutive patients are presented, together with follow-up findings ranging from 15 months to 4 years 5 months. Parameters reviewed include cleft-dental gap closure, maintenance of attached gingiva at the cleft site, maintenance of a positive overjet and overbite, closure of residual oronasal fistula, the need for prosthetics to complete dental rehabilitation, and surgical morbidity. Thirteen of the patients also underwent simultaneous sagittal split osteotomies of the mandible, and 29 had a genioplasty performed. In 32 of the patients surgical cleft-dental gap closure was planned, and was successfully executed in all but one. Thirty-seven patients underwent successful simultaneous oronasal fistula closure, but in three cases, small residual fistulas remained. In all cases, attached gingiva was maintained in the region of the cleft site and along the tooth-bearing surfaces. Almost all of the patients maintained a positive overjet (39 of 40) and 85% maintained a positive (34 of 40) or at least neutral (4 of 10) overbite. Complications were few and generally not serious.
本文描述了对Le Fort I截骨术的改良方法，该方法可同时常规且安全地治疗单侧唇腭裂（UCLP）青少年患者的上颌骨发育不全、口鼻瘘残留、骨缺损、软组织瘢痕以及牙裂间隙问题。文中呈现了连续40例患者接受该手术的结果，以及15个月至4年5个月的随访结果。评估参数包括牙裂间隙闭合情况、裂隙部位附着龈的维持情况、正常覆盖和覆合的维持情况、口鼻瘘残留的闭合情况、完成牙齿修复所需的修复体以及手术并发症。其中13例患者同时接受了下颌骨矢状劈开截骨术，29例患者进行了颏成形术。32例患者计划进行手术性牙裂间隙闭合，除1例患者外其余均成功完成。37例患者成功同时闭合了口鼻瘘，但有3例仍残留小瘘管。在所有病例中，裂隙部位及牙槽嵴表面均维持了附着龈。几乎所有患者（40例中的39例）维持了正常覆盖，85%的患者（40例中的34例）维持了正常覆合或至少中性覆合（10例中的4例）。并发症较少且一般不严重。
